Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are now widely used to treat overweight, obesity and type 2 diabetes (T2DM), with growing evidence of benefits that extend beyond blood sugar control.

In asthma, where overweight, obesity and metabolic dysfunction can lead to increased severity of symptoms and adverse events such as acute exacerbations, the authors suggest that GLP-1 RAs may improve asthma outcomes through weight loss, modulation of airway inflammation, and improvements in metabolic functions. Reductions in occurrence of asthma exacerbations are likely to reduce systemic corticosteroid exposure (a common treatment for acute asthma exacerbations orally or intravenously) and thus may reduce the risk of corticosteroid exposure-associated adverse events such as osteoporosis or new-onset T2DM. As such, as the clinical use of GLP-1 RAs expands, reliable estimates of their impact on asthma control are needed for individuals living with both asthma and overweight, obesity or T2DM.

The researchers conducted a nationwide self-controlled cohort study using linked Danish health registers. Adult individuals with a prior asthma diagnosis or ≥2 asthma inhaler prescriptions redeemed within 12 months) were included on the date of their first GLP-1 RA dispensing (index date). Eligible individuals had continuous registration data for at least 12 months before and after the index date.

Individuals with COPD or patients with severe asthma treated with new and relatively expensive biologic drugs within 12 months before or after the index date were excluded. Overweight or obesity was defined using ICD-10 codes for those conditions. Those who had no evidence of T2DM – with no diagnosis recorded or no evidence of other first line diabetes drugs prescribed – were also placed in the with obesity/overweight group. Those with a T2DM diagnosis or prescriptions recorded for first line diabetes drugs such as metformin were placed in the T2DM group.

The primary outcome was exacerbations, defined as an inpatient asthma hospital contact(s) and/or systemic oral or intravenous corticosteroid course(s). Secondary outcomes were the use of rescue medication (inhaled short-acting β2-agonists), inhaled corticosteroid exposure, and chest infection events defined as redemption of antibiotics commonly used for lower airway infections

The cohort comprised 27,523 individuals (mean age 54 years, 66% female) with asthma and comorbid overweight or obesity (49%) or T2DM (61%) and 26% recorded as having both conditions. Around 50% of the GLP-1 prescriptions were liraglutide, 48% semaglutide, and 2% others (exenatide, dulaglutide, lixisenatide).

Compared with the year before GLP-1 RA treatment, GLP-1 RA treatment was associated with a 26% lower exacerbation rate overall; and 28% lower in men compared with 23% lower in women. When stratified according to GLP1 RA treatment indication, the analysis showed individuals with asthma and comorbid overweight or obesity and individuals with asthma and comorbid T2DM had similar effect estimates – a 22% reduction in those with overweight or obesity and a 26% reduction in those with T2D.

Reliever medication use fell by 14% overall, suggesting fewer symptoms despite daily inhaled corticosteroid exposure also decreasing by 23% (inhaled corticosteroids are used to prevent exacerbations and treat symptoms in asthma). Furthermore, pneumonia events were reduced by 10%. People also living with allergic rhinitis saw similar decreases (23%) in exacerbations to those living without allergic rhinitis (28%). The authors are also working on updated analyses to show differences between men and women for these specific outcomes.

The authors conclude: “In this nationwide cohort of over 27,000 individuals with asthma and also overweight, obesity or type 2 diabetes, use of GLP-1 drugs  was associated with significant reductions in exacerbation burden as well as reliever use, exposure to inhaled corticosteroids and pneumonia events, irrespective of whether the drugs were being used to treat obesity or type 2 diabetes.”

The authors explain that their study did not have access to clinical records (just if people had used GLP-1 and hospital admissions), so data on BMI and weight loss for participants were not available.

But Dr Håkansson says: “There’s a high chance that the weight loss is a major contributor to these results. A common symptom in both asthma and obesity is shortness of breath, and the presence of excess fatty tissue creates a pro-inflammatory state in the body in general. There’s also evidence from other studies suggesting that the inflammation caused by excess adipose tissue is distinct from the ‘classic’ asthma inflammation which often is driven by allergies or cells called eosinophils.”

And he adds: “As the use of GLP-1 therapies increase, researchers are finding an increasing number of effects outside of weight loss.”

