# Risk of New‐Onset Ischaemic and Haemorrhagic Stroke in Patients With Type 2 Diabetes With Chronic Kidney Disease on SGLT‐2 Inhibitor Users: A Population‐Based Cohort Study

## TL;DR

This study finds that SGLT2 inhibitors reduce the risk of ischaemic and haemorrhagic strokes in patients with type 2 diabetes and chronic kidney disease.

## Contribution

The study provides new evidence that SGLT2 inhibitors offer protective effects against stroke in T2D patients with CKD.

## Key findings

- SGLT2i therapy was associated with a 14% reduced risk of ischaemic stroke and 20% reduced risk of haemorrhagic stroke.
- The protective effect remained significant after sensitivity analysis with sex and age matching.

## Abstract

Type 2 diabetes (T2D) and chronic kidney disease (CKD) increase the risk of ischaemic and haemorrhagic strokes. However, the effect of sodium‐glucose cotransporter 2 inhibitors (SGLT2i) on reducing the risk of ischaemic and haemorrhagic strokes in patients with T2D and CKD remains unclear. Thus, this study was conducted to explore the role of SGLT2i in the prevention of ischaemic and haemorrhagic strokes.

In this retrospective cohort study, Cox regression analysis was employed to examine the hazard ratio (HR) between users and nonusers of SGLT2i on incident ischaemic and haemorrhagic strokes following 1:1 propensity score matching. The Kaplan–Meier method was used to determine the risk of study outcome over time between users and nonusers of SGLT2i. Finally, a sensitivity analysis of the HR was performed between users and nonusers of SGLT2i on incident ischaemic and haemorrhagic strokes after 1:2 sex and age matching.

After 1:1 propensity score matching of patients by age, sex, T2D duration, and comorbidities, 107,819 users of SGLT2i and 107,819 nonusers were enrolled for analysis. SGLT2i therapy was associated with significantly reduced incidence of ischaemic and haemorrhagic strokes (HR 0.86, [95% CI, 0.81–0.90]; HR 0.80, [95% CI, 0.74–0.87]). Furthermore, the HR was even more significant in the sensitivity test for incident ischaemic and haemorrhagic strokes.

SGLT2i reduced the risk of incident ischaemic and haemorrhagic strokes among patients with T2D and CKD. The protective profile of the SGLT2i against incident ischaemic and haemorrhagic strokes makes it a clinical option for those with T2D with CKD.