Glucagon-Like Peptide-1 Receptor Agonist Exposure and Long-Term Outcomes in Patients with Asymptomatic Carotid Stenosis: A Propensity Score-Matched Real-World Analysis.

“Glucagon-Like Peptide-1 Receptor Agonist Exposure and Long-Term Outcomes in Patients with Asymptomatic Carotid Stenosis: A Propensity Score-Matched Real-World Analysis. Rai P(1), Bathla G(1), Aggarwal E(1), Chen HA(1), Kakadiya J(1), McIntyre MK(1), Salim HA(1), Azzam AY(1), Essibayi MA(1), Yedavalli VS(1), Khan M(1), Dmytriw AA(1), Altschul DJ(1), Abaricia JO(1), Colasurdo M(1), Malhotra A(1), Gandhi D(1), Lakhani DA(2). Author information: (1)From the Department of Radiology (P.R., G.B., E.A.), Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55902; Department of Neurosurgery (H.A.C., D.G.), University of Maryland Medical Center, Baltimore, MD, USA; Department of Neuroradiology (J.K., H.A.S., A.Y.A., D.A.L.), Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA; Department of Neurological Surgery (M.K.M., J.O.A.), Interventional Radiology (M.C.), Oregon Health & Science University, Portland, OR, USA; Department of Neuroradiology (H.A.S.), MD Anderson Medical Center, Houston, TX, USA; Department of Radiology and Radiological Sciences (H.A.S., V.S.Y., M.K.), Johns Hopkins Medical Center, Baltimore, Maryland, USA; Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab (A.Y.A., M.A.E., D.J.A.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; Neuroendovascular Program (A.A.D.), Massachusetts General Hospital, Harvard University, Boston, MA, USA; Neurovascular Centre (A.A.D.), Departments of Medical Imaging and Neurosurgery, St Michael's Hospital, Toronto, ON, Canada and Department of Radiology (A.M.), Yale New Haven Hospital, New Haven, CT, USA. (2)From the Department of Radiology (P.R., G.B., E.A.), Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55902; Department of Neurosurgery (H.A.C., D.G.), University of Maryland Medical Center, Baltimore, MD, USA; Department of Neuroradiology (J.K., H.A.S., A.Y.A., D.A.L.), Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA; Department of Neurological Surgery (M.K.M., J.O.A.), Interventional Radiology (M.C.), Oregon Health & Science University, Portland, OR, USA; Department of Neuroradiology (H.A.S.), MD Anderson Medical Center, Houston, TX, USA; Department of Radiology and Radiological Sciences (H.A.S., V.S.Y., M.K.), Johns Hopkins Medical Center, Baltimore, Maryland, USA; Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab (A.Y.A., M.A.E., D.J.A.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; Neuroendovascular Program (A.A.D.), Massachusetts General Hospital, Harvard University, Boston, MA, USA; Neurovascular Centre (A.A.D.), Departments of Medical Imaging and Neurosurgery, St Michael's Hospital, Toronto, ON, Canada and Department of Radiology (A.M.), Yale New Haven Hospital, New Haven, CT, USA dhairyalakhani@gmail.com. BACKGROUND: Asymptomatic carotid stenosis is a prevalent manifestation of atherosclerotic disease and, despite contemporary guideline-directed medical therapy, remains associated with downstream cerebrovascular events and mortality. Given the vascular and cardiometabolic benefits of glucagon-like peptide-1 receptor agonists (GLP-1As), we evaluated whether GLP-1A exposure is associated with lower long-term event rates in patients with asymptomatic carotid stenosis. METHODS: This retrospective study used the TriNetX US Collaborative Network. Adults (≥18 years) with carotid stenosis (January 1, 2016-September 30, 2025) were included; patients with prior/baseline cerebrovascular events and those undergoing carotid revascularization within 6 months were excluded to operationalize an asymptomatic cohort. GLP-1A exposure was defined as any GLP-1A use within 6 months following carotid stenosis diagnosis; non-exposed patients served as comparators. Cohorts were propensity score-matched 1:1, and outcomes were assessed using Kaplan-Meier and Cox proportional hazards models. RESULTS: After matching, 30,332 patients were included in each cohort. GLP-1A exposure was associated with lower hazards of ischemic stroke (HR 0.63/0.71/0.73 at 1/3/5 years; 5-year cumulative event probability 5.55% vs 6.85%), hemorrhagic stroke (HR 0.63/0.69/0.74; 2.04% vs 2.35%), large-vessel occlusion stroke (HR 0.70/0.77/0.81; 2.04% vs 2.27%), and all-cause mortality (HR 0.42/0.58/0.64; 17.11% vs 21.49%). The composite of ischemic stroke or mortality was also lower (HR 0.48/0.61/0.66; 20.88% vs 25.85% at 5 years) in the GLP-1A exposed cohort. CONCLUSIONS: In large real-world cohort with asymptomatic carotid stenosis, GLP-1A exposure was associated with lower hazards of stroke subtypes, large-vessel occlusion stroke, and mortality across 1-5 years. These observational findings warrant prospective validation to clarify causality and optimal integration into contemporary medical management. © 2026 by American Journal of Neuroradiology.”