The study examined the facilitators and challenges of so-called tobacco endgame policies in Europe. These policies refer to goals and measures aimed at reducing the use of tobacco products in the population to such a low level that it no longer places a significant burden on public health. Tobacco causes more than seven million premature deaths worldwide each year.

The EU’s Tobacco-Free Generation target was launched in the 2021 Cancer Plan and was recently reinforced in the Safe Hearts Plan. The aim is to reduce the use of tobacco products among the European population to below five per cent by 2040.

EU support is decisive for achieving the targets

According to the study, achieving the targets is particularly supported by broad political commitment, effective and long-term cooperation between different actors, and an active civil society that keeps the issue visible and brings public opinion to light.

In contrast, tobacco industry influence on decision-making, the visible marketing of new nicotine products, and the slowness of regulation make progress towards the targets more difficult.

The interviewees saw the EU’s role as central in reducing the use of tobacco and nicotine products. Common EU regulation and examples from other countries can accelerate national measures and encourage countries to set more ambitious targets for reducing the use of tobacco and nicotine products.

“The ongoing revision of EU tobacco legislation provides an important opportunity to strengthen Member States’ actions and accelerate progress towards the Tobacco-Free Generation target,” says Senior Specialist Hanna Ollila from the Finnish Institute for Health and Welfare.

Finland has been a forerunner

In some countries, the target has been extended to cover nicotine products as well. Finland has been a forerunner in this respect. In Finland, the objective of the Tobacco Act is to end the use of tobacco and nicotine products. In practice, the aim is to achieve a prevalence below five per cent by 2030.

“It is important for Finland to continue its active role and ensure that national regulation remains up to date, particularly with regard to new nicotine products. The rapid increase in the use of nicotine pouches among young people requires swift additional measures, such as raising the age limit,” Ollila states.

The study is based on interviews with 23 experts in eight European countries. The interviewees included officials, researchers and representatives of non-governmental organisations. It was carried out as part of the Joint Action on Tobacco Control 2 -project, within a work package led by THL.

“Glaucoma is a leading cause of blindness, and evidence has linked migraine with an increased risk of glaucoma, with both conditions affecting the capacity of the blood vessels in the brain to alter blood flow in response to stimuli,” said study author Chien-Hsiang Weng, MD, MPH, of Brown University in Providence, Rhode Island. “Since CGRP inhibitors help regulate blood vessel contraction and inflammation in the nervous system, there has been hope that these drugs could benefit eye health in people at risk of glaucoma.”

For this retrospective study investigators enrolled adults diagnosed with migraine who had, in 2018–2024, been treated with migraine preventive drugs known as calcitonin gene-related peptide (CGRP) inhibitors.

They matched 36,822 subjects who took (CGRP) inhibitors to an equal number of subjects who were treated with other types of migraine prevention drugs.

The drugs in the CGRP inhibitor group were erenumab, fremanezumab, galcanezumab, eptinezumab, atogepant and rimegepant. The drugs in the non-CRGP inhibitor group were valproate, topiramate, flunarizine, candesartan, lisinopril, metoprolol, propranolol, nadolol, amitriptyline and venlafaxine.

The subjects were followed for up to three years to see who developed glaucoma.

A total of 73,644 subjects were included in the final analysis.

During the study period, 153 subjects, (0.42%), in the CGRP inhibitor cohort developed glaucoma, compared to 223 subjects (0.61%) in the non-CGRP inhibitor cohort.

After adjusting the data for age, migraine frequency and history of high blood pressure, the investigators reported that subjects treated with CGRP inhibitors had achieved a 25% lower risk of developing glaucoma than those taking other migraine drugs.

Notably, the researchers also reported that the reduced risk of glaucoma only appeared in CGRP inhibitors using monoclonal antibodies– erenumab, fremanezumab, galcanezumab and eptinezumab. The reduced risk was not found with the CGRP receptor antagonists (or gepants), atogepant and rimegepant.

The authors concluded, “Among adults with migraine receiving preventive treatment, systemic use of CGRPi, particularly monoclonal antibody CGRPi, is associated with a reduced risk of glaucoma compared with the use of other migraine preventive medications.”

The findings appeared on April 30, 2026 in Cardiovascular Diabetology – Endocrinology Reports.

