Healthy lifestyle habits lower CV risk in type 2 diabetes, regardless of GLP-1 use

Key takeaways:

Adults who reported two or more healthy lifestyle habits had reduced risk for CV events than those reporting zero or one habits.
Healthy lifestyle habits were tied to lower CV risk, regardless of GLP-1 use.

Adults with type 2 diabetes who adhered to eight healthy lifestyle habits had a 60% lower risk for cardiovascular events than those who reported zero or one healthy lifestyle habits, researchers reported.

In a prospective cohort study of adults with type 2 diabetes enrolled in the U.S. Veterans Affairs Million Veteran Program, researchers assessed the risk for major adverse CV events according to the number of self-reported healthy lifestyle habits for each participant. The risk for CV events declined with each additional lifestyle habit a person reported, and the findings were similar regardless of whether adults were using a GLP-1 receptor agonist.

“Even in the era of highly effective GLP-1-based pharmacotherapy, lifestyle remains fundamental to diabetes management and can substantially amplify CV benefits,” Frank Hu, MD, PhD, professor and chair of the department of nutrition at Harvard T.H. Chan School of Public Health, told Healio.

Researchers obtained data from 98,261 adults with type 2 diabetes who enrolled in the Million Veteran Program from January 2011 through September 2023. There were eight healthy lifestyle habits assessed in the study:

being in the upper 40th percentile in Plant Diet Index score;
partaking in 7.5 or more metabolic equivalent physical activity hours per week;
not smoking;
not frequently drinking heavy amounts of alcohol;
sleeping 7 to 9 hours per day;
no opioid use disorder;
having good stress management; and
having a social interaction score of 50 or higher.

GLP-1 use was obtained through pharmacy records. Major adverse CV events included nonfatal stroke, nonfatal myocardial infarction and CV death.

During 632,543 person-years of follow-up, a major adverse CV event occurred among 10,443 adults with type 2 diabetes. In an adjusted model, adults who reported two or more healthy lifestyle habits had lower risk for a CV event than those who reported zero or one healthy lifestyle habits. The risk for CV events decreased further among those who reported more healthy lifestyle habits, with adults who said they engaged in all eight healthy lifestyle habits having the lowest CV risk (HR = 0.4; 95% CI, 0.3-0.54; P < .0001). Individually, all eight lifestyle habits were associated with reduced risk for a major adverse CV event.

Of the study group, 13,394 adults used a GLP-1 receptor agonist. Of GLP-1 users, 21.4% said they used the drug before enrolling in the Million Veteran Program and 78.6% used a GLP-1 after enrollment. Major adverse CV events occurred among 590 adults who used a GLP-1. Adults receiving a GLP-1 had reduced risk for a major adverse CV event compared with nonusers (HR = 0.84; 95% CI, 0.76-0.92).

Compared with adults not using a GLP-1 who reported three or fewer healthy lifestyle habits, adults who engaged in six to eight healthy lifestyle habits had lower risk for major adverse CV events, both if they used a GLP-1 (HR = 0.57; 95% CI, 0.46-0.71) and if they did not use a GLP-1 (HR = 0.67; 95% CI, 0.63-0.71).

“GLP-1 therapy should be combined with, not substituted for, comprehensive lifestyle management,” Hu said of the study findings. “Continued counseling and structured support for diet, physical activity, weight control and smoking cessation remain essential, as healthy habits appear to amplify the CV benefits of GLP-1 treatment. Integrating pharmacotherapy with multidisciplinary lifestyle programs may therefore achieve greater reductions in CV risk than either strategy alone.”

Hu said the study’s findings need to be confirmed in trials to examine whether combining structured lifestyle intervention with GLP-1 therapy could lead to even greater CV benefits in the type 2 diabetes population in real-world settings.

For more information:

Frank Hu, MD, PhD, can be reached at fhu@hsph.harvard.edu or on LinkedIn @FrankHu.