Medical Professionals Reference (MPR)Semaglutide Superior to Tirzepatide in Reducing Cardiovascular Event Risk

The STEER real-world study demonstrates Wegovy® (semaglutide 2.4 mg) provides superior cardiovascular protection compared to tirzepatide (Zepbound®) in patients with obesity and established CVD. This retrospective analysis suggests cardiovascular benefits are molecule-specific rather than class effects.

⚕️ Key Clinical Considerations ⚕️

• Statistical Significance: 57% greater risk reduction for MACE in on-treatment analysis (HR 0.43, p<0.05) and 29% reduction in intention-to-treat analysis across 10,625 matched patients per group.
• Methodology Limitations: Retrospective observational design with potential unmeasured confounding, relatively short follow-up (3.8-8.6 months), and administrative claims data subject to coding inaccuracies.
• Event Rates: Low absolute event rates (0.1-0.8%) suggest need for larger studies and longer follow-up to confirm clinical significance of relative risk reductions.
• Population Specificity: Limited to adults ≥45 years with obesity/overweight and established CVD without diabetes, restricting generalizability to broader patient populations.
• Real-World Applicability: Propensity-matched analysis provides insight into treatment effectiveness outside controlled trial conditions, complementing SELECT trial findings.

🎯 Clinical Practice Impact 🎯

• Patient Communication: Counsel patients that, although this study suggests Wegovy® may offer superior cardiovascular protection compared to tirzepatide, the evidence comes from observational data with inherent limitations. Emphasize that both medications require lifestyle modifications and regular monitoring.
• Practice Integration: Consider cardiovascular risk as a key factor when choosing between GLP-1 receptor agonists for patients with obesity and established CVD. Document rationale for medication selection and monitor for both cardiovascular outcomes and typical GLP-1 side effects.
• Risk Management: Maintain awareness of Wegovy®’s boxed warning for thyroid tumors and contraindications in patients with personal/family history of medullary thyroid carcinoma or MEN 2 syndrome.
• Action Items: Review current patients on tirzepatide with CVD to assess potential benefits of switching to Wegovy®, while considering individual patient factors, treatment response, and insurance coverage patterns.

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