Dr Simon Cork, Senior Lecturer in Physiology at Anglia Ruskin University in Cambridge, UK and lead author, said: “This is the most comprehensive review to date of long term cardiovascular outcome trials for GLP 1 receptor agonists. We know that one of the factors that weighs on people’s minds when considering going onto these drugs is the potential long-term side effects. Our results show that, when taken over a prolonged period of at least one year, these medications do much more than help control blood sugar or weight. They significantly reduce the risk of heart attacks, strokes and premature death in people who are already vulnerable.

The investigators conducted a review and meta-analysis of randomized, placebo-controlled cardiovascular outcome trials evaluating GLP-1RAs in adults at high cardiovascular risk.

Each trial had enrolled ≥ 3,000 subjects with a minimum follow-up of 12 months.

The primary outcome of this meta-analysis was major adverse cardiovascular events (MACE). Secondary outcomes included cardiovascular mortality, all-cause mortality, non-fatal myocardial infarction, non-fatal stroke, hospitalization for heart failure, and adverse events.

Eleven trials enrolling a total of 91,490 subjects were included. The mean period of follow-up was 2.7 years.

The investigators reported that GLP-1RA treatment was associated with a significant 13% reduction in MACE compared with placebo. The analysis also showed significant reductions in cardiovascular mortality, all-cause mortality, non-fatal myocardial infarction, non-fatal stroke, and hospitalization for heart failure.

“We found the benefits to be consistent across different drugs, trial designs and patient groups. This has important implications for clinical practice and health policy, particularly given cardiovascular disease is the leading cause of death in the UK,” the authors concluded.

Researchers surveyed 700 adults across the United States who had used e-cigarettes in the past 30 days. Study participants made hypothetical monthly purchases across seven product categories: disposable e-cigarettes, pod devices, pod starter kits, pod refill packs, tank devices, e-liquids, and cigarettes.

The study found that higher pre-tax base prices and higher taxes both reduced e-cigarette use, measured by product units purchased and the amount of nicotine consumed.

To reflect real-world conditions, the experiment used three pre-tax price levels, low, medium, and high, representing roughly the 25^th, 50^th, and 75^th percentiles observed in the marketplace. Compared with lower prices, mid-range prices were linked to roughly 30 to 33% fewer product units purchased, while the highest prices were linked to roughly 49% to 51% fewer products purchased. Higher taxes also reduced purchases.

The analysis found that different e-cigarette types often act as substitutes: when the price of one product rises, adults may switch to another. At the same time, certain products function as complements, such as tank devices and e-liquids, or pod devices and refill packs, because they are used together. Notably, the study did not find statistically significant evidence that raising e-cigarette prices led to greater cigarette consumption among the general adult e-cigarette-using sample.

“Our findings suggest that increasing e-cigarette prices can effectively reduce vaping without the unintended consequence of more smoking among adult vapers,” said Shaoying Ma, PhD, first author of the study and research scientist at the Center for Tobacco Research at the OSUCCC – James. “However, because adult vapers navigate a complex marketplace of disposables, pods, and tanks, a one-size-fits-all tax may not be sufficient to reduce nicotine consumption. Policymakers may consider tiered tax designs to achieve specific public health goals.”

The researchers emphasize that price remains a powerful tool for curbing nicotine use, as states continue to refine their tobacco control strategies.

Coauthors in the study include Sooa Ahn, Hojin Park, Qian Yang, John FP Bridges, and Ce Shang.

Sacubitril/Valsartan Use across Transitions between Community, Hospital, and Skilled Nursing Facility Settings (presented by Andrew R. Zullo, PharmD, PhD)

Sacubitril/valsartan is an angiotensin receptor-neprilysin inhibitor (ARNI) that improves outcomes in heart failure. However, its use in hospital and ambulatory settings remain low and its use in post-hospitalization skilled nursing facility settings is not well characterized. Dr. Zullo and his colleagues conducted a retrospective parallel cohort study to describe ARNI use among older adults who transferred to skilled nursing facilities after being hospitalized for heart failure. The study assessed ARNI exposure of about 207,695 older adults who were discharged to skilled nursing facilities in the Long-Term Care Data Cooperative or the Veterans Health Administration from 1 year before hospitalization through 100 days after admission. Dr. Zullo and colleagues found that 5.4% of the Long-Term Care Data Cooperative patients and 8% of VA patients were exposed to ARNI. Among those exposed to ARNI before their admission, less than half of both the Long-Term Care Data Cooperative and VA patient populations received ARNI during their stay in a skilled nursing facility setting. Dr. Zullo and his colleagues concluded that ARNI use is infrequent among older adults discharged to skilled nursing facilities after hospitalization for heart failure, and discontinuation is common.

