Stroke risk in diabetic patients with concomitant cardiovascular disease the CARDIAB-Stroke study - 18/08/26

Doi : 10.1016/j.ando.2026.103058

Ziad Arow, MD ^1,^2,⁎ , Tzipi Hornik-Lurie, PhD ³ , Ranin Hilu, MD ² , Ela Giladi, MD ² , Mustafa Gabarin, MD ² , Yoav Arnson, MD ² , Joseph Levy, PhD ³ , Hana Vaknin-Assa, MD ² , Abid Assali, MD ² , David Pereg, MD ²

For the CARDIAB research group

¹ Groupe CardioVasculaire Intervetionnel, Clinique Pasteur, Toulouse, France. 45 Avenue de Lombez, 31076 Toulouse, France

² Cardiology Department, Meir Medical Center, Tel-Aviv University, Israel. 59 Tchernichovsky Street Kfar Saba 44281, Israel

³ Meir Medical Center Research Institute, Kfar Saba, Israel. 59 Tchernichovsky Street Kfar Saba 44281, Israel

^⁎ Corresponding author: Groupe CardioVasculaire Interventionnel, Clinique, Pasteur, 45 Avenue de Lombez, 31076 Toulouse, France Groupe CardioVasculaire Interventionnel, Clinique, Pasteur, 45 Avenue de Lombez Toulouse 31076 France

Sous presse. Manuscrit accepté. Disponible en ligne depuis le Tuesday 18 August 2026

Highlights

•	Patients with T2DM and ASCVD experience an exceptionally high risk of CVA/TIA.
•	Treatment with SGLT2-I and GLP-1RA significantly reduces stroke risk, with the greatest benefit seen when both are combined.
•	Despite proven efficacy, these therapies remain underutilized, emphasizing the need for broader adoption in routine practice.

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Abstract

Background: Patients with type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular disease (ASCVD) are at high risk of stroke and transient ischemic attack (TIA), yet many remain undertreated with cardioprotective therapies. We assessed stroke risk, its predictors, and the impact of sodium-glucose cotransporter-2 inhibitors (SGLT2-I) and glucagon-like peptide-1 receptor agonists (GLP-1RA).

Methods: The nationwide CARdiovascular and DIABetes (CARDIAB) cohort included patients with T2DM and ASCVD. Stroke predictors and associations between SGLT2-I andGLP-1RA use and outcomes were evaluated.

Results: A total of 138,397 patients (60% male; median age 72 years) were followed for a median of 5.5 years. Overall, 28,676 patients (20.7%) experienced stroke or TIA. Higher risk was associated with smoking, prior stroke or TIA, chronic kidney disease, older age, male sex, and Arab ethnicity. Follow-up in cardiology or endocrinology clinics and treatment with aspirin, statins, SGLT2-I, and GLP-1RA were protective. Patients treated with both SGLT2-I and GLP-1RA had the lowest event rates (361 per 10,000 patient-years), corresponding to a 22% relative risk reduction (HR 0.78; 95% CI, 0.75–0.81).

Conclusion: Patients with T2DM and ASCVD face a markedly elevated stroke risk. SGLT2-I and GLP-1RA use was associated with significant risk reduction, particularly when combined. Greater uptake of these therapies and comprehensive risk factor management are needed to mitigate stroke burden in this high-risk group.

Le texte complet de cet article est disponible en PDF.

Keywords : SGLT2-I, GLP-1RA, Type 2 diabetes mellitus, Stroke, TIA