Non-traumatic subarachnoid hemorrhage is a serious complication of intracranial aneurysms, which is a leading cause of death and permanent disability. Identifying modifiable risk factors is a pressing concern in clinical practice. Given the well-established anti-inflammatory, antihypertensive, and vascular-protective effects of GLP-1 agonists, this study aimed to determine whether GLP-1 agonists would be beneficial in reducing the risk of aneurysm rupture and increasing the chances of survival.
It was a retrospective study that utilized the global research database of TriNetX, a health care research network that includes data from over 90 health care organizations worldwide, mostly from the USA. The data spanned the period from January 2010 to January 2025. It was a prospective analysis that would allow a long-term outcome to be measured.
Key findings:
The study examined those diagnosed as having unruptured intracranial aneurysms and those diagnosed as having type 2 diabetes.
The study used patients taking GLP-1 receptor agonists (n = 2517) and those not taking GLP-1 receptor agonists (n = 23,431).
Propensity score matched those taking GLP-1 receptor agonists to those not taking GLP-1 receptor agonists in equal numbers (1:1 ratio) for 95 clinical and demographic factors: age, sex, smoking status, hypertension, and other vascular risk factors.
The study matched each group to have 2275 participants in each group to have equal factors in each group.
In this case, GLP-1 receptor agonists were shown to lower the risk of nontraumatic subarachnoid hemorrhage by having a hazard ratio of 0.66 (95% CI, 0.50 to 0.87).
All-cause mortality also proved lower in those taking GLP-1 receptor agonists, by having a hazard ratio of 0.63 (95% CI, 0.52 to 0.76).
A pre-specified subgroup analysis was performed to exclude patients with a history of intracranial aneurysm treatment, including surgical clipping or endovascular coiling. In the matched and untreated subgroup, the results were consistent, and the use of the GLP-1 receptor agonist was still associated with a decreased risk of
Non-Traumatic Subarachnoid Hemorrhage (HR 0.68, 95% CI 0.47 to 0.98) and all-cause mortality (HR, 0.64 [95% CI, 0.53–0.77]).
GLP-1 receptor agonist use was significantly associated with a decreased risk of non-traumatic subarachnoid hemorrhage and increased mortality in intracranial aneurysm patients with type 2 diabetes. The results from this population-based study support a potential protective effect of GLP-1 receptor agonists in aneurysm-related events and emphasize that these observations should be confirmed in a prospective setting.
Reference:
Feghali, J., Ruchika, F. N. U., Horowitz, M. A., Xu, R., Jackson, C. M., Caplan, J. M., Huang, J., Tamargo, R. J., & Gonzalez, L. F. (2026). Glucagon-like peptide-1 receptor agonists and decreased subarachnoid hemorrhage risk in patients with intracranial aneurysm. Stroke; a Journal of Cerebral Circulation, STROKEAHA.125.053599. https://doi.org/10.1161/strokeaha.125.053599
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