Published online Jun 15, 2017. doi: 10.4239/wjd.v8.i6.270
Peer-review started: February 12, 2017
First decision: March 28, 2017
Revised: April 20, 2017
Accepted: May 3, 2017
Article in press: May 5, 2017
Published online: June 15, 2017
Processing time: 135 Days and 22 Hours
Diabetes mellitus (DM) is a major risk factor for cardiovascular events, including ischemic stroke. Moreover, ischemic stroke appears to be more severe in these patients and to be associated with less favorable outcomes. However, strict glycemic control does not appear to reduce the risk of ischemic stroke. On the other hand, newer glucose-lowering agents (glucagon-like peptide 1 receptor agonists and sodium-glucose cotransporter 2 inhibitors) reduced the risk of cardiovascular events in recent randomized, placebo-controlled trials. Semaglutide also reduced the risk of ischemic stroke. These benefits are independent of glucose lowering and might be due to the favorable effects of these agents on body weight and blood pressure. Pioglitazone also reduced the risk of recurrent stroke in patients with insulin resistance or type 2 DM but the unfavorable safety profile limits its use. In contrast, sulfonylureas and dipeptidyl peptidase 4 inhibitors have a neutral effect on cardiovascular morbidity and might be less attractive options in this high-risk population.
Core tip: Diabetes mellitus is a major risk factor for ischemic stroke. However, strict glycemic control does not appear to reduce the risk of ischemic stroke. On the other hand, glucagon-like peptide 1 receptor agonists and sodium-glucose cotransporter 2 inhibitors reduce the risk of cardiovascular events. These benefits are independent of glucose lowering and might be due to favorable effects on weight and blood pressure. Pioglitazone also reduced the risk of recurrent stroke but the unfavorable safety profile limits its use. Finally, sulfonylureas and dipeptidyl-peptidase-4 inhibitors have neutral effects on cardiovascular morbidity and might be less attractive options.