Tirzepatide, a dual GIP/GLP-1 receptor agonist, is showing remarkable cardiovascular benefits for adults with type 2 diabetes (T2D) and established atherosclerotic cardiovascular disease (ASCVD). The SURPASS-CVOT trial found that tirzepatide not only matched dulaglutide in preventing major cardiovascular events but also improved kidney function, lowered mortality, and supported weight loss.
This finding is particularly relevant for clinicians, as cardiovascular disease remains the leading cause of death among people with diabetes. The trial’s head-to-head comparison with dulaglutide offers practical insight into real-world prescribing choices.
SURPASS-CVOT enrolled adults with T2D who had ASCVD. Participants were randomly assigned to receive tirzepatide or dulaglutide. Researchers tracked major adverse cardiovascular events (MACE), kidney function, HbA1c, body weight, and all-cause mortality.
Unlike typical trials that use a placebo, SURPASS-CVOT used dulaglutide as an active comparator. “This allowed us to see the actual benefits tirzepatide adds beyond standard care,” said Dr. Dipti Itchhaporia, MD, MACC.
The trial demonstrated that tirzepatide was non-inferior to dulaglutide for MACE prevention. However, secondary outcomes favoured tirzepatide: Markers of kidney health improved significantly.
All-cause death rates were lower. HbA1c reductions were stronger. Participants experienced greater body weight reduction.
These benefits are critical for patients with diabetes, who often face overlapping risks from obesity, kidney disease, and cardiovascular complications. Tirzepatide’s dual action could simplify management by targeting multiple conditions simultaneously.
Tirzepatide stimulates both GIP and GLP-1 receptors. This dual mechanism improves insulin sensitivity, reduces appetite, and promotes weight loss. Dulaglutide, by contrast, only targets GLP-1.
Dr. Stephen Nicholls, MBBS, PhD, FACC, explained, “Tirzepatide’s dual pathway likely drives the additional benefits, especially for kidney function and weight management” .
The National Institute for Health and Care Excellence (NICE) currently recommends GLP-1 receptor agonists for high-risk T2D patients. Tirzepatide could offer a new option for patients who need stronger metabolic and cardiovascular protection.
Clinicians may consider tirzepatide for patients with obesity or kidney complications, particularly those already on dulaglutide with incomplete response. Its ability to reduce cardiovascular risk, support kidney function, and promote weight loss makes it a compelling therapy.
The trial reflects a growing trend in cardiometabolic medicine: combining cardiovascular protection with diabetes management. Traditionally, therapies focused mainly on blood sugar control. Now, addressing multiple complications simultaneously improves long-term outcomes.
Further research will explore tirzepatide’s long-term safety and potential benefits in patients without established cardiovascular disease. Cost, side effects, and practical dosing will also shape adoption in NHS settings.
Healthcare providers are advised to review the SURPASS-CVOT results carefully. Integrating tirzepatide into care could improve survival, kidney function, and quality of life for patients with T2D and cardiovascular disease.
The SURPASS-CVOT trial firmly establishes tirzepatide as a leading therapy in managing type 2 diabetes with cardiovascular risk. Its dual GIP/GLP-1 mechanism not only improves blood sugar control but also delivers meaningful reductions in body weight, kidney risk, and all-cause mortality .
For clinicians, this represents a significant step forward. Traditionally, treatment decisions balanced glycaemic control with cardiovascular protection separately. Tirzepatide allows both to be addressed simultaneously, simplifying treatment strategies and potentially improving adherence.
Moreover, the trial’s use of dulaglutide as an active comparator underscores the real-world relevance of the findings. Patients in everyday clinical settings often already receive GLP-1 therapy.
Tirzepatide’s superior outcomes in weight reduction, kidney function, and mortality suggest it could replace or complement existing therapies for high-risk individuals. This could be particularly impactful , where obesity and cardiovascular complications remain pressing public health concerns.
Moreover, the broader implications extend beyond diabetes management. By improving multiple cardiometabolic risk factors at once, tirzepatide may reduce the long-term burden on NHS services; as a result, patients may experience fewer hospital admissions, lower medication requirements, and improved quality of life. As clinicians evaluate the integration of tirzepatide into treatment pathways, shared decision-making will be key. Considering both efficacy and patient preference ensures optimal outcomes.
In summary, tirzepatide represents a paradigm shift in cardiometabolic care. It merges glucose control with cardiovascular and renal protection, offering patients a comprehensive, evidence-based therapy that addresses the complex challenges of type 2 diabetes.
Sources:
- American College of Cardiology. (2026, January 27). ACCEL Lite: SURPASS-CVOT: Effect of Tirzepatide versus Dulaglutide on MACE. https://www.acc.org/Latest-in-Cardiology/Articles/2026/01/26/20/39/accel-lite-27jan2025
- Nicholls, S. J., Bhatt, D. L., Buse, J. B., et al. (2024). Comparison of tirzepatide and dulaglutide on major adverse cardiovascular events in participants with type 2 diabetes and atherosclerotic cardiovascular disease: SURPASS-CVOT design and baseline characteristics. American Heart Journal, 267, 1–11. https://doi.org/10.1016/j.ahj.2023.09.007
