DIET & NUTRITION 
PATIENT EDUCATION 
OBESITY/WEIGHT MANAGEMENT 
EXERCISE/TRAINING 
LEGAL MATTERS 
GUIDELINES/RECOMMENDATIONS A post hoc analysis of the industry-funded SURPASS-CVOT trial found tirzepatide associated with a 3 percentage point absolute reduction in a six-component cardiorenal composite versus dulaglutide over 47 months in 13,165 patients with type 2 diabetes and ASCVD. No prespecified power calculations were performed for the expanded endpoint.
Clinical Considerations
- Composite events occurred in 24% on tirzepatide vs 27% on dulaglutide; number needed to treat was 27 to prevent one event.
- Individual components — mortality, MI, stroke, revascularization, kidney composite, heart failure hospitalization — were each numerically lower but with small absolute differences.
- Gastrointestinal adverse events were higher with tirzepatide (43% vs 36%), and treatment-emergent discontinuations were more frequent.
- No subgroup interaction by age, sex, prior MI, heart failure, kidney function, or baseline SGLT2 inhibitor use; marginal interaction by BMI.
Practice Applications
- Interpret findings as hypothesis-generating given the post hoc design and industry funding.
- Consider tirzepatide’s GI tolerability profile when selecting incretin therapy.
- Recognize the original SURPASS-CVOT only established noninferiority for the three-component MACE outcome.
- Monitor for evolving guideline guidance on incretin selection in high-risk diabetes populations.
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