Effectiveness of Pharmacist-Led Telemedicine Deprescribing vs. Usual Care for Older Adults with Cognitive Impairment: A Pragmatic Randomized Clinical Trial (presented by Ariel R. Green, MD, PhD, MPH)

Dr. Green and colleagues conducted this study to evaluate the effectiveness of ALIGN, a pragmatic pharmacist-led deprescribing intervention for older adults with cognitive impairment in primary care. The intervention included: 1) a deprescribing brochure for patients/caregivers, 2) a telehealth visit with a clinic pharmacist; and 3) pharmacist-PCP communication with tailored recommendations. The study enrolled adults age 65 and older with mild cognitive impairment or dementia who were taking five or more medications. Participants were recruited from 21 community-based primary care clinics across Maryland between May 2024 and October 2025. Clinics were cluster-randomized to either implement the intervention or serve as a waitlist control. Dr. Green and colleagues found that ALIGN did not significantly reduce overall or potentially inappropriate medication prescribing in people with cognitive impairment. However, the between-group differences were clinically meaningful, indicating effectiveness when implemented as intended.

Measuring Hospitalization, Deaths, and Hospice Care from Skilled Nursing Facility Electronic Health Records vs. Medicare Claims (presented by Christopher M. Santostefano, MPH, RN)

In this study, Mr. Santostefano and colleagues aimed to validate measures of hospitalization, death, and hospice care between skilled nursing facility EHR data and Medicare claims. Using the Long-Term Care (LTC) Data Cooperative dataset, Medicare claims, and encounter records, Mr. Santostefano and colleagues were able to match available EHR documentation at the person-level to concurrent Medicare claims for a specific outcome (hospitalizations, date of death, and hospice care). Mr. Santostefano and his colleagues found that almost 93% of EHR-identified hospital stays matched to an inpatient, emergency department, or observation claims, with comparable match rates among Medicare and Medicare Advantage enrollees. Mr. Santostefano and his colleagues observed high levels of alignment between the LTC Data Cooperative skilled nursing facility EHR data and person-matched Medicare claims for hospitalizations and deaths. However, hospice care was more often missing from the EHR documentation than the other two outcome specific cohorts.

Catching influenza increases the short-term risk of cardiovascular conditions, and existing evidence has shown that the vaccine reduces the risk of heart attack and stroke by preventing flu infection in the first place. The new study, which included 1,221 adults aged 40 or older in Denmark, looked at whether cardiovascular risk was reduced even if people were infected with flu despite being vaccinated.

‘If confirmed by additional studies in other settings, this would strengthen the case for prioritising influenza vaccination among people at risk of heart disease or stroke and would support refining recommendations across Europe,’ says Dr Roberto Croci, Statens Serum Institut in Copenhagen.

The study used Danish health registry data from 2014 to 2025 and included individuals aged 40 and above with a first-ever hospital admission for a heart attack or stroke within a year after an influenza virus infection. It included all lab-confirmed flu virus infections that occurred during nine consecutive influenza seasons.

The study population comprised 660 males and 561 females aged 40 years and above, with a median age of 75. Most patients were hospitalised with a stroke (65%), while 35% had a heart attack.

The risk of a first-time hospitalisation for heart attack and stroke during the first week after testing positive for influenza was found to be significantly higher than for any other period before or after; it increased threefold for a stroke and fivefold for a heart attack. This increased risk was reduced by half for people who were infected but had been vaccinated against influenza for that influenza season.

The study did not account for differences in effectiveness between influenza vaccines, which can vary depending on how well the vaccine formulation matches the viral strains circulating in that season. It could also not assess whether vaccination timing or gender affected outcomes.

