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 involving more than 63,000 military veterans. The preliminary study, to be presented at the American Heart Association's Scientific Sessions 2025, found that veterans who adopted at least six healthy lifestyle factors while taking GLP-1 RA medications had a 50% lower risk of major cardiovascular events compared to those following three or fewer healthy habits and not taking these medications.
The research analyzed data from the Million Veteran Program, a national initiative studying how genes, lifestyle, military experiences and exposures affect health and wellness in U.S. veterans. The program uses data from medical records, biospecimens and self-reported surveys available at https://www.research.va.gov/mvp/. Study participants included veterans with Type 2 diabetes who had no previous history of heart attack, stroke, cancer or advanced chronic kidney disease.
Researchers 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. The analysis revealed 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 cardiovascular events.
"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's importance lies in demonstrating that while GLP-1 RA medications alone reduced cardiovascular risk by 20% compared to non-users, the combination with multiple healthy lifestyle habits produced substantially greater benefits. This finding is particularly significant given that people with Type 2 diabetes are twice as likely to die from cardiovascular disease, according to the Know Diabetes by Heart initiative, a collaborative effort between the American Heart Association and American Diabetes Association detailed at https://knowdiabetesbyheart.org/.
Chiadi E. Ndumele, M.D., Ph.D., FAHA, chair of the American Heart Association's Council on Lifestyle and Cardiometabolic Health, noted that "these findings suggest that a healthy lifestyle really complements the powerful effects of GLP-1RAs. Rather than medications versus lifestyle, health care professionals should really be emphasizing both to achieve the best clinical outcomes for our patients."
The study limitations include its observational nature and the predominantly white male veteran population, which may limit generalizability to more diverse groups. The research also 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, as abstracts presented at American Heart Association scientific meetings are not peer-reviewed.
With Type 2 diabetes incidence more than doubling in the U.S. over the past 20 years, these findings provide crucial evidence for comprehensive treatment approaches that integrate medication with multiple lifestyle interventions to substantially reduce cardiovascular complications in this high-risk population.
