GLUCAGON-LIKE peptide-1 receptor agonist (GLP-1RA) prescriptions are associated with a reduced risk of aneurysmal rupture in patients with type 2 diabetes and unruptured intracranial aneurysms (IA), a 2026 retrospective cohort study has found.
IAs and SAHs
Subarachnoid haemorrhages (SAH) are most often the result of IA rupture, which often leads to substantial morbidity and mortality. IAs occur in up to 3% of the population. Inflammation plays a central role in aneurysm formation, growth, and eventual rupture.
Due to their known anti-inflammatory and antihypertensive properties, GLP-1RAs have come under recent investigation as potential mitigators of nontraumatic SAH risk in patients with unruptured IAs.
GLP-1RAs and Reduced Risk of Haemorrhagic Stroke
The study identified more than 24,700 patients with type 2 diabetes and unruptured IAs between 2008 and 2025. There were more than 3,100 with GLP-1RA prescriptions and more than 8,000 without.
GLP-1RA prescriptions were associated with a significantly lower risk of nontraumatic SAH diagnoses at three years, with a decreased effect at five years.
Supporting Research
Another 2026 retrospective cohort study analysed data from January 2010 to January 2025, spanning across more than 90 healthcare organisations. Similarly, patients with unruptured IAs and type 2 diabetes who received GLP-1RAs were compared with those who did not. After matching, each cohort comprised of more than 2,200 patients.
GLP-1RA use was associated with a significantly lower rate of SAH and all-cause mortality after a five-year follow-up.
Limitations
An inherent limitation of both studies is that cohorts were comprised of patients engaged with healthcare systems, favouring individuals who seek or receive care.
The database used to identify populations in both studies, TriNetX, is not a fully centralised system. Differences in data collection across participating institutions may have affected data completeness and consistency.
SAH or death occurring at external hospitals are not systematically captured. Some events may therefore be missed.
Clinical Implications
Both studies suggested that GLP-1RAs have a potential neuroprotective effect in reducing nontraumatic SAH risk in patients with type 2 diabetes and IAs.
Researchers encouraged future prospective, controlled trials to define the role of GLP-1RAs in SAH prevention in high-risk populations.
Reference
Li SY et al. GLP-1 receptor agonists and aneurysm rupture risk in type 2 diabetes: a multicenter retrospective study. J Clin Neurosci. 2026;DOI:10.1016/j.jocn.2026.111905.
Feghali J et al. Glucagon-like peptide-1 receptor agonists and decreased subarachnoid hemorrhage risk in patients with intracranial aneurysm. 2026;DOI:10.1161/STROKEAHA.125.053599.