However, the results add to the growing importance of protecting against infectious diseases in people at risk of cardiovascular events. ‘Highlighting the dual protection offered by vaccination, against both infection and its cardiovascular complications, could have a substantial public health impact,’ the authors said.

Factoring the vaccine’s added protection against these conditions into economic and burden analysis could also help make a stronger economic case for influenza vaccination programmes.

Their study, published in JAMA Network Open, was the first to assess trends in young children’s nicotine exposures across all types of products.

Researchers at the New Jersey Poison Control Center, based at Rutgers New Jersey Medical School, used the National Poison Data System to analyze more than 92,000 reported nicotine exposures in children ages 5 and younger between 2016 and 2023 to understand how the rise of newer products – specifically disposable e-cigarettes and nicotine pouches – has changed the risks for young children.

They found that while tobacco exposures from conventional products such as cigarettes decreased by 43%, electronic cigarette-related incidents have increased 243% over the past eight years and often involved children who inhaled the vapors directly from the devices. They also found children exposed to e-cigarettes were more likely to require a visit to a health care facility compared with those exposed to cigarettes.

“This significant spike in children breathing in these substances tells us the risk has changed: It’s no longer just about a toddler swallowing something they found on the floor,” said Perry Rosen, lead author who conducted the research at the New Jersey Poison Control Center before becoming a medical student at New York Institute of Technology College of Osteopathic Medicine. “Many recent cases involve children actively using e-cigarette devices after gaining access to them.”

Young children naturally mimic the behaviors they see around them. “When children see caregivers or older family members vaping, they may copy that behavior—bringing the device to their mouth and inhaling—without any understanding they are exposing themselves to a harmful substance,” said Diane Calello, executive and medical director of the New Jersey Poison Control Center. Unlike cigarettes, these devices are often ready to use, brightly colored, require little effort to activate, and appear more like toys than a harmful product.

Even moderate ongoing exposure among users of vaping products—which can include adolescents—has been associated with lasting health effects on developing lungs, including increased  risk of bronchitis and worsening asthma, although such effects have not yet been reported in young children.

Despite federal laws passed in 2019 and 2020 to raise the minimum purchase age and restrict certain flavors, the upward trend in childhood poisonings has continued.

In New Jersey, liquid nicotine can only be sold in child‑resistant containers under the New Jersey Liquid Nicotine Child-Resistant Container Act (N.J.S.A. 2A:170‑51.9), which adopts federal safety standards requiring packaging that young children cannot easily open. This state law aligns with the federal Child Nicotine Poisoning Prevention Act of 2015, which mandates child‑resistant “special packaging” for all liquid nicotine products nationwide. However, while these may prevent a child from swallowing the liquid, children may still be lured by an enticing device and mimic the behavior they see – inhaling the nicotine.

She emphasized that existing protections focus largely on liquid nicotine ingestion, not behavioral exposure. “Child-resistant packaging may prevent a toddler from swallowing liquid nicotine, but it does nothing to stop a child from copying what they see an adult do,” Rosen said. That’s why we need safety standards that address the device itself, not just the container.”

“Current laws which focus on child-resistant packaging for nicotine liquids, are no longer enough,” Calello said. “This study underscores the need for safety regulations at the device level. For example, manufacturers should be required to include flow restrictors or designs that make it more difficult for a child to activate a device.”

The findings, published in Communications Medicine, are based on nearly two decades of electronic health records from more than 650,000 U.S. adults with IBS, making it the largest real-world study to examine the long-term safety of IBS treatments.

IBS is a chronic gastrointestinal condition affecting about 10% of the U.S. population. There is no cure, but dietary modifications, behavioral therapy and medications can help manage symptoms.

“Many patients are diagnosed with IBS at a young age and may remain on medications for years,” said Ali Rezaie, MD, medical director of the GI Motility Program at Cedars-Sinai and senior author of the study. “However, most clinical trials of these medications last less than a year, so we know very little about their long-term safety. This study begins to address that gap.”

Researchers assessed patients taking Food and Drug Administration-approved IBS medications, as well as antidepressants, antispasmodics and opioid-based antidiarrheal drugs, such as loperamide and diphenoxylate—widely used and recommended in IBS care. They found that long-term antidepressant use was associated with a 35% higher risk of death, and that loperamide and diphenoxylate use were associated with roughly double the risk of death.

