Current 62 - Tirzepatide Matches Dulaglutide for Cardiovascular Outcomes in Type 2 Diabetes

Summary

Incretin‑based therapies play an expanding role in type 2 diabetes management and weight‑loss strategies. Tirzepatide, a dual incretin agonist of the glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide receptors (GLP‑1/GIP receptor agonist), produces greater reductions in A1C, body weight, and blood pressure compared with selective GLP‑1 receptor agonists. Although most currently available GLP‑1 receptor agonists have demonstrated reductions in major adverse cardiovascular events among high-risk populations, the cardiovascular effects of tirzepatide have remained uncertain.

The SURPASS‑CVOT (Study of Tirzepatide Compared with Dulaglutide on Major Cardiovascular Events in Participants with Type 2 Diabetes) trial published in NEJM evaluated tirzepatide versus dulaglutide in adults with type 2 diabetes and established atherosclerotic cardiovascular disease.¹ In this double‑blind, noninferiority trial, participants were randomized to weekly tirzepatide (up to 15 mg) or dulaglutide (1.5 mg). The primary endpoint—cardiovascular death, myocardial infarction, or stroke—was assessed over a median of 4 years. Tirzepatide met noninferiority criteria with dulaglutide (HR 0.92; 95.3% CI 0.83–1.01; p=0.003), but did not demonstrate statistical superiority (p=0.09). Overall adverse‑event rates were comparable between groups, with gastrointestinal events occurring more frequently with tirzepatide.¹

Despite study limitations, overall, tirzepatide was shown to be noninferior to dulaglutide for secondary cardiovascular prevention, with metabolic advantages that may translate into long‑term cardiovascular benefit.²

Sources

1. Nicholls SJ, Pavo I, Bhatt DL, et al. Cardiovascular outcomes with tirzepatide versus dulaglutide in type 2 diabetes. N Engl J Med. 2025;393(24):2409‑2420. doi:10.1056/NEJMoa2505928.

2. Gerstein HC, Colhoun HM, Dagenais GR, et al. Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised, placebo-controlled trial. Lancet. 2019;394(10193):121-130. doi:10.1016/S0140-6736(19)31149-3.

This summary was created with assistance from generative artificial intelligence (Microsoft Copilot, 2026)