Cardiometabolic & kidneyCohort study
Cardiovascular outcomes of semaglutide and tirzepatide for patients with type 2 diabetes in clinical practice
- Target trial emulation cohort studies
- five cohort studies
- propensity-score matched
- trial emulation (SUSTAIN-6, SURPASS-CVOT)
- head-to-head comparison
Authors' conclusion
These findings support a comparable cardiovascular benefit of tirzepatide and semaglutide in clinical practice
Study context
- Population
- Patients with elevated CV risk, including obesity and T2DM, in US insurance programs, 2018–2025
- Exposure
- Tirzepatide vs semaglutide
- Outcome
- Composite of:
- MI
- Stroke
- All-cause mortality
Main finding
MI, stroke or all-cause mortality (head-to-head)
Hazard ratio
1.06
95% CI 0.95–1.18
Tirzepatide vs Semaglutide
HR 1.06 (95% CI 0.95–1.18)
As reported in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| MI or stroke, expanded population | 0.82 (0.74–0.91) | |
| Composite including mortality, expanded population | 0.87 (0.75–1.01) | |
| 0.512Hazard ratio (log scale) |
Trial emulation benchmarking
- High agreement between reference trials and emulations for all individual endpoints except all-cause mortality in SUSTAIN-6
Original publication
Cardiovascular outcomes of semaglutide and tirzepatide for patients with type 2 diabetes in clinical practice. Nat Med. Published 9 November 2025. doi:10.1038/s41591-025-04102-x
Summarised from the published abstract; every number is checked against it