The study does not establish that these medications directly cause death; rather, the observed associations may reflect higher rates of adverse outcomes, such as cardiovascular events, falls and stroke, which were more frequent among exposed patients.

Although antidepressants are not FDA-approved for IBS, they are commonly prescribed for IBS patients to help reduce pain, calm symptoms and make the condition easier to manage. The study found that other recommended treatments, including FDA-approved medications and antispasmodics, were not associated with increased mortality risk.

Researchers emphasized that while the increase in risk is significant and may sound concerning, the overall risk to any individual patient is small.

“IBS patients should not panic, but they do need to understand and weigh the small but meaningful risks when considering long-term treatments,” said Rezaie, the director of Bioinformatics at the Medically Associated Science and Technology (MAST) Program at Cedars-Sinai. “Patients should speak with their healthcare provider about the safest and most effective options for managing their symptoms.”

Rezaie said more research is needed to confirm these findings and identify which patients may be at greatest risk. He also called for future treatment guidelines to better address the long-term safety of medications commonly used to manage IBS.

In the meantime, he emphasized a more personalized approach to IBS patient care.

“Treatment for IBS patients should focus on identifying the underlying causes and using the safest, evidence-based options available rather than relying on a single class of medications for long-term management,” Rezaie said.

Additional Cedars-Sinai authors include Sepideh Mehravar, MD, Yee Hui Yeo, MD, and Mark Pimentel, MD.

Other authors include Parnian Naji, MD, Wee Han Ng, Nils Burger, PhD, and Will Takakura, MD.

Conflicts of Interest: Mark Pimentel is also a consultant for and received grant support from Bausch Health. Ali Rezaie reports serving as a consultant for Bausch Health and Ardelyx. In addition, Cedars-Sinai Medical Center has a licensing agreement with Gemelli Biotech. Ali Rezaie and Mark Pimentel have equity in Gemelli Biotech and Good LFE. The remaining authors disclose no conflicts.

This ‘overview’ of systematic reviews summarises existing evidence from several systematic reviews and makes the findings more accessible.  The overview pooled the evidence from fourteen systematic reviews of smoking cessation interventions from 2014 to 2023.

Findings from higher-quality reviews consistently showed greater smoking cessation with nicotine-containing e‑cigarettes than other interventions. Lower-quality reviews produced more variable and imprecise estimates. When restricted to higher-quality evidence, results consistently favoured nicotine e‑cigarettes over nicotine replacement therapy, non-nicotine e-cigarettes, and other comparators.

The overview also created an ‘Evidence and Gap Map’ (EGM) to identify gaps in the current evidence that urgently need to be filled.  There are currently no high-quality systematic reviews directly comparing nicotine e-cigarettes with cytisine, bupropion, or nicotine pouches.  Also, direct evidence comparing nicotine e-cigarettes with varenicline is extremely limited, with only a single small trial at high risk of bias.

The EGM also showed that current evidence of serious adverse events associated with e-cigarettes is inconclusive, and that most of the studies collected data from high-income countries.  Future primary research on e-cigarettes for smoking cessation should continue to collect data on serious adverse events and expand its data collection to include low-and middle-income countries.

Lead author DrAngela Difeng Wu, Senior Researcher and Lecturer at the Nuffield Department of Primary Care Health Sciences, University of Oxford, says “We hope this overview and Evidence and Gap Map can lay to rest some claims that evidence is ‘mixed’ regarding the impacts of nicotine e-cigarettes on smoking abstinence.  In fact, the evidence is clear and consistent across all of the meta-analyses we consulted:  e-cigarettes are effective at helping people stop smoking.”

To speak with lead author Dr Angela Difeng Wu, please contact her at the Nuffield Department of Primary Care Health Sciences, University of Oxford by email (angela.wu@phc.ox.ac.uk).

Full citation for article: Wu AD, Conde M, Butler AR, Knight E, Lindson N, Livingstone-Banks J, Hajek P, McRobbie H, Begh R, Theodoulou A, Notley C, Turner T, Zhitnik E, and Hartmann-Boyce J. Electronic Cigarettes for Smoking Cessation: An Overview of Systematic Reviews and Evidence and Gap Map.  Addiction. 2026. DOI: 10.1111/add.70388.

