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A large cohort investigation led by researchers at the Harvard T.H. Chan School of Public Health and the Department of Veterans Affairs Boston Healthcare System reveals that medications and daily habits act as powerful partners rather than alternatives.

Million Veteran Program Data Reveals Combined Benefits

The investigation examined health outcomes among more than 98,000 adults living with type 2 diabetes and no prior history of cardiovascular disease. Researchers utilized records from the Veterans Affairs’ Million Veteran Program spanning from 2011 to 2023 to track how medication usage and daily routines interacted over time.

Among the participant pool, more than 13,000 individuals used a GLP-1 receptor agonist. To measure lifestyle quality, investigators tracked eight distinct factors: eating a healthy diet, engaging in regular exercise, avoiding smoking, getting restful sleep, maintaining minimal alcohol intake, managing stress effectively, sustaining social connections, and avoiding opioid use disorder.

“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.”

Frank Hu, Fredrick J. Stare Professor of Nutrition and Epidemiology and chair of the Department of Nutrition, via Harvard

Quantifying the Reduction in Major Adverse Cardiovascular Events

The study measured major adverse cardiovascular events, defined as non-fatal stroke, myocardial infarction, or cardiovascular death. By controlling for demographic and health-related confounders, the research team isolated the specific protective effects of both interventions.

Patients who combined a GLP-1 receptor agonist with adherence to six to eight healthy habits experienced a 43% lower risk of major adverse cardiovascular events compared to patients who did not use a GLP-1 RA and adhered to three or fewer such habits. Each strategy also provided independent protection: participants utilizing a GLP-1 medication saw a 16% lower risk, while those maintaining all eight healthy habits achieved a 60% lower risk compared to peers managing one or fewer healthy behaviors.

Public Health Implications and Study Limitations

The findings emphasize that population-level investments in nutrition, physical activity, sleep, stress management, and social connection remain vital even as pharmaceutical treatments expand. However, the study authors noted certain methodological constraints. Because the investigation relied on observational data, residual confounding from socioeconomic status remained a possibility, though statistical controls were applied.

Additionally, the participant pool primarily consisted of white male veterans, which could limit direct generalization to other demographics. Despite this demographic skew, the observed protective associations remained consistent across both men and women as well as different racial and ethnic groups.