A study published February 25, 2026, in The Lancet Diabetes & Endocrinology has found that individuals with type 2 diabetes who use GLP-1 receptor agonists in combination with adopting healthy lifestyle habits experience a significantly lower risk of cardiovascular complications. The research, led by Harvard T.H. Chan School of Public Health and the Department of Veterans Affairs Boston Healthcare System, examined data from nearly 98,000 adults.
Researchers analyzed lifestyle factors, GLP-1 RA usage, and cardiovascular health outcomes using data from the Veterans Affairs’ Million Veteran Program, spanning from 2011 to 2023. Participants included adults diagnosed with type 2 diabetes who had not previously experienced a major cardiovascular event. The study defined major adverse cardiovascular events (MACE) as non-fatal stroke or myocardial infarction, or cardiovascular death.
The findings demonstrate that healthy habits and GLP-1 RAs are complementary strategies, rather than substitutes, in improving cardiovascular outcomes. According to Frank Hu, Fredrick J. Stare Professor of Nutrition and Epidemiology and chair of the Department of Nutrition at Harvard, “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.”
The study assessed eight low-risk lifestyle habits: a higher quality diet, regular physical activity, not smoking, sufficient restful sleep, limited alcohol intake, effective stress management, strong social connections and support, and avoidance of opioid use disorder. Participants adhering to all eight habits demonstrated a 40% lower risk of MACE compared to those adopting one or fewer habits. GLP-1 RA users exhibited an 84% lower risk of MACE compared to non-users.
Notably, the greatest benefit was observed in participants utilizing GLP-1 receptor agonists and maintaining six to eight low-risk lifestyle factors, experiencing a 43% reduction in MACE risk compared to those with three or fewer lifestyle factors and no GLP-1 RA use. The research team reported a total of 10,443 cases of MACE during the study’s follow-up period, encompassing 632,543 person-years.
The study is the first large-scale cohort investigation to examine the combined effects of lifestyle and GLP-1 RAs on heart health, according to researchers. The findings reinforce the importance of a holistic approach to diabetes management, integrating both pharmacological interventions and behavioral modifications for optimal cardiovascular protection.
