A major new study has found that some of the most widely prescribed drugs for type 2 diabetes not only control blood sugar but also significantly lower the risk of serious heart problems in patients at moderate cardiovascular risk. The research, published in Diabetes Research and Clinical Practice, compared four popular GLP-1 receptor agonists (GLP-1RAs): dulaglutide, exenatide, liraglutide, and semaglutide.
These injectable or oral medicines are already recognised for helping people manage blood sugar and weight. Now, the findings suggest that semaglutide (sold as Wegovy/Ozempic/Rybelsus) and liraglutide (Victoza/Saxenda) stand out in cutting cardiovascular risk.
Researchers emulated a “target trial” using data from over 81,000 US adults with type 2 diabetes who started one of the four GLP-1 drugs between 2014 and 2021. All patients were deemed at moderate risk of cardiovascular disease, a group often under-studied in clinical trials, which tend to focus on patients with existing or high cardiovascular risk.
The study used advanced statistical methods, including propensity score matching, to simulate the fairness of a randomised controlled trial. Patients were followed for nearly two years on average.
Semaglutide reduced the risk of major adverse cardiovascular events (MACEheart attack, stroke, or death) by 15% compared with dulaglutide. It also lowered all-cause mortality by 19% and cut stroke risk by 18%.
Liraglutide showed a 16% reduction in MACE and a 21% lower risk of death. Dulaglutide and exenatide were less effective by comparison, though still beneficial relative to no treatment. Severe hypoglycaemia (dangerously low blood sugar requiring emergency care) was rare and similar across all drugs.
Type 2 diabetes affects 4.3 million people in the UK, with a further 2.4 million at high risk. Cardiovascular disease is the leading cause of death among these patients.
The new evidence comes as the NHS is already rolling out GLP-1 drugs, not only for diabetes but also for obesity management. NICE currently recommends semaglutide for some adults with obesity and type 2 diabetes, but cost and supply issues have limited access.
GLP-1 drugs were originally developed to help lower blood glucose, but their effects on weight loss and cardiovascular protection have driven much of their popularity. Clinical trials such as LEADER (liraglutide) and SUSTAIN-6 (semaglutide) previously demonstrated cardiovascular benefits in high-risk patients.
This new study broadens the evidence base, showing similar protective effects in those at moderate risk. A recent meta-analysis in The Lancet Diabetes & Endocrinology (2024) also concluded that GLP-1 therapies reduce both heart attacks and strokes across a range of patient populations.
However, the NHS faces challenges balancing cost, availability, and clinical benefit. Semaglutide, in particular, is in short supply worldwide due to soaring demand for weight loss. Health economists have argued that demonstrating cardiovascular benefits beyond diabetes could strengthen the case for wider NHS funding.
Many experts caution that medication should not be viewed as a silver bullet. Professor Naveed Sattar of the University of Glasgow, who co-authored several GLP-1 trials, has repeatedly stressed that lifestyle measures, including diet, exercise, and smoking cessation, remain crucial for long-term cardiovascular health.
Researchers say more work is needed to confirm the findings in the UK and European populations. They also call for trials directly comparing GLP-1 drugs head-to-head, something not yet done on a large scale.
In the meantime, patients and clinicians may take confidence that semaglutide and liraglutide offer not just blood sugar and weight benefits, but also a measurable reduction in life-threatening cardiovascular events. As demand for these drugs continues to rise, the latest evidence may influence not only prescribing decisions but also NHS policy on which treatments are prioritised for people living with type 2 diabetes.
