Exercise is part of the Whole Health program at the VA Pittsburgh Healthcare System. A new study found that, in type 2 diabetes patients, use of GLP‑1 drugs combined with healthy lifestyle habits is associated with reduced risk of major adverse cardiovascular events. VA photo
BOSTON, MA — In Type 2 diabetes patients, use of GLP‑1 drugs combined with healthy lifestyle habits is associated with reduced risk of major adverse cardiovascular events. The findings underscore the importance of integrating lifestyle modification with pharmacotherapy in Type 2 diabetes management, according to a recent study.
The prospective cohort study published in The Lancet Diabetes & Endocrinology examined the combined association of GLP-1 receptor agonist use and adherence to eight lifestyle habits with cardiovascular outcomes in Type 2 diabetes patients.1
The analysis, which used data from the VA’s Million Veteran Program (MVP), represents the first large‑scale effort to evaluate how medication and lifestyle factors jointly influence heart health in this population, according to a press release on the study by VA Research Communications.
In the United States, the number of people with diabetes has more than doubled in the past 20 years. In 2021, 29.1 million individuals, or 12.0% of the U.S. population, lived with diabetes. Type 2 diabetes is shifting toward older age with increasing prevalence of comorbidities. Obesity is considered a major driver of long-term comorbidities in patients with Type 2 diabetes, particularly cardiovascular disease. Managing obesity includes lifestyle modifications and pharmacological therapies, each offering varying degrees of success in weight loss and cardiovascular disease risk reduction.
GLP-1 receptor agonists, such as liraglutide and semaglutide, are a class of popular weight loss medications that imitate a naturally occurring hormone, GLP-1, in the body. In patients with Type 2 diabetes, GLP-1 receptor agonists have demonstrated value in reducing body weight and improving blood sugar control. Cardiovascular outcome trials have shown that GLP-1 receptor agonists have a cardioprotective effect and reduce the risk of major adverse cardiovascular events, the researchers explained.
Despite pharmacological advances, lifestyle modification remains that key management for Type 2 diabetes. The long-term combined effects of lifestyle habits and GLP-1 receptor agonists on cardiovascular outcomes are unknown. In this study, the investigators aimed to determine the independent and combined association of a healthy lifestyle and GLP-1 receptor agonists on the risk of major adverse cardiovascular events.
The study authors are affiliated with Harvard T.H. Chan School of Public Health, Harvard Medical School, Brigham and Women’s Hospital and Boston University School of Public Health in Boston; VA Boston Healthcare System; UCLA David Geffen School of Medicine in Los Angeles; Université Paris Cité, Centre for Research in Epidemiology and Statistics (CRESS) and the George Pompidou European Hospital, AP-HP, in Paris; University of Connecticut Health Center in Farmington, CT; Emory University in Atlanta; and Atlanta VA Healthcare System.
“GLP-1 RAs are rapidly changing diabetes and obesity care, and there is a growing perception that effective pharmacotherapy might lessen the need for lifestyle change,” Frank B. Hu, MD, PhD, professor and chair of the Department of Nutrition at Harvard T.H. Chan School of Public Health, told U.S. Medicine. “We wanted to address a practical clinical question: In contemporary care, do healthy habits still matter for cardiovascular risk among patients using GLP-1 RAs, and if so, do lifestyle and GLP-1 therapy provide complementary benefits? The study was designed to inform everyday clinical practice and reinforce how to maximize cardiovascular prevention in patients with diabetes.”
This study included participants with Type 2 diabetes enrolled in the VA’s MVP between Jan. 10, 2011, and Sept. 30, 2023. These participants completed the MVP Lifestyle Survey and had no previous history of myocardial infarction, stroke or advanced chronic kidney disease. The eight low-risk lifestyle habits assessed were a higher quality diet, being physically active, not smoking, restful sleep, no heavy alcohol intake, good stress management, social connection and support and no opioid use disorder.
The researchers used statistical analyses to assess the risk of major adverse cardiovascular events, which is defined as non-fatal stroke or myocardial infarction, or cardiovascular death, according to GLP-1 receptor agonist use and low-risk lifestyle habits.
Of the 98,261 study participants, the investigators concluded that individuals living with Type 2 diabetes had a substantially lower risk of major adverse cardiovascular events when they used a GLP‑1 receptor agonist in combination with several healthy lifestyle habits, according to the press release. A total of 10,443 participants developed major adverse cardiovascular events.
The study found that individuals who adopted all eight lifestyle habits had a 60% lower risk of major cardiovascular events, while GLP‑1 users had a 16% lower risk, the researchers explained in the press release. Also, participants using GLP-1 receptor agonists and adhering to six to eight low-risk lifestyle factors had a 43% lower risk of major adverse cardiovascular events than did those with three or fewer low-risk lifestyle factors and no GLP-1 receptor agonist use.
“The major takeaway is that GLP-1 RAs and healthy habits work together: Patients with diabetes who combined GLP-1 therapy with healthier lifestyles had the lowest cardiovascular risk, and lifestyle benefits remained important even among GLP-1 users,” Hu said. “For integrated health systems like the VA, Military Health System and Indian Health Service, where long-term chronic disease management is central, these results support embedding lifestyle counseling and follow-up into GLP-1 prescribing workflows, rather than treating medication as a stand-alone solution. The longer the patients can adhere to the lifestyle habits, the better the health outcomes.”
Hu suggested that clinicians should treat GLP-1 therapy and lifestyle change as complementary parts of cardiometabolic care, not substitutes.
“In practice, I would 1) prescribe GLP-1 RAs when indicated, 2) set lifestyle goals as part of the same treatment plan, and 3) reinforce that healthier eating, physical activity, smoking avoidance, good sleep and stress management can meaningfully amplify cardiovascular risk reduction beyond medication alone,” Hu said.
For physicians, the key change in practice would be making lifestyle support routine and structured for patients receiving GLP-1 therapy, similar to how clinicians routinely manage statins plus blood pressure plus diabetes medications together, Hu pointed out.
“To support adherence, clinicians can: Use brief, prioritized goal-setting (start with 1–2 changes), provide concrete prescriptions (e.g., walking plan, DASH/Mediterranean pattern, sleep targets), leverage multidisciplinary teams (dietitians, pharmacists, health coaches), use follow-up touchpoints (portal messages, group visits, telehealth) and track progress in the EHR the same way we track A1c and BP,” Hu explained.
The study noted several limitations, including its observational design and a study population drawn largely from male veterans. However, results were similar across demographic groups, according to the press release.
- Nguyen XT, Li Y, Czernichow S, Rassy N, et al. VA Million Veteran Program. Combined associations of GLP-1 receptor agonists and a healthy lifestyle with cardiovascular outcomes among individuals with type 2 diabetes: a prospective cohort study. Lancet Diabetes Endocrinol. 2026 Feb 25:S2213-8587(25)00395-X. doi: 10.1016/S2213-8587(25)00395-X. Epub ahead of print. Erratum in: Lancet Diabetes Endocrinol. 2026 Feb 27:S2213-8587(26)00038-0. doi: 10.1016/S2213-8587(26)00038-0. PMID: 41763234.
