Individuals with type 2 diabetes (T2D) who used a GLP-1 receptor agonist (GLP-1 RA) in combination with healthy lifestyle habits had a significantly lower risk of poor heart health, according to a new study led by researchers at the Harvard TH Chan School of Public Health and the Department of Veterans Affairs Boston Healthcare System. This study is the first large cohort investigation to examine the combined effects of healthy habits and GLP-1 RA on cardiovascular health, demonstrating that the two strategies are complementary rather than substitutes in improving cardiovascular outcomes among patients with diabetes.
“Our findings emphasize 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 outweigh the benefits of modern drugs,” said Frederick J. Lewis, MD, professor of nutrition and epidemiology and chair of the Department of Nutrition. Steyer said.
The study will be published on February 25, 2026 Lancet Diabetes and Endocrinology.
Researchers examined the lifestyle habits, GLP-1 RA use, and cardiovascular health outcomes of more than 98,000 adults living with T2D and without prior heart disease, using data from the Department of Veterans Affairs’ Million Veteran Program from 2011 to 2023. Healthy lifestyle habits the researchers considered included a healthy diet, regular exercise, not smoking, restful sleep, minimal alcohol consumption, good stress management, social connections 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 study participants used GLP-1 RA. When analyzing the relationship between lifestyle, GLP-1 RA, and heart health, the researchers controlled for potential demographic and health-related confounders.
The study found that maintaining a healthy lifestyle and using GLP-1 RA significantly reduced MACE risk. People who used a GLP-1 RA and followed six to eight healthy habits had a 43% lower risk than those who did not use a GLP-1 RA and followed three or fewer such habits. The study also found that healthy habits and GLP-1 RA use independently benefited heart health. People who followed all eight healthy habits had a 60% lower risk than those who followed one or fewer, and those who used a GLP-1 RA had a 16% lower MACE risk than those who did not follow it.
“From a public health perspective, the results underscore the continued importance of population-level investment and policy in promoting healthy diet, physical activity, sleep, stress management, and social connection, even in the modern medicine era,” Hu said. “As innovative treatments expand, scalable lifestyle interventions remain essential to reducing the overall burden of heart disease and other chronic diseases.”
The researchers noted that the study had some limitations. The results were based on observational data, meaning that residual confounding by socioeconomic status and other factors was possible, although these variables were accounted for in the analysis. Additionally, the study population consisted primarily of white male veterans, which may limit the generalizability of the results, although the overall findings were consistent across different racial and ethnic groups and between men and women.
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