Embargoed for release: Wednesday, February 25, 2026, 6:30 PM ET
Key points:
In a study of heart health among adults living with type 2 diabetes (T2D), the use of GLP-1 receptor agonists (GLP-1 RAs) in combination with adherence to healthy lifestyle habits was linked with reduced risk of a major adverse cardiovascular event (MACE), including heart attack, stroke, or cardiovascular disease death. 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 healthy habits.
The study also found that GLP-1 RA usage and healthy habits independently benefited heart health, though at different magnitudes: Those with T2D who used a GLP-1 RA had a 16% lower risk of a MACE, while those who adhered to eight healthy lifestyle habits had a 60% lower risk.
According to the researchers, the findings indicate that lifestyle interventions remain central to diabetes management and heart health and can amplify the benefits of GLP-1 RAs, demonstrating to policymakers the importance of promoting healthy habits even in a modern drug era.
Boston, MA—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.
Article information
“Combined associations of GLP-1 medications and a healthy lifestyle with cardiovascular outcomes among individuals with diabetes,” Xuan-Mai T. Nguyen, Yanping Li, Sébastien Czernichow, Nathalie Rassy, Serena C. Houghton, Bing Lu, Yuk-Lam Ho, Brian R. Charest, Dong D. Wang, David R. Gagnon, John Michael Gaziano, Walter C. Willett, Peter W.F. Wilson, Kelly Cho, Frank B. Hu, The Lancet Diabetes & Endocrinology, February 25, 2026, doi: 10.1016/S2213-8587(25)00395-X
The study was based on data from the Million Veteran Program, Office of Research and Development, Veterans Heath Administration, and was supported by the Veterans Administration MVP awards #000 and #001. Support for VA/CMS data provided by the Department of Veterans Affairs, VA Health Services Research and Development Service, VA Information Resource Center (Project Numbers SDR 02-237 and 98-004).
Hu received a research grant from Analysis Group. Czernichow received consulting fees from Novo Nordisk, Boehringer, AstraZeneca, MSD, Roche, Amgen, Pfizer, and Fresenius; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Novo Nordisk, Janssen-Cilag, J&J, and Novartis; and support for attending meetings or travel from Novo Nordisk and Lilly. Additionally, Czernichow participated in an advisory board for Novo Nordisk and Lilly and has stock or stock options for Alifert and Jellynov.
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