Tirzepatide and the risk of atherosclerotic cardiovascular events: population based cohort study.

Krüger N, Schneeweiss S, Wang SV

BMJ (Clinical research ed.)5 Aug 2026

PMID42556854DOI10.1136/bmj-2026-100011PepBankPUB-42556854

Publisher page PubMedAsk about this study

Summary

The text of this summary is not shown here, because the article license does not allow reuse. Read it at the source (opens in a new tab)

Text rights: Publisher copyright. Results still quote short attributed sentences.

Results from this study7

7 results from studies that gave the peptide. 7 results from people.

01HumanObservational studyEfficacy outcome
In adults with type 2 diabetes and established atherosclerotic cardiovascular disease, tirzepatide was associated with lower one-year MACE risk than sitagliptin.
In plain wordsIn adults with type 2 diabetes and heart or vessel disease, tirzepatide was linked to fewer serious heart events than sitagliptin over one year.
Peptide
Tirzepatide
Outcome
DecreaseOne-year MACE
Study
n = 52,971
Comparator
Sitagliptin
Analysis
Primary
Outcome group
Cardiovascular events · Cardiovascular
Studied dose
Dose not stated · 1 yearAs given in this study (human).
Measurements
One-year MACE risk
2.9%
tirzepatide
One-year MACE risk
4.4%
sitagliptin
HR
0.68 ratio
MACE
Source sentences
Summary
At one year, the weighted one year risk of MACE was 2.9% (95% confidence interval (CI) 2.5% to 3.4%) in the tirzepatide group and 4.4% (3.8% to 4.9%) in the sitagliptin group (risk difference -1.4%, 95% CI -2.1% to -0.7%; number needed to treat (NNT)=70), corresponding to a hazard ratio of 0.68 (95% CI 0.58 to 0.80).
1 context sentence(design, population, supporting numbers)
Summary · context
52 971 participants aged ≥40 years with type 2 diabetes and established atherosclerotic cardiovascular disease who initiated tirzepatide (n=35 353) or sitagliptin (n=17 618), a cardiovascular outcome neutral comparator serving as a placebo proxy.
Report a problemFND-4255685401
02HumanObservational studyEfficacy outcome
In adults with type 2 diabetes and established atherosclerotic cardiovascular disease, tirzepatide was associated with a lower hazard of myocardial infarction than sitagliptin.
In plain wordsIn adults with type 2 diabetes and heart or vessel disease, tirzepatide was linked to fewer heart attacks than sitagliptin.
Peptide
Tirzepatide
Outcome
DecreaseMyocardial infarction
Study
n = 52,971
Comparator
Sitagliptin
Outcome group
Cardiovascular events · Cardiovascular
Studied dose
Dose not stated · 1 yearAs given in this study (human).
Measurements
HR
0.67 ratio
myocardial infarction
Source sentences
Summary
tirzepatide was associated with a lower hazard for myocardial infarction (hazard ratio 0.67, 0.52 to 0.87; NNT=130)
1 context sentence(design, population, supporting numbers)
Summary · context
52 971 participants aged ≥40 years with type 2 diabetes and established atherosclerotic cardiovascular disease who initiated tirzepatide (n=35 353) or sitagliptin (n=17 618), a cardiovascular outcome neutral comparator serving as a placebo proxy.
Report a problemFND-4255685402
03HumanObservational studyEfficacy outcome
In adults with type 2 diabetes and established atherosclerotic cardiovascular disease, tirzepatide showed no meaningful difference in ischaemic stroke versus sitagliptin.
In plain wordsIn adults with type 2 diabetes and heart or vessel disease, tirzepatide and sitagliptin showed no meaningful difference in strokes.
Peptide
Tirzepatide
Outcome
No significant changeIschaemic stroke
Study
n = 52,971
Comparator
Sitagliptin
Outcome group
Cardiovascular events · Cardiovascular
Studied dose
Dose not stated · 1 yearAs given in this study (human).
Measurements
HR
0.91 ratio
ischaemic stroke
Source sentences
Summary
ischaemic stroke showed no meaningful difference (0.91, 0.64 to 1.28; NNT 2500)
1 context sentence(design, population, supporting numbers)
Summary · context
52 971 participants aged ≥40 years with type 2 diabetes and established atherosclerotic cardiovascular disease who initiated tirzepatide (n=35 353) or sitagliptin (n=17 618), a cardiovascular outcome neutral comparator serving as a placebo proxy.
Report a problemFND-4255685403
04HumanObservational studySafety outcome
In adults with type 2 diabetes and established atherosclerotic cardiovascular disease, hospital admissions for infection were lower with tirzepatide than with sitagliptin.
In plain wordsIn adults with type 2 diabetes and heart or vessel disease, tirzepatide was linked to fewer hospital stays for infection than sitagliptin.
Peptide
Tirzepatide
Outcome
DecreaseInfections requiring hospital admission
Study
n = 52,971
Comparator
Sitagliptin
Outcome group
Adverse events · Infection
