3 Studies Endocrinologists and Cardiologists Should Read Before AHA 2025

Cardiovascular disease remains the leading cause of death among individuals with type 2 diabetes, and new analyses suggest that even small adjustments like taking low-dose aspirin, maintaining healthy lifestyle habits, or improving cardiovascular health scores can make a difference.

These 3 studies, to be presented at the American Heart Association (AHA) Scientific Sessions 2025, explored how these interventions can help reduce cardiovascular and cognitive risks in adults with diabetes, including the potential additive benefits of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) when combined with lifestyle modifications.

Can Low-Dose Aspirin Reduce Risk of Heart Attack, Stroke, or Death?

Adults with T2D and a moderate or high risk for cardiovascular disease who took low-dose aspirin were less likely to experience major cardiovascular events, including heart attack, stroke, or death, compared with those who did not take aspirin, according to findings to be presented by Aleesha Kainat, MD, clinical assistant professor of medicine at the University of Pittsburgh Medical Center (UPMC).¹

Kainat and her team analyzed 10 years of electronic health record data from more than 11,600 adults treated within the UPMC system. The mean age was about 62 years, with about 46% of the group being female. All patients had T2D and an elevated 10-year atherosclerotic cardiovascular disease (ASCVD) risk score; patients with high risk of bleeding were excluded from the study.

“That’s an important limitation because aspirin’s bleeding risk is crucial in real-life decision-making and a person's independent bleeding risk has to be accounted for whenever we are prescribing a medication,” Kainat noted.

Over the follow-up period, patients who reported taking low-dose aspirin were less likely to experience a heart attack (42.4% vs 61.2%), stroke (14.5% vs 24.8%), or death from any cause (33% vs 50.7%) compared with nonusers (P < .001). The reduction in cardiovascular events was greatest among participants who took aspirin consistently throughout the study period. The association held across blood sugar levels, with somewhat greater reductions among those with lower hemoglobin A_1c, indicating better diabetes control. Kainat said the authors were “somewhat surprised by the magnitude of the findings.”

“We’ll need to look at how we balance the cardiovascular benefits of low-dose aspirin with its known bleeding risks for individual high-risk individuals, such as those who have high inflammatory burden or subclinical coronary calcifications,” she said. “It is also an open area of inquiry to see how low-dose aspirin’s benefit might interact with the myriad of emerging therapies for type 2 diabetes and heart disease, such as GLP-1 medications and other lipid lowering agents besides statins, so we look forward to conducting more research on this important topic.”

Kainat noted that bleeding outcomes were not tracked in this analysis and that the study’s observational design means the findings cannot prove causality.

Can Lifestyle Habits Affect Outcomes With GLP-1s?

Combining healthy lifestyle habits with GLP-1 RA therapy can further reduce cardiovascular risk in adults with T2D beyond using GLP-1 RAs alone, according to an analysis of more than 63,000 military veterans in the Million Veteran Program.²

“Taking a GLP-1 RA alone is less effective than combining it with other beneficial lifestyle factors,” said Xuan-Mai Nguyen, MD, PhD, researcher at the Department of Veterans Affairs Boston Healthcare System and resident at the University of California, Los Angeles. “The more healthy lifestyle factors adopted, the better.”

The 8 measured lifestyle factors were:

• Healthy eating
• Physical activity
• Not smoking
• Restful sleep
• Little to no alcohol intake
• Good stress management
• Social connection and support
• No opioid addiction

Nguyen and her team found that individuals who used GLP-1 RAs and followed at least 6 of these healthy lifestyle habits had a 50% lower risk of major cardiovascular events compared with peers who followed 3 or fewer habits and did not use GLP-1s. Participants who adopted all 8 lifestyle factors had a 63% lower risk of cardiovascular events compared with those who followed 1 or fewer. GLP-1 RA use alone was associated with a 20% reduction in risk. According to the authors, each lifestyle factor was independently associated with lower cardiovascular risk.

The cohort primarily consisted of White male veterans, and the authors cautioned that the observational design limits causal interpretation.

Can Better Cardiovascular Health Protect Against Dementia in T2D?

Optimal cardiovascular health, measured by the AHA’s Life’s Essential 8 (LE8) metrics, may help lower the risk of mild cognitive impairment and dementia among adults with T2D, even for those with a high genetic predisposition to cognitive decline.³

LE8 includes 8 essential components for optimal heart and brain health, with 4 health behaviors and 4 health factors—the more adopted behaviors and factors, the higher the score:

• Eat better
• Be more active
• Quit tobacco
• Get healthy sleep
• Manage weight
• Control cholesterol
• Manage blood sugar
• Manage blood pressure

Researchers analyzed genetic and health data from nearly 40,000 adults with T2D enrolled in the UK Biobank and All of Us. Over a 13-year follow-up, participants with moderate or high cardiovascular health based on LE8 scores had a 15% lower risk of developing mild cognitive impairment and a 15% lower risk of developing dementia compared with those with low cardiovascular health. Among participants with a high genetic risk for dementia, those with moderate or high cardiovascular health had a 27% lower risk of mild cognitive impairment and a 23% lower risk of dementia.

Presenting author Yilin Yoshida, PhD, MPH, FAHA, assistant professor of medicine and head of a research lab on precision diabetes management at Tulane University School of Medicine, explained there are several ways having diabetes can increase someone’s risk of cognitive decline. For example, she said patients with T2D tend to have higher blood pressure and insulin resistance and are more likely to have obesity, and that controlling these factors can improve cardiovascular health for these patients.

“In the past, we focused on the message: live healthy, live long,” Yoshida said. “However, it’s not just living long, it’s living long and maintaining our cognitive function and capacity for longer independence and better quality of life. Our study’s findings support that you can do both.”

References

1. Low-dose aspirin linked to lower cardiovascular event risk for adults with type 2 diabetes. News release. American Heart Association. November 3, 2025. Accessed November 5, 2025. https://newsroom.heart.org/news/low-dose-aspirin-linked-to-lower-cardiovascular-event-risk-for-adults-with-type-2-diabetes
2. Healthy lifestyle combined with newer diabetes medications lowered cardiovascular risk. News release. American Heart Association. November 3, 2025. Accessed November 5, 2025. https://newsroom.heart.org/news/healthy-lifestyle-combined-with-newer-diabetes-medications-lowered-cardiovascular-risk
3. Optimal cardiovascular health among people with type 2 diabetes may offset dementia risk. News release. American Heart Association. November 3, 2025. Accessed November 5, 2025. https://newsroom.heart.org/news/optimal-cardiovascular-health-among-people-with-type-2-diabetes-may-offset-dementia-risk