Glp-1s Combined With Healthy Habits May Improve Heart Health In Diabetes

• A recent study found that people with type 2 diabetes who used GLP-1 receptor agonists (GLP-1 RAs) in combination with healthy lifestyle habits had a reduced risk of major adverse cardiovascular events.
• The findings show that GLP-1 RAs, when combined with healthy habits, independently improved heart health, though to varying degrees. 
• The researchers noted that lifestyle interventions remain pivotal in diabetes management and can amplify the benefits of GLP-1 RAs. 

Type 2 diabetes is a growing health concern in the United States, overlapping with the obesity epidemic.

According to the Centers for Disease Control and Prevention (CDC), 40.1 million people in the United States have diabetes, either diagnosed or undiagnosed. That is an estimated 12% of the population. 

According to research from 2017, the prevalence of diabetes will increase by 54% by 2030. This is an estimated 54.9 million people. 

Type 2 diabetes can lead to various complications, including cardiovascular disease. This is the leading cause of death among people with diabetes. 

A recent study published in The Lancet Diabetes & Endocrinology found that a combination of GLP-1 receptor agonists (GLP-1 RAs) and healthy lifestyle habits can reduce the risk of major adverse cardiovascular events (MACE) in people with type 2 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,” Frank Hu, MD, Fredrick J. Stare Professor of Nutrition and Epidemiology and chair of the Department of Nutrition at the Harvard T.H. Chan School of Public Health, and corresponding author of the study, said in a press release. 

GLP-1s and 6 healthy habits lower cardiovasculr risk by 43%

The study used data from the Veterans Affairs’ Million Veteran Program from 2011 to 2023.

The researchers looked at the lifestyle habits, GLP-1 RA usage, and cardiovascular outcomes of over 98,000 adults who had type 2 diabetes and no previous history of cardiovascular disease. 

The researchers considered 8 healthy habits: 

• healthy diet
• regular exercise
• not smoking
• restful sleep
• minimal alcohol consumption
• good stress management
• social connection and support
• not having opioid use disorder

The MACEs they considered were: 

• non-fatal stroke
• myocardial infarction (heart attack)
• cardiovascular death

The study found that using a GLP-1 RA and maintaining a healthy lifestyle significantly reduced the risk for MACE. 

“We know that GLP-1 receptor agonists can improve cardiovascular health in patients with diabetes. We also know that good lifestyle habits such as eating [a] heart-healthy diet, getting regular physical activity, and getting enough quality sleep, are all beneficial in controlling the risk factors that lead to heart disease,” Cheng-Han Chen, MD, board certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, CA, who was not involved in the study, told Healthline. 

“It is thus not surprising that combining both GLP-1 receptor agonists and healthy lifestyle modifications can have additive beneficial effects.”

Individuals who used a GLP-1 RA and adhered to between six and eight healthy habits showed a 43% lower risk of MACE than those who did not use a GLP-1 RA and adhered to three or fewer habits. 

Those who adhered to all eight healthy habits had a 60% reduced risk compared to those who adhered to only one or fewer. Finally, people who used a GLP-1 RA had a 16% lower MACE risk than 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 in the press release.

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

More studies needed to understand heart health benefits

The researchers noted that the study had limitations. 

First, the results were based on observational data. This means that it was possible there was some residual confounding by socioeconomic status and other factors. However, these variables were accounted for during analysis. 

Additionally, the study population consisted predominantly of white male veterans.

This may have limited the generalizability of the results. However, the findings were consistent across racial and ethnic groups and between males and females.

“Keeping diabetes under control is a long-term process,” Chen said.

“It is important to understand the composition of your food so that you can make the correct choices. We recommended getting regular physical activity. It is also important to avoid alcohol and tobacco, and to get enough quality sleep.”

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