Lancet Diabetes Endocrinol
Drugs plus lifestyle: GLP 1 therapy and healthy behaviors show additive heart benefits
Clinical takeaway: When prescribing GLP‑1 receptor agonists for patients with type 2 diabetes, continue to prioritize and reinforce healthy lifestyle behaviors, as combining both may confer the greatest cardiovascular benefit.
In a prospective cohort of 98,261 adults with type 2 diabetes from the VA Million Veteran Program, both GLP‑1 RA use and adherence to healthy lifestyle habits were independently associated with fewer major adverse cardiovascular events (MACE: nonfatal MI, stroke, or CV death) over ~632,000 person‑years of follow‑up. Compared with patients with ≤1 low‑risk lifestyle habit, those adhering to all eight healthy habits had a 60% lower MACE risk (adjusted hazard ratio [HR], 0.40; 95% confidence interval [CI], 0.30–0.54). GLP‑1 RA use alone was associated with a more modest but significant risk reduction vs. nonuse (adjusted HR, 0.84; 95% CI, 0.76–0.92). The greatest benefit was observed with combination therapy: patients using GLP‑1 RAs and following 6 to 8 healthy habits had a 43% lower MACE risk compared with those with ≤3 healthy habits and no GLP‑1 RA use (adjusted HR, 0.57; 95% CI, 0.46–0.71), supporting additive associations rather than substitution.
Source: Nguyen XT, et al; VA Million Veterans Program. (2026, April). Lancet Diabetes Endocrinol. Combined associations of GLP-1 receptor agonists and a healthy lifestyle with cardiovascular outcomes among individuals with type 2 diabetes: a prospective cohort study