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New research highlights the importance of consistent medication adherence and the potential benefits of timing physical activity for optimal cardiovascular health. Two studies presented recently shed light on the impact of discontinuing diabetes medications and the benefits of morning exercise.
Stopping GLP-1 medications for diabetes can quickly diminish the heart-protective benefits they provide, a new analysis reveals. Researchers found that even a brief interruption in treatment—as little as six months—can increase the risk of serious cardiovascular events.
“Discontinuing GLP-1 medications can rapidly erode, and potentially reverse, the cardiovascular protection these medications offer,” said Dr. Ziyad Al-Aly, of the Veterans Affairs Saint Louis Health Care System in Missouri. “Months of discontinuation can negate years of progress.”
The study examined data from more than 333,000 adults with type 2 diabetes treated with GLP-1 medications or a class of older drugs called sulfonylureas, using three years of medical records from a U.S. Department of Veterans Affairs database.
GLP-1 medications used in the study include Ozempic and Victoza from NOVOb.CO Novo Nordisk, and Trulicity and Mounjaro from LLY.N Eli Lilly.
Patients who continued taking GLP-1 medications saw their cardiovascular risk decrease by 18% compared to those taking sulfonylureas. However, stopping treatment for just six months erased much of this protection, increasing risk by 4% compared to continuing treatment.
After two years off treatment, cardiovascular risk increased by 22% compared to continued use, according to a report published in BMJ Medicine.
“Resuming treatment did restore some cardioprotective effects, but only partially,” Dr. Al-Aly noted.
Many patients start and stop these medications due to side effects, shortages, and cost, he pointed out.
“When they stop, it’s not just the weight that comes back. They experience a resurgence of inflammation, blood pressure, and cholesterol,” Dr. Al-Aly said.
“Weight regain is visible, but the metabolic reversal is not. We view this as a form of metabolic ‘whiplash,’ which appears to be detrimental to heart health.”
In a separate study, researchers found that exercising in the morning may be linked to a lower risk of cardiometabolic disease. While any exercise is beneficial, morning physical activity may offer additional advantages.
Researchers followed 14,000 U.S. Volunteers who shared heart rate data derived from Fitbit devices. They found that those who regularly exercised in the morning were 31% less likely to develop coronary artery disease than those who exercised later in the day.
They were as well 18% less likely to develop hypertension, 21% less likely to develop high cholesterol, 30% less likely to develop type 2 diabetes, and 35% less likely to develop obesity, regardless of the total amount of daily physical activity.
The study indicated that exercising between 7 and 8 a.m. Was associated with the lowest risks of coronary artery disease.
Researchers plan to present their findings at the annual meeting of the American College of Cardiology this month in New Orleans.
The data, representing the first large-scale study to evaluate the timing of exercise based on long-term wearable device use, does not determine if the relationship between timing and cardiometabolic health is causal or influenced by other factors.
Biological factors such as hormones, sleep, or genetics, as well as behavioral and psychological factors, could also be involved, the researchers noted.
Further research could help determine the role of these factors and inform exercise recommendations, the authors said.
“In the past, researchers have focused primarily on how much physical activity someone gets, the number of minutes or the intensity of the activity,” said Prem Patel, a medical student at the Chan School of Medicine at the University of Massachusetts, in a statement.
“Now, with about one in three Americans owning a wearable device, we have the opportunity to look at exercise at a minute-by-minute level, which opens up a lot of doors in terms of new analyses.”
