A big real‑world analysis of over 118,000 people with type‑2 diabetes shows that tirzepatide cuts the chances of heart attacks, heart‑failure hospitalizations, strokes, major cardiovascular events and even death compared to usual care, and it does a bit better than semaglutide for strokes and overall cardiovascular risk. The drug didn’t change the risk of sudden cardiac death. These findings suggest tirzepatide could be a powerful tool for people looking to improve heart health while managing diabetes or weight.

Tirzepatide shows benefits on cardiovascular (CV) parameters and major adverse cardiovascular events (MACE) in clinical trials, but real-world data, especially for type 2 diabetes (T2D), are limited. This systematic review and meta-analysis seeks to address this gap. Multiple databases and registries were searched for real-world observational studies involving individuals with T2D receiving tirzepatide. The co-primary outcomes were acute coronary syndrome (ACS), heart failure (HF), sudden cardiac death, and stroke. RevMan Web was used to conduct meta-analyses employing random-effects models to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Eight retrospective cohort studies (N = 118 252) were included. Compared to the control group, tirzepatide reduced risks of ACS (HR 0.74 [0.62-0.89], P = .001), HF (HR 0.65 [0.53-0.82], P = .0002), stroke (HR 0.71 [0.62-0.81], P < .00001), MACE (HR 0.72 [0.60-0.86], P = .0004), and all-cause mortality (HR 0.49 [0.37-0.67], P < .00001). However, the risk of sudden cardiac death was similar between groups. The risk of composite outcomes of all-cause mortality plus CV outcomes was also lower with tirzepatide (HR 0.65 [0.54-0.79], P < .0001). Compared to semaglutide, tirzepatide had lower risks of stroke and MACE but similar risks for ACS, HF, sudden cardiac death, all-cause mortality, and composite outcomes. Tirzepatide offers the potential to reduce the risks of ACS, HF, stroke, MACE, and death in real-world patients with T2D, suggesting CV benefits. Larger trials are needed to confirm long-term CV effects and define its role in T2D and CV management.