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In people with type 2 diabetes (T2D) and no established cardiovascular disease (CVD), starting glucagon-like peptide-1 receptor agonist (GLP-1) treatment and then stopping is associated with twice the combined risk of heart attack, stroke or death compared with staying on treatment, according to a study published in The Lancet Regional Health—Europe.

However, as the study was observational, it cannot determine whether discontinuing GLP-1s directly causes the increased risk or whether people who stop were already in poorer health. The researchers did not know why people stopped, which could include side effects, cost or illness such as frailty or cancer.

GLP-1s reduce cardiovascular events, such as heart attacks and strokes, and death in people with T2D and in some people with obesity, but up to 50% of people stop treatment within the first year. While stopping GLP-1s is linked to weight gain and worsening of several cardiometabolic risk factors, such as blood sugar levels and blood pressure, it remains unclear if stopping treatment increases the risk of cardiovascular events and death compared with continued treatment.

Researchers analyzed electronic medical records from more than 300 diabetes clinics in the Italian Association of Clinical Diabetologists (AMD) database, collected between 2004 and 2024, identifying over 80,000 people with T2D and no established CVD who had started a GLP-1. People who continued treatment took a GLP-1 for nearly three years on average, compared with just over one year for those who stopped.

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