Tirzepatide matches dulaglutide on heart risk in SURPASS-CVOT, full results show

The full results of SURPASS-CVOT, published in the New England Journal of Medicine, show that weekly tirzepatide (Mounjaro) was noninferior to weekly dulaglutide for preventing cardiovascular death, heart attack or stroke in adults with type 2 diabetes and established atherosclerotic cardiovascular disease ^[1].

The trial was double-blind and used an active comparator rather than a placebo. A total of 13,299 patients were randomly assigned in a 1:1 ratio to receive tirzepatide (up to 15 mg) or dulaglutide (1.5 mg) as a weekly subcutaneous injection; 134 were later excluded for not meeting inclusion criteria, leaving 6,586 patients in the tirzepatide group and 6,579 in the dulaglutide group for the main analysis ^[1].

Patients in that analysis had a mean age of 64.1 years, and 29.0% were women. Their mean body-mass index was 32.6, their mean glycated hemoglobin level was 8.4%, and they had lived with diabetes for an average of 14.7 years ^[1].

The main endpoint was a composite of death from cardiovascular causes, heart attack or stroke. It occurred in 801 patients (12.2%) taking tirzepatide and 862 patients (13.1%) taking dulaglutide, for a hazard ratio of 0.92 with a 95.3% confidence interval of 0.83 to 1.01 ^[1].

That result met the trial's test for noninferiority, with a p value of 0.003 against a margin that allowed an upper confidence limit below 1.05. It did not meet the test for superiority, where the upper limit of the confidence interval had to fall below 1.00; that comparison produced a p value of 0.09 ^[1]. In plain terms, the trial showed tirzepatide was at least as good as dulaglutide, but not clearly better.

On safety, the incidence of adverse events "appeared to be similar in the two groups, although more gastrointestinal adverse events were observed in the tirzepatide group," the authors wrote ^[1]. The trial was funded by Eli Lilly and registered as NCT04255433 ^[1].

Why it matters for patients

Dulaglutide is a GLP-1 receptor agonist that has already been shown to reduce cardiovascular events, which is why it was chosen as the comparison drug ^[1]. That means this trial answers whether tirzepatide is at least as good as an established option, not how either drug compares with a placebo or with no add-on treatment.

The people studied all had type 2 diabetes plus atherosclerotic cardiovascular disease, a group at elevated heart risk ^[1]. The results do not establish what tirzepatide does for cardiovascular risk in people who take it for weight loss alone, or in people without diagnosed heart or blood vessel disease. Those questions have not been reported.

Tirzepatide is a dual agonist that acts on the GLP-1 and glucose-dependent insulinotropic polypeptide receptors ^[1]. Mounjaro is the brand name for tirzepatide used in type 2 diabetes; the same molecule is also sold as Zepbound. Semaglutide, sold as Ozempic, Wegovy and Rybelsus, was not part of this comparison, and no head-to-head cardiovascular data between tirzepatide and semaglutide appear in this publication.

The gastrointestinal finding is the practical difference the trial flagged: digestive side effects were seen more often with tirzepatide than with dulaglutide ^[1]. The publication does not provide a breakdown of which specific gastrointestinal events occurred or how many patients stopped treatment because of them.

What happens next

The journal's April 16, 2026 issue is scheduled to carry several letters about the trial from outside researchers, along with a reply from authors Nicholls, Pavo and D'Alessio ^[1]. No further trial analyses, label changes or regulatory decisions based on SURPASS-CVOT have been disclosed.