Staying on Diabetes Medication May Lower Heart Attack and Stroke Risk

Staying consistent with prescribed diabetes medication may significantly reduce the risk of serious cardiovascular problems, including heart attacks and strokes. Recent research suggests that people with type 2 diabetes who maintain high medication adherence experience fewer major cardiovascular events than those with poor adherence. The findings reinforce the importance of long-term treatment, regular medical follow-up, and managing blood sugar effectively, while also highlighting the broader role of diabetes care in protecting heart and brain health.

For people living with type 2 diabetes, taking prescribed medication consistently may do far more than keep blood sugar under control. New research suggests that long-term adherence to glucose-lowering treatment is closely associated with a lower risk of serious cardiovascular problems, including heart attacks and strokes.

The findings come from a large nationwide study led by researchers at the University of Copenhagen, which followed 79,510 adults in Denmark who were newly diagnosed with type 2 diabetes and had started non-insulin glucose-lowering medication. Researchers examined pharmacy records over as long as 10 years, allowing them to identify how consistently patients continued to obtain their prescribed medicines.

The study, published in The Lancet Regional Health – Europe in 2026, divided participants into three long-term adherence patterns. About 41% maintained high adherence, 33% showed intermediate adherence, and 26% experienced an early decline and remained in the low-adherence group.

Lower adherence was linked to higher cardiovascular risk

The differences in cardiovascular outcomes were substantial. Compared with people who maintained high adherence, those in the low-adherence group had a 27% higher adjusted rate of major cardiovascular events. People with intermediate adherence had a 7% higher rate. Over the follow-up period, researchers recorded 15,276 cardiovascular events across the study population.

The cardiovascular events were not all the same: roughly 49% were cases of ischemic heart disease, 30% were strokes and 21% involved heart failure. Notably, researchers did not find a significant association between adherence patterns and heart failure, suggesting that much of the overall relationship was driven by ischemic heart disease and stroke.

The association was particularly strong for ischemic heart disease, a condition in which narrowed or blocked arteries reduce blood flow to the heart. People with low medication adherence had a 45% higher rate of ischemic heart disease than those with high adherence. Their stroke rate was also 24% higher.

Another striking finding involved the amount of time people remained free from a cardiovascular event. Participants with high adherence stayed free of major cardiovascular events for an average of 220 additional days, a little more than seven months, over 10 years compared with people in the low-adherence group.

Younger adults may face an even greater risk

Younger adults appeared especially vulnerable. According to the University of Copenhagen's report, low adherence among younger patients was associated with a 73% higher rate of experiencing a cardiovascular event before age 55 compared with consistent medication use.

That finding is significant because people who develop type 2 diabetes earlier in life may experience decades of exposure to elevated blood glucose and other cardiovascular risk factors.

Why diabetes and cardiovascular disease are connected

The relationship between diabetes and heart disease is already well established. The American Diabetes Association (ADA) says atherosclerotic cardiovascular disease, including heart attack and stroke, remains a leading cause of illness and death among people with diabetes. High blood pressure, abnormal cholesterol levels and obesity also commonly occur alongside diabetes, making comprehensive cardiovascular risk management particularly important.

Persistently elevated blood glucose can gradually damage blood vessels and contribute to cardiovascular complications. Glucose-lowering medicines help manage blood sugar, while some newer treatments can provide cardiovascular and kidney protection extending beyond glucose control alone.

The ADA's 2026 Standards of Care recommend that adults with type 2 diabetes who have established cardiovascular disease or are at high cardiovascular risk receive medications with demonstrated cardiovascular benefits when clinically appropriate. These include certain SGLT2 inhibitors and GLP-1 receptor agonists. Treatment should nevertheless be individualized according to cardiovascular and kidney health, weight, side effects, cost, treatment accessibility and individual preferences.

Association does not necessarily mean causation

Importantly, the Danish study does not prove that missing diabetes medication directly causes a heart attack or stroke.

It was an observational study, meaning researchers could identify relationships between medication adherence and health outcomes but could not establish direct cause and effect.

There were other limitations. Pharmacy records indicated whether prescriptions were redeemed, but could not confirm whether every dose was actually taken. Researchers also lacked complete information on potential factors including blood glucose control, body mass index and lifestyle behaviour.

People with lower adherence were also more likely to live alone, have lower incomes and have additional chronic health conditions, factors that could independently affect cardiovascular health. Researchers adjusted for socioeconomic indicators and conducted sensitivity analyses, but some residual differences between the groups may remain.

Even after those adjustments, however, lower medication adherence remained associated with greater cardiovascular risk.

Diabetes is a growing global health challenge

The findings matter against the backdrop of a rapidly expanding global diabetes burden.

According to the World Health Organization, the number of people living with diabetes increased from around 200 million in 1990 to 830 million in 2022. More than half of people with diabetes did not take medication for the condition in 2022, with treatment coverage particularly low in low- and middle-income countries. WHO identifies heart attacks, strokes, kidney failure, blindness and lower-limb amputation among the major consequences of diabetes.

Medication adherence itself is complex. Cost, side effects, complicated treatment schedules, access to healthcare, forgetfulness and social or financial pressures can all interfere with long-term treatment. This means prescribing an effective drug is only one part of successful diabetes management.

Regular medical follow-up, clear communication, medication reviews, simpler treatment plans where appropriate and support for financial or social barriers may help people remain on prescribed therapies.

People experiencing side effects or difficulties following their treatment plan should speak with a healthcare professional rather than stopping or changing medication on their own.

Diabetes management is also heart protection

The larger message from the research is that managing type 2 diabetes is not simply about today's blood sugar reading. It is about protecting the heart, brain, kidneys and blood vessels for years or decades to come.

For millions of people living with type 2 diabetes, consistently following an appropriate prescribed treatment plan could therefore be an important component of reducing long-term cardiovascular risk.

The evidence strengthens the case for healthcare systems to focus not only on which diabetes medication is prescribed, but also on whether patients have the information, access and support necessary to continue taking that treatment consistently over time.

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