Combining healthy lifestyle and GLP-1 therapy reduces heart risks in diabetes

Individuals living with type 2 diabetes (T2D) had a significantly lower risk of poor cardiovascular health when they used a GLP-1 receptor agonist (GLP-1 RA) in combination with adhering to healthy lifestyle habits, according to a new study led by researchers at Harvard T.H. Chan School of Public Health and the Department of Veterans Affairs Boston Healthcare System. The study is the first large cohort investigation to examine the combined effects of healthy habits and GLP-1 RAs on heart health, showing that the two strategies are complementary, rather than substitutes, in improving cardiovascular outcomes among patients with diabetes.

"Our findings underscore that, 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 corresponding author Frank Hu, Fredrick J. Stare Professor of Nutrition and Epidemiology and chair of the Department of Nutrition.

The study will be published February 25, 2026, in The Lancet Diabetes & Endocrinology.

The researchers examined the lifestyle habits, GLP-1 RA usage, and cardiovascular health outcomes of more than 98,000 adults living with T2D and without any prior cardiovascular disease, using data from the Veterans Affairs' Million Veteran Program from 2011 to 2023. The healthy lifestyle habits the researchers considered were healthy diet, regular exercise, not smoking, restful sleep, minimal alcohol intake, good stress management, social connection and support, and no opioid use disorder. The major adverse cardiovascular events (MACEs) they considered were non-fatal stroke, myocardial infarction, or cardiovascular death. More than 13,000 of the study participants used a GLP-1 RA. When analyzing the relationship between lifestyle, GLP-1 RAs, and heart health, the researchers controlled for potential demographic and health-related confounders.

The study found that maintaining a healthy lifestyle and using a GLP-1 RA led to significantly reduced MACE risk. Those who used a GLP-1 RA and adhered to six to eight healthy habits had a 43% lower risk compared to those who did not use a GLP-1 RA and adhered to three or fewer such habits. The study also found that healthy habits and GLP-1 RA usage independently benefited heart health. Those who adhered to all eight healthy habits had a 60% lower risk compared to those who adhered to one or fewer, and those who used a GLP-1 RA had a 16% lower MACE risk compared to those who didn't. 

"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," Hu said. "As novel therapies expand, scalable lifestyle interventions remain essential for reducing the overall burden of cardiovascular disease and other chronic diseases."

The researchers noted that the study had some limitations. The results were based on observational data, meaning residual confounding by socioeconomic status and other factors was possible, though these variables were accounted for in the analysis. Additionally, the study population primarily consisted of white male veterans, which may limit the generalizability of the results, though the overall findings were consistent across different racial and ethnic groups and between men and women.