November 9, 2026

expert reaction to a retrospective cohort study looking at GLP-1 RA discontinuation and cardiovascular events and all-cause mortality in people with type 2 diabetes

Scientist responds to a retrospective cohort study published in The Lancet Regional Health – Europe* looking at GLP-1 RA discontinuation and cardiovascular events and all-cause mortality in people with type 2 diabetes.

Prof Naveed Sattar, Professor of Cardiometabolic Medicine/Honorary Consultant, University of Glasgow, said:

“The major limitation of these findings is that they are observational. As the authors appropriately acknowledge, the results do not necessarily mean that stopping the medication itself leads to an immediate increase in risk, nor that risks become higher than they would have been had individuals never started treatment in the first place.

“Indeed, the reported excess risks could readily reflect residual confounding. People who discontinue treatment, for whatever reason, may differ systematically from those who continue, with characteristics associated with a higher underlying risk of future disease. Factors such as poorer adherence, adverse effects, socioeconomic circumstances, deteriorating health, or other unmeasured determinants could all contribute to both treatment discontinuation and subsequent outcomes. As such, these data should be interpreted as associations rather than evidence that stopping the medication directly causes higher cardiovascular or other health risks.

“What we do know from large randomized controlled trials is that initiating approved obesity medications can reduce cardiovascular risk in appropriate patient groups. Semaglutide has been shown to lower the risk of major adverse cardiovascular events in people with overweight or obesity and established cardiovascular disease, including many without diabetes. Similarly, tirzepatide has demonstrated cardiovascular benefit in people with type 2 diabetes at elevated cardiovascular risk. These robust trial data underpin regulatory approvals and clinical guideline recommendations. However, randomized evidence specifically examining the consequences of treatment discontinuation on cardiovascular outcomes remains limited, meaning observational findings such as these should be interpreted cautiously and not assumed to demonstrate a causal effect of stopping therapy.”

* ‘GLP-1 receptor agonist discontinuation and cardiovascular events and all-cause mortality in people with type 2 diabetes: a retrospective cohort study’ by Antonio Ceriello et al. was published in The Lancet Regional Health – Europe on Monday 9 November 2026.

DOI: 10.1016/j.lanepe.2026.101881

Declared interests

Prof Naveed Sattar: “NS has consulted for and/or received speaker honoraria from Abbott Laboratories, AbbVie, Afimmune, Amgen, AstraZeneca, Boehringer Ingelheim, Carmot Therapeutics, Eli Lilly, Gan & Lee, GlaxoSmithKline, Hanmi Pharmaceuticals, Janssen, Kailera, Mass Medicines, Menarini-Ricerche, Merck Sharp & Dohme, Metsera, Novartis, Novo Nordisk, Pfizer, Regeneron, Roche, Sanofi, Structure Therapeutics, UCB Pharma and Verdiva Bio; and received grant support paid to his University from AstraZeneca, Boehringer Ingelheim, Novartis, and Roche. He does not hold any stocks or shares in any medical companies.”