Combining GLP-1 Medications with Healthy Lifestyle Habits Dramatically 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 reduction 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 taking GLP-1 RA medications while maintaining at least six healthy lifestyle habits had a 50% lower risk of serious cardiovascular events compared to veterans receiving standard diabetes care without GLP-1 medications and following fewer healthy habits.

The research analyzed data from the Million Veteran Program, a national program studying how genes, lifestyle, military experiences and exposures affect health and wellness in U.S. veterans. Lifestyle modifications are recommended as the cornerstone for preventing and managing Type 2 diabetes, said lead study author Xuan-Mai Nguyen, M.D., Ph.D., a researcher with the Department of Veterans Affairs Boston Healthcare System. 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.

The study examined eight heart-healthy lifestyle factors: healthy eating, physical activity, not smoking, restful sleep, no-to-moderate alcohol intake, good stress management, social connection and support, and no opioid addiction. Researchers found that participants adhering to all eight healthy lifestyle habits had a 63% lower risk of major cardiovascular events compared to those following one or fewer habits. When examined individually, all healthy lifestyle factors were independently associated with lower likelihood of major adverse cardiovascular events.

The analysis revealed that GLP-1 RA medication use alone was associated with a 20% reduction in cardiovascular risk, consistent with previous research. However, the combination of medication with multiple healthy lifestyle habits produced substantially greater benefits. Taking a GLP-1 RA alone is less effective than combining it with other beneficial lifestyle factors, Nguyen noted. The more healthy lifestyle factors adopted, the better.

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

The study's implications are significant given that people living with Type 2 diabetes are twice as likely to die from cardiovascular disease, according to Know Diabetes by Heart, a collaborative initiative of the American Heart Association and American Diabetes Association. The incidence of Type 2 diabetes has more than doubled in the past 20 years in the U.S., making effective prevention strategies increasingly important.

Study limitations include that the analysis was based on observational data and the participant group primarily consisted of white male veterans, potentially limiting generalizability to more diverse populations. The research also does not predict how cardiovascular risk might change for adults without Type 2 diabetes who take GLP-1 RA medications to treat obesity. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.