Combining Healthy Lifestyle with GLP-1 Medications Reduces Cardiovascular Risk in Type 2 Diabetes Patients

People with Type 2 diabetes who combined healthy lifestyle habits with GLP-1 receptor agonist medications experienced significantly greater reductions in cardiovascular risk compared to those relying on medication alone, according to research to be presented at the American Heart Association's Scientific Sessions 2025. The study of more than 63,000 military veterans found that those adopting at least six healthy lifestyle factors while taking GLP-1 RA medications had a 50% lower risk of major adverse cardiovascular events compared to veterans receiving standard diabetes care with fewer healthy lifestyle habits.

The findings are particularly significant given that people living with Type 2 diabetes are twice as likely to die from cardiovascular disease, according to the Know Diabetes by Heart initiative. The incidence of Type 2 diabetes has more than doubled in the past 20 years in the U.S., making effective prevention strategies crucial for public health.

Lead study author Xuan-Mai Nguyen, M.D., Ph.D., emphasized that lifestyle modifications remain the cornerstone for preventing and managing Type 2 diabetes. Our study's findings suggest that people with Type 2 diabetes taking GLP-1 receptor agonists can improve their heart health even more by adding and maintaining healthy lifestyle habits, Nguyen said. They also indicate that if someone does not have access to GLP-1 RAs, adopting healthy lifestyle habits can still lower the risk of having a stroke, heart attack or dying from heart-related issues.

The research analyzed data from the Million Veteran Program, which studies how genes, lifestyle, military experiences and exposures affect health and wellness in U.S. veterans. Researchers examined eight heart-healthy lifestyle habits: healthy eating, physical activity, not smoking, restful sleep, no-to-moderate alcohol intake, good stress management, social connection and support, and no opioid addiction. The study included veterans with Type 2 diabetes who had no previous history of heart attack, stroke, cancer or advanced chronic kidney disease.

The analysis revealed striking results across different combinations of lifestyle and medication use. Participants adhering to all eight healthy lifestyle habits showed a 63% lower risk of major cardiovascular events compared to those following one or fewer habits. Veterans taking GLP-1 RA medications alone had a 20% lower risk compared to non-users, consistent with prior research. However, the most substantial benefit came from the combination approach - those taking GLP-1 RA medications while adopting at least six healthy lifestyle habits achieved the 50% risk reduction.

Chiadi E. Ndumele, M.D., Ph.D., FAHA, chair of the American Heart Association's Council on Lifestyle and Cardiometabolic Health, noted the importance of these findings for clinical practice. This is a very interesting study with powerful observations about the combined impact of healthy lifestyle and GLP-1 RA use on cardiovascular risk, Ndumele said. Rather than medications versus lifestyle, health care professionals should really be emphasizing both to achieve the best clinical outcomes for our patients.

The study does have limitations, including its observational nature and the predominantly white male veteran population, which may limit generalizability to more diverse groups. Additionally, the research doesn't predict cardiovascular risk changes for adults without Type 2 diabetes who take GLP-1 RA medications for obesity treatment. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

With cardiovascular disease remaining a leading cause of death globally and Type 2 diabetes prevalence continuing to rise, this research provides important evidence for integrated treatment approaches that combine pharmaceutical interventions with comprehensive lifestyle modifications to achieve optimal cardiovascular protection for diabetes patients.