Healthy Lifestyle Combined With GLP-1 RA Use Lowers Cardiovascular Risk in Patients With Type 2 Diabetes

Findings to be presented at the American Heart Association Scientific Sessions 2025 in New Orleans suggest that combining healthy lifestyle habits with GLP-1 receptor agonist (GLP-1 RA) therapy can significantly lower cardiovascular risk in patients with type 2 diabetes (T2D). The data, presented in Abstract Poster MP511, highlight the additive benefits of lifestyle modification and medication use in reducing the risk of major adverse cardiovascular events (MACE), including heart attack, stroke, and cardiovascular-related death.

Researchers analyzed data from over 63,000 U.S. military veterans with T2D apart of the Million Veteran Program, a large-scale study aimed at understanding the effects of genes, lifestyle, and military experiences on health. The results revealed that the individuals who adopted 6 or more healthy lifestyle habits combined with GLP-1 RA treatment experienced a 50% lower risk of suffering major cardiovascular events compared to those who followed fewer healthy habits and were given standard diabetes care without GLP-1 RA therapy.

“Lifestyle modifications are recommended as the cornerstone for preventing and managing type 2 diabetes,” said lead study author Xuan-Mai Nguyen, MD, PhD, a researcher with the Department of Veterans Affairs Boston Healthcare System and a second-year medicine resident at the University of California, Los Angeles.

Nguyen continued, “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. 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.”

When examined individually, each lifestyle factor—healthy eating, regular physical activity, adequate sleep, non-smoking status, moderate alcohol intake, stress management, and social connection—was independently associated with lower cardiovascular risk. However, the most significant protection was observed among those who combined multiple habits with medication use.

“Taking a GLP-1 RA alone is less effective than combining it with other beneficial lifestyle factors,” Nguyen said. “Achieving some healthy lifestyle behaviors can lower the risk of a major adverse cardiovascular event. The more healthy lifestyle factors adopted, the better.”

GLP-1 RAs represent a class of drugs given via injection that help lower blood glucose levels and are also beneficial in the aspect of weight management, which is beneficial for heart health. It has been confirmed in the previous studies that GLP-1 RAs, on their own, can lower the risk of MACE. The latest research, however, indicates that a strategy combining drug and lifestyle changes is even more effective.

Chiadi E. Ndumele, MD, PhD, FAHA, chair of the American Heart Association’s Council on Lifestyle and Cardiometabolic Health, noted the strength of the association observed. “This is a very interesting study with powerful observations about the combined impact of healthy lifestyle and GLP-1 RA use on cardiovascular risk,” he said. “These findings suggest that a healthy lifestyle really complements the powerful effects of GLP-1 RAs. Rather than medications versus lifestyle, health care professionals should really be emphasizing both to achieve the best clinical outcomes for our patients.”

Researchers recognized that the study's observational design imposes limitations on the ability to infer causality. The majority of the population consisted of older white male veterans; hence, the findings may not be applicable to a wider population. The study also does not address how cardiovascular consequences may change in non-diabetic adults treated with GLP-1 RAs for obesity.

Still, the findings add to growing evidence that pairing GLP-1 RA therapy with sustainable, heart-healthy lifestyle choices can lead to the greatest reduction in cardiovascular risk among patients with T2D.

REFERENCES

Healthy lifestyle combined with newer diabetes medications lowered cardiovascular risk. American Heart Association. Published November 3, 2025. Accessed November 6, 2025. https://newsroom.heart.org/news/healthy-lifestyle-combined-with-newer-diabetes-medications-lowered-cardiovascular-risk?preview=5030&preview_mode=True