N Engl J Med

Tirzepatide matched dulaglutide for heart protection in patients with type 2 diabetes

December 19, 2025

A head-to-head CV outcomes trial comparing tirzepatide with dulaglutide in patients with T2DM and established ASCVD demonstrated superior CV protection with tirzepatide. The SURPASS-CVOT trial (NCT04255433) enrolled 13,299 participants across 640 sites globally, with a mean diabetes duration of 14.7 years and baseline HbA1c of 8.4%. Clinically, tirzepatide was noninferior to dulaglutide for the composite outcome of CV death, MI, or stroke over a ~4-year follow-up (12.2% vs. 13.1%; hazard ratio, 0.92; P=0.003), while offering significantly greater reductions in HbA₁c and body weight, with similar overall safety though a higher GI side‑effect burden.

Clinical takeaway: In patients with T2DM and ASCVD, tirzepatide is a validated alternative to dulaglutide, offering at least equivalent CV protection plus superior metabolic benefits, making it a compelling choice when weight loss and glycemic control are priorities.

Source:

Nicholls SJ, et al; SURPASS-CVOT Investigators. (2025, December 18). N Engl J Med. Cardiovascular Outcomes with Tirzepatide versus Dulaglutide in Type 2 Diabetes. https://pubmed.ncbi.nlm.nih.gov/41406444/