{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T05:18:46Z","timestamp":1787635126974,"version":"build-2736575974"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Stroke"],"abstract":"<jats:p>Stroke is a multifactorial cardiovascular disease (CVD), which predominantly affects older adults. Consequently, cardiovascular risk factors and related comorbidities are highly prevalent among people presenting with acute stroke. These conditions, and the stroke event itself, may require specific pharmacological therapies to reduce subsequent risk. Over recent decades, two novel pharmacological drug classes, sodium\u2013glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists, which were initially developed as glucose-lowering therapies for type 2 diabetes mellitus, have been used for management of related cardiovascular conditions. These agents are not currently included in secondary stroke prevention guidelines, despite growing evidence suggesting that they may directly or indirectly improve long-term, stroke-related outcomes. It is therefore essential that the stroke community remains up-to-date with these developments while awaiting updated clinical guidelines. This will ensure optimal management of coexisting cardiovascular disease and reduce subsequent risk. In this commentary, we summarize and discuss what we consider to be the most relevant and impactful recent studies for contemporary clinical stroke practice.<\/jats:p>","DOI":"10.3389\/fstro.2026.1918465","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T04:23:36Z","timestamp":1787631816000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Cardiometabolic drugs after stroke: time to embrace SGLT2 inhibitors and incretin-based therapies?"],"prefix":"10.3389","volume":"5","author":[{"given":"H\u00e5kon","family":"Ihle-Hansen","sequence":"first","affiliation":[{"name":"Department of Medicine, B\u00e6rum Hospital, Vestre Viken Hospital Trust","place":["Drammen, Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hege","family":"Ihle-Hansen","sequence":"additional","affiliation":[{"name":"Department of Acute Medicine, Oslo University Hospital, Ullev\u00e5l","place":["Oslo, Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rolf A.","family":"Blauenfeldt","sequence":"additional","affiliation":[{"name":"Danish Stroke Center, Department of Neurology, Aarhus University Hospital","place":["Aarhus, Denmark"]},{"name":"Department of Clinical Medicine, Aarhus University","place":["Aarhus, Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesse","family":"Dawson","sequence":"additional","affiliation":[{"name":"Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow","place":["Glasgow, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00f8ren Z.","family":"Diederichsen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Copenhagen University Hospital - Rigshospitalet","place":["Copenhagen, Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guri","family":"Hagberg","sequence":"additional","affiliation":[{"name":"Department of Neurology, Oslo University Hospital, Ullev\u00e5l","place":["Oslo, Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1161\/01.STR.0000047852.05842.3C","article-title":"Poor outcome after first-ever stroke: predictors for death, dependency, and recurrent stroke within the first year","volume":"34","author":"Appelros","year":"2003","journal-title":"Stroke"},{"key":"B2","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1056\/NEJMoa2416394","article-title":"Tirzepatide as compared with semaglutide for the treatment of obesity","volume":"393","author":"Aronne","year":"2025","journal-title":"N. Engl. J. Med."},{"key":"B3","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/S2213-8587(24)00271-7","article-title":"Effects of GLP-1 receptor agonists on kidney and cardiovascular disease outcomes: a meta-analysis of randomised controlled trials","volume":"13","author":"Badve","year":"2025","journal-title":"Lancet Diabetes Endocrinol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1056\/NEJMoa2030186","article-title":"Sotagliflozin in patients with diabetes and chronic kidney disease","volume":"384","author":"Bhatt","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"B5","year":"2024"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1177\/23969873221100032","article-title":"European Stroke Organisation (ESO) guideline on pharmacological interventions for long-term secondary prevention after ischaemic stroke or transient ischaemic attack","author":"Dawson","year":"2022","journal-title":"Eur. Stroke. J."},{"key":"B7","doi-asserted-by":"publisher","first-page":"S140","DOI":"10.2337\/dc23-S009","volume":"46","author":"ElSayed","year":"2022","journal-title":"Diabetes Care"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1384","DOI":"10.1161\/CIRCULATIONAHA.118.037778","article-title":"Empagliflozin reduced mortality and hospitalization for heart failure across the spectrum of cardiovascular risk in the EMPA-REG OUTCOME trial","volume":"139","author":"Fitchett","year":"2019","journal-title":"Circulation"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1198","DOI":"10.1053\/j.gastro.2022.08.045","article-title":"AGA clinical practice guideline on pharmacological interventions for adults with obesity","volume":"163","author":"Grunvald","year":"2022","journal-title":"Gastroenterology"},{"key":"B10","doi-asserted-by":"publisher","first-page":"328","DOI":"10.2174\/1871530319666191014110414","volume":"20","author":"Habib","year":"2020","journal-title":"Endocr Metab. Immune Disord. Drug Targets"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1321","DOI":"10.1056\/NEJMoa1506930","article-title":"Pioglitazone after ischemic stroke or transient ischemic attack","volume":"374","author":"Kernan","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"B12","doi-asserted-by":"publisher","first-page":"e364","DOI":"10.1161\/STR.0000000000000375","article-title":"2021 Guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American heart association\/American stroke association","volume":"52","author":"Kleindorfer","year":"2021","journal-title":"Stroke"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1394","DOI":"10.1056\/NEJMoa2313917","article-title":"Semaglutide in patients with obesity-related heart failure and type 2 diabetes","volume":"390","author":"Kosiborod","year":"2024","journal-title":"N. Engl. J. Med."