Studied dose
Dose not stated · 1 yearAs given in this study (human).
Measurements
HR
0.64 ratio
infections requiring admission
Source sentences
Summary
Infections requiring hospital admission were lower with tirzepatide (0.64, 0.55 to 0.75; NNT=48)
1 context sentence(design, population, supporting numbers)
Summary · context
52 971 participants aged ≥40 years with type 2 diabetes and established atherosclerotic cardiovascular disease who initiated tirzepatide (n=35 353) or sitagliptin (n=17 618), a cardiovascular outcome neutral comparator serving as a placebo proxy.
Report a problemFND-4255685404
05HumanObservational studySafety outcome
In adults with type 2 diabetes and established atherosclerotic cardiovascular disease, infection related mortality was lower with tirzepatide than with sitagliptin.
In plain wordsIn adults with type 2 diabetes and heart or vessel disease, tirzepatide was linked to fewer deaths from infection than sitagliptin.
Peptide
Tirzepatide
Outcome
DecreaseInfection related mortality
Study
n = 52,971
Comparator
Sitagliptin
Outcome group
Mortality · Infection
Studied dose
Dose not stated · 1 yearAs given in this study (human).
Measurements
HR
0.4 ratio
infection related mortality
Source sentences
Summary
as was infection related mortality (0.40, 0.26 to 0.61; NNT=200)
1 context sentence(design, population, supporting numbers)
Summary · context
52 971 participants aged ≥40 years with type 2 diabetes and established atherosclerotic cardiovascular disease who initiated tirzepatide (n=35 353) or sitagliptin (n=17 618), a cardiovascular outcome neutral comparator serving as a placebo proxy.
Report a problemFND-4255685405
06HumanObservational studyEfficacy outcome
In adults with type 2 diabetes and established atherosclerotic cardiovascular disease, all cause mortality was lower with tirzepatide than with sitagliptin.
In plain wordsIn adults with type 2 diabetes and heart or vessel disease, tirzepatide was linked to fewer deaths from any cause than sitagliptin.
Peptide
Tirzepatide
Outcome
DecreaseAll-cause mortality
Study
n = 52,971
Comparator
Sitagliptin
Outcome group
Mortality · Cardiovascular
Studied dose
Dose not stated · 1 yearAs given in this study (human).
Measurements
HR
0.55 ratio
all cause mortality
Source sentences
Summary
all cause mortality (0.55, 0.42 to 0.72; NNT=122).
1 context sentence(design, population, supporting numbers)
Summary · context
52 971 participants aged ≥40 years with type 2 diabetes and established atherosclerotic cardiovascular disease who initiated tirzepatide (n=35 353) or sitagliptin (n=17 618), a cardiovascular outcome neutral comparator serving as a placebo proxy.
Report a problemFND-4255685406
07HumanObservational studyOther
Negative control outcomes (lumbar radiculopathy and abdominal hernia) showed no association with tirzepatide use, which argues against residual confounding.
In plain wordsTwo unrelated control conditions showed no link to tirzepatide, which supports the main findings.
Peptide
Tirzepatide
Outcome
No significant changeNegative control outcomes
Study
n = 52,971
Comparator
Sitagliptin
Outcome group
Cardiovascular events · Cardiovascular
Studied dose
Dose not stated · 1 yearAs given in this study (human).
Source sentences
Summary
Negative control outcomes showed no association.
1 context sentence(design, population, supporting numbers)
Summary · context
52 971 participants aged ≥40 years with type 2 diabetes and established atherosclerotic cardiovascular disease who initiated tirzepatide (n=35 353) or sitagliptin (n=17 618), a cardiovascular outcome neutral comparator serving as a placebo proxy.
Report a problemFND-4255685407

AI wrote and checked these results. AI can make mistakes, so check important results against the source.

Registered trials1

Trials this study reports on, or that list this study as a reference. Registry data from ClinicalTrials.gov.

1 trial · 1 completed · source ClinicalTrials.gov (opens in a new tab)

CompletedPhase not statedNCT07203677

Comparative Effectiveness of Tirzepatide Versus Sitagliptin in Individuals at Cardiovascular Risk (TIRZSITA-CVOT)

Brigham and Women's Hospitaln = 49,06519 Sept 2025 to 15 Oct 2025

Type2 Diabetes Mellitus · Atherosclerotic Cardiovascular Disease

Trial page ClinicalTrials.govUpdated 30 Apr 2026

Version history

PepBank keeps every version of the data on this study. Status changes from Retraction Watch, Europe PMC and Crossref are listed with their source.

Version 2Current
12 Oct 2026, 12:10 UTC
Study results updated
Version 1
9 Oct 2026, 03:07 UTC
First added · source update from Europe PMC

Subjects

Terms as the source lists them.

Publication types

MeSH terms

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