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Focus Pixel Art/Getty Images In a new observational study, the use of GLP-1s alongside healthy lifestyle habits was associated with a reduced risk of cardiovascular issues for people with type 2 diabetes. Participants using a GLP-1 and adhering to six-to-eight healthy habits had a 43% lower risk of issues like heart attacks and strokes compared with those not using a GLP-1 and adhering to three or fewer healthy habits. GLP-1 use and adherence to healthy habits also reduced the risk of cardiovascular issues independently of each other. GLP-1 medications are known for their use in treating diabetes and assisting with weight loss. The name GLP-1 is short for glucagon-like peptide-1 receptor agonists. They work by mimicking the effects of a hormone called glucagon-like peptide-1 that plays a role in blood sugar regulation as well as influencing digestion and feelings of fullness after eating. People with type 2 diabetes, obesity, or both often receive advice on lifestyle habits that might help with managing these conditions, and this is also the case when doctors prescribe GLP-1s. Healthy habits such as eating a healthy diet, exercising, and avoiding smoking can all help with blood sugar control and support healthy weight loss. While many studies have looked at how healthy lifestyle choices can support the use of GLP-1 medications, less attention has been paid to their long-term effects on cardiovascular health. Cardiovascular disease is an important consideration for people with diabetes. The American Diabetes Association reports that people with diabetes are twice as likely to have heart disease or a stroke than those who do not. This new study, published in The Lancet Diabetes & Endocrinology and funded by the Department of Veteran Affairs, aims to shine a light on how effective lifestyle and medication together might be at protecting people with diabetes. What did the study look at? For the study, the researchers examined data for 98,261 people with type 2 diabetes who were enrolled on the US Veterans Affairs’ Million Veteran Program between Jan 10, 2011, and Sept 30, 2023. Each of the participants had no previous history of heart attacks, strokes, or advanced chronic kidney disease. Over 13,000 of the participants used a GLP-1. The researchers identified eight healthy lifestyle habits to look at in the study, which were: a higher quality diet being physically active not smoking restful sleep no heavy alcohol intake good stress management social connection and support no opioid use disorder Medical News Today spoke to Frank Hu , MD, PhD, Fredrick J. Stare Professor of Nutrition and Epidemiology and chair of the Department of Nutrition at Harvard T H Chan School of Public Health, Boston, MA, one of the authors of the study. Hu explained that they assessed the participants’ diets using the Healthy Plant-Based Diet Index (hPDI): “a dietary score that rewards higher intake of healthy plant foods (such as whole grains, fruits, vegetables, nuts, and legumes) while penalizing intake of less healthy plant foods and animal foods to reflect overall plant-based diet quality.” The researchers defined a healthy diet as one that landed in the upper 40% of the hPDI. The study authors also looked to see if the participants experienced major adverse cardiovascular events, or MACE. This covered non-fatal strokes or heart attacks as well as death from cardiovascular causes. With this information, the study authors then assessed how the risk of MACE related to the use of GLP-1s and adherence to the eight healthy lifestyle habits. How did GLP-1 use and healthy habits affect cardiovascular risk? Overall, the researchers found that using a GLP-1 in tandem with adhering to healthy habits was associated with a greater reduction in risk of MACE than that provided by the medication or the lifestyle habits on their own. During the years the researchers observed, a total of 10,433 participants experienced a MACE. The participants that used a GLP-1 and also adhered to between six and eight of the healthy habits had a 43% lower risk of MACE than those who did not use GLP-1s and adhered to three or fewer of the healthy habits. Both GLP-1 use and adherence to the healthy habits also improved MACE risk on their own. Participants who adhered to all eight of the healthy habits had a 60% lower risk of MACE compared with those who adhered to one or none. Using a GLP-1 was associated with a 16% lower risk compared with not using one. MNT asked Hu whether any of the healthy habits appeared to have a greater impact than others. “All eight individual lifestyle habits are important for reducing cardiovascular risk,” Hu replied. “Among them, being physically active, non-smoking, and no drug abuse are the most important ones. “But diet, sleep, stress management, no heavy alcohol use, and social connections all contributed to cardiovascular risk reduction.” What are the implications and limitations of these findings? The researchers believe that these findings underline just how important a healthy lifestyle can be, even alongside ground-breaking medical interventions. “Even in the era of highly effective GLP-1 pharmacotherapy, lifestyle habits remain central to diabetes management and cardiovascular risk reduction and can substantially amplify the benefits of modern medications,” said Hu in a press release . It is worth noting that the majority of the participants in this study were white, male veterans. This means that the results may not reflect what would happen in the broader population, although they were consistent between different sexes as well as different racial and ethnic groups here. The study was also an observational one, so it may be that there were other factors at play that influenced the results. Despite these potential limitations, the researchers believe that their findings provide more evidence that a healthy lifestyle should remain an important aspect of treating and preventing disease. “From a public health perspective, the results underscore the continued importance of population-level investments and policy in promoting healthy diet, physical activity, sleep, stress management, and social connection, even in a modern drug era.” — Frank Hu, MD, PhD “As novel therapies expand, scalable lifestyle interventions remain essential for reducing the overall burden of cardiovascular disease and other chronic diseases,” Hu added. 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