The results suggest that the five-year risk of major cardiovascular events such as heart attacks and the risk of end-stage kidney disease were reduced by 15% and 19%, respectively, for the patients taking GLP-1-RA drugs such as semaglutide (Ozempic) and tirzepatide (Mounjaro). For the study, the researchers analyzed electronic health records data on about 175,000 type 1 diabetes patients in the U.S.

About 2 million Americans, including 314,000 children and adolescents, have been diagnosed with type 1 diabetes, according to the Centers for Disease Control and Prevention. The autoimmune disorder destroys the pancreas’s insulin-producing cells and requires lifelong insulin injections to control blood sugar levels.

The risks of side effects of particular concern for type 1 diabetes patients taking GLP-1-RAs—severe hypoglycemia and diabetic ketoacidosis; a severe lack of insulin, causing acid accumulation in the blood—were not increased among the patients taking these drugs.

The findings were published online March 19 in Nature Medicine.

“These risk reductions for heart and kidney disease outcomes are comparable to what we’ve seen for type 2 diabetes patients taking GLP-1-RA drugs, and it’s reassuring that we saw no sign of any new safety issues,” says study senior author Jung-Im Shin, MD, PhD, an associate professor in the Bloomberg School’s Department of Epidemiology.

Patients with type 1 diabetes face high lifetime risks of cardiovascular and kidney disease. Chronic excess blood sugar promotes atherosclerosis that leads to heart attacks and strokes, and elevated blood-sugar levels can damage the kidney’s urine-filtering structures. There have been few GLP-1-RA clinical trials that measure these outcomes in patients with type 1 diabetes.

Landmark clinical trials have found that GLP-1-RA drugs lower the risks of major cardiovascular events and kidney failure in type 2 diabetes patients by roughly 20%. An estimated 29 million Americans have been diagnosed with type 2 diabetes, according to the CDC.

“The type 1 diabetes population, compared to the type 2 diabetes population, is relatively small and relatively young, so it is inherently difficult to conduct a large-scale clinical trial that can show clear differences in cardiovascular and kidney event rates in this population within a reasonable time,” Shin says.

Two small trials in type 1 diabetes patients a decade ago suggested that the combination of insulin treatment and a GLP-1-RA could cause potentially severe low blood sugar levels (hypoglycemia), and reducing insulin to minimize this risk could cause a different serious complication called diabetic ketoacidosis.

For the new study, the researchers used de-identified electronic health records from a large commercial database covering patients from more than 60 health systems across the U.S. The analysis included 174,678 type 1 diabetes patients and covered January 2013 through March 2024. The team used a “sequential target trial emulation” design—mimicking a clinical trial-type protocol—and accounted for baseline differences between those who began taking GLP-1-RAs and those who didn’t.

The average five-year risk of major cardiovascular events was 4.3% in the GLP-1-RA group vs. 5.0% in the non-GLP-1-RA group, a relative risk reduction of about 15%. The data also suggested a risk reduction of about 21% for heart attacks and 16% for all-cause mortality. The five-year risk of end-stage kidney disease was 1.6% for the GLP-1-RA group vs. 1.9% for the non-GLP-1-RA group, for an estimated relative risk reduction of 19% among those taking GLP-1-RA.

The analysis also found that the GLP-1-RA group had estimated risk reductions of 18% for heart failure, and 28% for major adverse liver events. Patients who initiated GLP-1-RAs also were about 22% more likely to achieve weight loss of at least 10% over five years.

Safety-related outcomes were similarly encouraging. Estimated risks of hospitalization for hypoglycemia and for diabetic ketoacidosis were significantly lower—18% and 17% respectively—in the GLP-1-RA group.

“These findings suggest that physicians are being relatively careful when selecting the type 1 diabetes patients who will receive these drugs, and that the patients are adjusting their insulin doses appropriately,” Shin says. “While our study fills a critical knowledge gap and informs clinical practice for type 1 diabetes patients, ultimately large clinical trials are needed to confirm these findings.”