},{"key":"B14","doi-asserted-by":"publisher","first-page":"684","DOI":"10.1016\/j.kint.2023.10.016","article-title":"Executive summary of the KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease: known knowns and known unknowns","volume":"105","author":"Levin","year":"2024","journal-title":"Kidney Int."},{"key":"B15","doi-asserted-by":"publisher","first-page":"2221","DOI":"10.1056\/NEJMoa2307563","article-title":"Semaglutide and cardiovascular outcomes in obesity without diabetes","volume":"389","author":"Lincoff","year":"2023","journal-title":"N. Engl. J. Med."},{"key":"B16","doi-asserted-by":"publisher","first-page":"1834","DOI":"10.1056\/NEJMoa1607141","article-title":"Semaglutide and cardiovascular outcomes in patients with type 2 diabetes","volume":"375","author":"Marso","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"B17","doi-asserted-by":"publisher","first-page":"4043","DOI":"10.1093\/eurheartj\/ehad192","volume":"44","author":"Marx","year":"2023","journal-title":"Eur. Heart. J."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1882","DOI":"10.1161\/CIRCULATIONAHA.122.059595","article-title":"GLP-1 receptor agonists for the reduction of atherosclerotic cardiovascular risk in patients with type 2 diabetes","volume":"146","author":"Marx","year":"2022","journal-title":"Circulation"},{"key":"B19","doi-asserted-by":"publisher","first-page":"3627","DOI":"10.1093\/eurheartj\/ehad195","article-title":"2023 Focused update of the 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: developed by the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) with the special contribution of the Heart Failure Association (HFA) of the ESC.","volume":"44","author":"McDonagh","year":"2023","journal-title":"Eur. Heart J"},{"key":"B20","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1001\/jamacardio.2020.4511","article-title":"Association of SGLT2 inhibitors with cardiovascular and kidney outcomes in patients with type 2 diabetes: a meta-analysis","volume":"6","author":"McGuire","year":"2021","journal-title":"JAMA Cardiol."},{"key":"B21","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1186\/s13098-025-01635-6","article-title":"Safety, efficacy, and cardiovascular benefits of combination therapy with SGLT-2 inhibitors and GLP-1 receptor agonists in patients with diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials","volume":"17","author":"Mousavi","year":"2025","journal-title":"Diabetol. Metab. Syndr."},{"key":"B22","unstructured":"Type 2 Diabetes in Adults: Management\n          \n          \n          2026"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2026.03.056","article-title":"2026 AHA\/ACC\/ADA\/ASN guideline for the prevention, detection, evaluation, management of cardiovascular-kidney-metabolic syndrome","volume":"87","author":"Ndumele","year":"2026","journal-title":"J. Am. Coll. Cardiol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"644","DOI":"10.1056\/NEJMoa1611925","article-title":"Canagliflozin and cardiovascular and renal events in type 2 diabetes","volume":"377","author":"Neal","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"B25","doi-asserted-by":"publisher","first-page":"2295","DOI":"10.1056\/NEJMoa1811744","volume":"380","author":"Perkovic","year":"2019","journal-title":"N. Engl. J. Med"},{"key":"B26","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1056\/NEJMoa2403347","article-title":"Effects of semaglutide on chronic kidney disease in patients with type 2 diabetes","volume":"391","author":"Perkovic","year":"2024","journal-title":"N. Engl. J. Med ."},{"key":"B27","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1111\/nep.14251","article-title":"Chronic kidney disease prevalence and clinical outcomes in anterior circulation acute ischemic stroke patients with reperfusion therapy: a meta-analysis","volume":"29","author":"Rajesh","year":"2024","journal-title":"Nephrology"},{"key":"B28","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1016\/S2213-85872100203-5","article-title":"Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of randomised trials","volume":"9","author":"Sattar","year":"2021","journal-title":"Lancet Diabetes Endocrinol."},{"key":"B29","doi-asserted-by":"publisher","first-page":"15364","DOI":"10.1038\/s41598-021-94945-4","article-title":"Effects of SGLT2 inhibitors on stroke and its subtypes in patients with type 2 diabetes: a systematic review and meta-analysis","volume":"11","author":"Tsai","year":"2021","journal-title":"Sci. Rep"},{"key":"B30","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1038\/s41581-022-00535-6","article-title":"Kidney and heart failure outcomes associated with SGLT2 inhibitor use","volume":"18","author":"van der Aart-van der Beek","year":"2022","journal-title":"Nat. Rev. Nephrol."},{"key":"B31","doi-asserted-by":"publisher","first-page":"1796","DOI":"10.1056\/NEJMoa2511774","volume":"393","author":"Wharton","year":"2025","journal-title":"N. Engl .J .Med."},{"key":"B32","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1056\/NEJMoa1812389","article-title":"Dapagliflozin and cardiovascular outcomes in type 2 diabetes","volume":"380","author":"Wiviott","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"B33","doi-asserted-by":"publisher","first-page":"234","DOI":"10.1038\/s41392-024-01931-z","article-title":"Glucagon-like peptide-1 receptor: mechanisms and advances in therapy","volume":"9","author":"Zheng","year":"2024","journal-title":"Signal Transduct.Target. Ther."},{"key":"B34","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1001\/jamainternmed.2025.5684","article-title":"Liraglutide in acute minor ischemic stroke or high-risk transient ischemic attack with type 2 diabetes: the LAMP randomized clinical trial","volume":"186","author":"Zhu","year":"2026","journal-title":"JAMA Inter. Med."}],"container-title":["Frontiers in Stroke"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fstro.2026.1918465\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T04:23:37Z","timestamp":1787631817000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fstro.2026.1918465\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,25]]},"references-count":34,"alternative-id":["10.3389\/fstro.2026.1918465"],"URL":"https:\/\/doi.org\/10.3389\/fstro.2026.1918465","relation":{},"ISSN":["2813-3056"],"issn-type":[{"value":"2813-3056","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,25]]},"article-number":"1918465"}}