Lifestyle Habits Can Amplify GLP-1 Heart Protection in T2D

TOPLINE:

Among US veterans with type 2 diabetes (T2D), adherence to 6 to 8 healthy lifestyle factors combined with GLP‑1 receptor agonist (RA) use was associated with a notably lower risk for major adverse cardiovascular events (MACE) than adherence to three or fewer lifestyle factors without GLP‑1 therapy.

METHODOLOGY:

• GLP-1 RAs help manage cardiovascular risk in patients with T2D; however, lifestyle change remains the foundation of diabetes care. The long-term combined effect of these drugs together with a healthy lifestyle on MACE is not fully understood.
• Researchers conducted a prospective cohort study of 98,261 US veterans with T2D between January 2011 and September 2023, with a follow-up duration of 632,543 person-years, to examine the combined impact of GLP-1 RA use and adherence to eight lifestyle habits on cardiovascular outcomes.
• The 8 low-risk lifestyle habits assessed were healthy eating, regular physical activity (≥ 7.5 metabolic equivalent hours/week), nonsmoking, restful sleep (7-9 hours/day), no or moderate alcohol intake (absence of frequent heavy drinking), good stress management, strong social connection and support, and no opioid use disorder.
• GLP‑1 RA use was ascertained from Veterans Health Administration pharmacy records. The primary outcome was MACE, defined as nonfatal stroke, nonfatal myocardial infarction, or cardiovascular death.

TAKEAWAY:

• Participants adhering to all 8 low-risk lifestyle habits had a 60% lower risk for MACE than those adhering to ≤ 1 (multivariable-adjusted hazard ratio [HR], 0.40; P < .0001).
• All 8 low-risk lifestyle factors were independently associated with a lower risk for MACE, with no opioid use disorder showing the strongest association (HR, 0.77; 95% CI, 0.66-0.89).
• Participants using GLP-1 RAs had a 16% lower risk for MACE than those not receiving GLP-1 therapy and receiving usual care (multivariable-adjusted HR, 0.84; 95% CI, 0.76-0.92).
• Participants using GLP-1 RAs who also adhered to 6 to 8 low-risk lifestyle factors had a 43% lower risk for MACE than those not receiving GLP-1 therapy who adhered to three or fewer lifestyle factors (HR, 0.57; 95% CI, 0.46-0.71).

IN PRACTICE:

"In a healthcare landscape, in which GLP-1 [RAs] remain costly and access is uneven, the additive benefit of lifestyle adherence highlighted by this study has important implications for health equity, resource allocation, and the long-term sustainability of diabetes care," experts noted in an accompanying editorial.

SOURCE:

The study was led by Xuan-Mai T. Nguyen, MD, Department of Medicine, UCLA David Geffen School of Medicine in Los Angeles. It was published online in The Lancet Diabetes & Endocrinology.

LIMITATIONS:

The analyses were based on Veterans Health Administration electronic health record data, and healthcare use outside this system was only incompletely captured. The estimation was based on observational data in which lifestyle factors were assessed at baseline. The cohort consisted of predominantly male veterans, which might limit generalizability to other populations.

DISCLOSURES:

The study used data from the Million Veteran Program (MVP) and was supported by Veterans Affairs MVP awards, along with additional support from other sources. One author reported receiving consulting fees, speaker honoraria, meeting/travel support; participation on advisory boards; and ownership of stock or stock options from certain companies in the healthcare and life sciences sectors. Another author reported receiving a research grant from a consulting/analysis firm.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article first appeared on Medscape.com.