This study has limitations, including unmeasured confounding due to the nature of observational study design despite the rigorous adjustment methods, and potential misclassification of type 1 diabetes. In addition, only hospitalized cases of hypoglycemia and diabetic ketoacidosis were captured in this study.

“Glucagon-Like Peptide-1 Receptor Agonists for Major Cardiovascular and Kidney Outcomes in Type 1 Diabetes” was co-authored by Yunwen Xu, Natalie Daya Malek, Alexander R. Chang, Justin B. Echouffo-Tcheugui, Elizabeth Selvin, Morgan E. Grams, Michael Fang, and Jung-Im Shin.

Support for the study was provided by the National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK139324, R01 DK115534, K01 DK138273).

High blood pressure (hypertension) damages the heart and is an indicator of heart disease risk. Taking proactive steps to control blood pressure can help prevent life-threatening cardiac events, yet the risks of uncontrolled hypertension may be overlooked among young women and their clinicians. Previous research has examined hypertensive heart disease risks primarily in men and post-menopausal women; this study is among the first to focus on younger women.

“Rising mortality for young women with hypertensive heart disease reflects an underestimation of cardiovascular risk, delayed diagnosis and missed opportunities for early intervention,” said Alexandra Millhuff, DO, a resident physician at the University of New Mexico and the study’s lead author. “This study underscores the urgent need for specific prevention strategies.”

Lifestyle modifications such as quitting smoking, eating a heart-healthy diet and exercising more are the first steps in managing high blood pressure, with the option to add blood pressure lowering medications if needed. If left unmanaged, having high blood pressure for an extended period can weaken the heart muscle and lead to heart failure, coronary artery disease, heart attacks and strokes. The new ACC/AHA Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults emphasizes the importance of earlier treatment to keep blood pressure below 130/80 mm Hg.

Researchers analyzed death certificate data from U.S. women who died between the ages of 25 years and 44 years to assess rates of death attributed to hypertensive heart disease during the study period. In 1999, the results showed that hypertensive heart disease accounted for 1.1 of every 100,000 deaths that occurred in young women. By 2023, that rate had risen over fourfold, accounting for 4.8 out of every 100,000 deaths within this population. Over 29,000 women died from hypertensive heart disease-related death during the study period.

The study also revealed striking differences based on factors like race and geography. Non-Hispanic Black women had the highest hypertension-related mortality rate over the study period at 8.6 per 100,000, compared to 2.3 per 100,000 in non-Hispanic White Americans. Across U.S. regions, women in the South had the highest hypertension-related mortality rate at 3.8 per 100,000, compared to 2.8 in the Midwest, 2.2 in the Northeast and 1.9 in the West. No differences were found among women living in urban versus rural areas.

Many studies have shown that women are prescribed blood pressure lowering medications at lower rates than men, and researchers said that heart disease treatment and awareness efforts have often focused on men or postmenopausal women, with less attention to assessing cardiovascular risk in younger women.

“We need to be screening patients of this demographic for hypertension more aggressively, and that includes mitigating risk factors and possibly using antihypertensive medications,” Millhuff said. “Even though hypertension is more prevalent in older populations, it’s something that we need to be vigilant about in younger populations, as well.”

The researchers said that women face specific cardiovascular risks related to hormonal and other physiological changes that occur during pregnancy and perimenopause. They emphasized the importance of controlling blood pressure and addressing other risk factors to ensure women are in optimal health before going through menopause or considering becoming pregnant.

Since most young women do not regularly see a cardiologist, the researchers emphasized the role of primary care and women’s health providers in screening for and managing hypertension in this patient population. They said that women can play an active role by asking their doctors about their cardiovascular risk and opportunities to better manage their health.

For more information about high blood pressure, visit www.CardioSmart.org/BloodPressure.

Millhuff will present the study, “Rising Hypertensive Heart Disease Mortality in Young Women: 25-Year Trends and Disparities,” on Sunday, March 29, at 9:30 a.m. CT / 14:30 UTC in Posters, Hall E.

ACC.26 will take place March 28-30, 2026, in New Orleans, bringing together cardiologists and cardiovascular specialists from around the world to share the newest discoveries in treatment and prevention. Follow @ACCinTouch, @ACCMediaCenter and #ACC26 for the latest news from the meeting.