Despite increasing GLP-1 receptor agonist use, high discontinuation rates may lead to weight regain and loss of cardiometabolic benefits. However, its effect on subsequent cardiovascular events remains unclear. However, the effect of GLP-1 receptor agonist discontinuation on subsequent cardiovascular events remains largely unexplored. Using nationwide healthcare data from South Korea (2002–2023), we emulated a hypothetical target trial comparing MACE risk after GLP-1 receptor agonist discontinuation versus continuation among adults with type 2 diabetes who completed at least 20 weeks of treatment. Discontinuers were matched 1:1 with eligible continuers at discontinuation, using propensity scores to adjust for confounding. After matching, 29,550 pairs were included (mean age, 58.5 years; 52.3% male). Compared with continuers, discontinuers had a 59% higher risk of MACE (HR 1.59, 95% CI 1.38–1.83). The 1-year absolute risk difference was 0.4% (1.3% vs. 0.9%) and increased to 2.4% at 5 years (5.8% vs. 3.4%). The association was consistent across subgroups, with larger absolute risks among older patients, males, those with established cardiovascular disease, and those with obesity. The cumulative incidence of adverse events was comparable between the discontinuation and continuation groups (7.95% vs. 8.30%; p = 0.12). Our findings may inform individualized treatment decisions and suggest that GLP-1 receptor agonists may have disease-modifying effects beyond metabolic benefits.