A major Danish study has found that GLP-1 diabetes drugs could significantly reduce the risk of heart attacks, strokes, and premature death in people with type 2 diabetes.
The research compared three widely used diabetes medications: GLP-1 receptor agonists (GLP-1 RA), SGLT2 inhibitors (SGLT2i), and DPP-4 inhibitors (DPP-4i). Researchers analysed nationwide data from Denmark, including tens of thousands of patients. Their goal was to identify which treatments offered the strongest protection against cardiovascular events.
Results showed GLP-1 receptor agonists outperformed the other drug classes. Patients using GLP-1 RA had lower rates of heart attacks and strokes. Mortality rates were also significantly reduced.
In contrast, DPP-4 inhibitors showed the least cardiovascular benefit. SGLT2 inhibitors offered intermediate protection but were particularly effective in lowering hospitalisation for heart failure.
The study’s lead author, Dr Sidsel Hastrup of Aarhus University Hospital, said, “These findings emphasise the importance of choosing the right medication for people with type 2 diabetes. GLP-1 receptor agonists not only help control blood sugar but also offer strong cardiovascular protection.”
Type 2 diabetes affects millions across the globe, with heart disease being the leading cause of death among these patients. While controlling blood sugar is vital, clinicians increasingly focus on drugs that also reduce heart risk. This Danish study strengthens the case for GLP-1 therapies as first-line treatments for at-risk patients.
The research analysed real-world data from national health registers. This approach allowed scientists to study everyday patients, rather than only those in tightly controlled clinical trials. It showed that the benefits of GLP-1 RA extend beyond ideal conditions.
Transitioning from one drug class to another could influence patient outcomes. For instance, DPP-4 inhibitors remain widely prescribed due to their safety and tolerability. However, their lower impact on cardiovascular health might prompt doctors to recommend GLP-1 or SGLT2 inhibitors for patients at high risk of heart events.
GLP-1 receptor agonists work by enhancing insulin secretion and reducing glucagon levels, which stabilises blood sugar. They also slow gastric emptying, helping patients feel fuller for longer. SGLT2 inhibitors, on the other hand, promote sugar excretion via urine and support weight loss. These mechanisms explain the cardiovascular benefits observed in patients .
The study also noted differences in mortality. Patients on GLP-1 RA experienced fewer deaths from cardiovascular causes compared with those on DPP-4i. The findings suggest that beyond glucose control, GLP-1 receptor agonists directly protect the heart and blood vessels.
Experts say these findings could influence prescribing patterns across Europe. Recent European guidelines already encourage clinicians to prioritise GLP-1 receptor agonists in people with type 2 diabetes who face high cardiovascular risk, because these medicines reduce heart attacks, strokes, and cardiovascular death beyond glucose control alone.
Real-world evidence like this Danish analysis strengthens the case for wider clinical adoption and supports a continued shift toward heart-protective diabetes therapies in everyday practice .
Despite their benefits, GLP-1 drugs are more expensive than DPP-4 inhibitors. Cost and accessibility remain challenges, particularly for health systems like the NHS. However, the reduction in cardiovascular events may offset costs by lowering hospital admissions and long-term complications.
The Danish study also highlighted that SGLT2 inhibitors have specific benefits for patients with heart failure. This finding supports recent guidelines that advocate combining drug classes based on individual risk profiles.
Overall, the research reinforces a shift in diabetes management: clinicians now prioritise drugs that protect the heart, not just control blood sugar. With type 2 diabetes prevalence rising, such strategies could save thousands of lives.
Patients should consult their doctors before switching medications. While GLP-1 receptor agonists show impressive benefits, individual factors such as kidney function, weight, and tolerance influence the best choice of therapy.
This nationwide Danish study provides strong evidence that GLP-1 receptor agonists should be considered for patients at high cardiovascular risk. Its findings highlight the need for personalised diabetes care, combining glucose control with cardiovascular protection.
Sources:
- Hastrup, S., Hedegaard, J. N., Andersen, G., Osler, M., Rungby, J., & Johnsen, S. P. (2026). A nationwide Danish comparative effectiveness study of GLP-1 RA, SGLT2i and DPP-4i treatment on risk of stroke, myocardial infarction and mortality in type 2 diabetes. Endocrinol Diabetes Metab, 9(1), e70165. https://pubmed.ncbi.nlm.nih.gov/41578841/
- Zhou, J., et al. (2023). Cardiovascular outcomes of GLP-1 receptor agonists in type 2 diabetes: A meta-analysis. Diabetes Obes Metab, 25(2), 345–356.
- Marso, S. P., et al. (2016). Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med, 375, 311–322.
- McDonagh, T. A., et al. (2021). 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J, 42, 3599–3726.
