Staying on diabetes medication has been associated with a reduced incidence of heart attacks and strokes, based on a ten-year study of close to 80,000 individuals.
How adherence impacts heart risk
Because type 2 diabetes raises the likelihood of cardiovascular disease, clinicians often prescribe glucose-lowering drugs to mitigate that danger. Yet adherence to these treatments varies, and irregular use may heighten vulnerability.
A team from the University of Copenhagen, together with partners, followed the prescription patterns of almost 80,000 adults for a decade. Their analysis revealed that individuals who maintained regular intake of their diabetes medication avoided major cardiac and vascular events for roughly seven additional months relative to irregular users.
“Prescribing the right medicine is only the first step. Our study shows that whether a person is actually able to keep taking their treatment in the following years has a real bearing on their heart health,” says Associate Professor Jordi Merino from the Novo Nordisk Foundation Center for Basic Metabolic Research (CBMR) at the University of Copenhagen, who led the study.
To capture actual prescribing behavior, the investigators accessed Denmark’s national health registries, examining data from 79,510 individuals newly identified with type 2 diabetes who initiated non-insulin therapy between 2005 and 2012.
Instead of depending on self-reports, the scientists applied an analytical approach tracking monthly pharmacy dispensation over ten years, which categorized participants into three distinct trajectories. Approximately 41% maintained high adherence, 33% exhibited moderate adherence, and 26% discontinued early and remained at consistently low adherence.
Individuals classified with low adherence experienced a 27% increased incidence of major cardiovascular events relative to consistently adherent patients, while the moderate-adherence cohort showed a 7% elevation.
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The association was most pronounced for ischemic heart disease, with low adherence linked to a 45% higher occurrence, and for stroke, where the same group faced a 24% greater risk.
Younger patients faced even greater consequences. In this subgroup, low adherence corresponded to a 73% higher likelihood of experiencing a cardiovascular incident before age 55 versus consistently adherent peers. Early-onset type 2 diabetes imposes a substantial cumulative vascular risk, making sustained therapy especially critical during prime employment and family-building periods.
The research highlighted a social component: participants with low adherence were disproportionately likely to reside alone, earn lower incomes, and cope with additional chronic illnesses. Thus, missed doses seldom stem solely from forgetfulness, but rather mirror broader life pressures.
To mitigate these confounders, the analysts controlled for such variables and other relevant covariates. Even after adjustment, reduced adherence remained associated with an raised risk of cardiovascular disease.
“These findings show that health systems need to move beyond checking medication habits once or twice a year,” says first author Researcher Lise B. Nielsen from CBMR. “Having access to medicine does not automatically mean a person can take it every day, so tracking habits over the long term could help doctors spot vulnerable patients before a major heart event happens.”
Methodology and Social Factors
People who did not take their medication consistently were more likely to live alone, have lower incomes, and manage other chronic conditions. Skipping pills often reflects wider pressures in a person’s life rather than just forgetfulness.
