Cardioprotection with GLP-1RA in T2D greater when combined with healthy lifestyle

Treatment with a glucagon-like peptide-1 receptor agonist (GLP-1RA) in combination with adherence to healthy lifestyle habits yields a greater reduction in the risk of cardiac events in individuals with type 2 diabetes (T2D) compared with GLP-1RA treatment alone, according to a prospective study.

The study included 98,261 individuals with T2D who participated in the US Veterans Affairs' Million Veteran Program. These participants had no previous history of myocardial infarction, stroke, or advanced chronic kidney disease.

Researchers assessed eight low-risk lifestyle habits, namely diet quality, physical activity, smoking status, sleep, alcohol intake, stress management, social connection and support, and opioid use. The outcome of interest was major adverse cardiovascular events (MACE), defined as nonfatal stroke or myocardial infarction, or cardiovascular death.

Over 632,543 person-years of follow-up, MACE occurred in 10,443 participants. In multivariable Cox proportional hazard regression models, the risk of MACE was lower among participants adhering to all eight low-risk lifestyle habits than among those adopting one habit or none (hazard ratio [HR], 0.40, 95 percent confidence interval [CI], 0.30–0.54).

Similarly, GLP-1RA users had a lower risk of MACE compared with nonusers (HR, 0.84, 95 percent CI, 0.76–0.92). A greater risk reduction was observed among GLP-1RA users who adhered to at least six low-risk lifestyle factors than among non–GLP-1RA users with three or fewer low-risk lifestyle factors (HR, 0.57, 95 percent CI, 0.46–0.71).

The findings underscore the importance of integrating lifestyle modification with pharmacotherapy in the management of T2D.