Comparative efficacy of tirzepatide and glucagon-like peptide-1 receptor agonists on cardiovascular outcomes in patients with type 2 diabetes: a systematic review and network meta-analysis
Pooled result · Class-level NMA: MACEResult — go to the resultHazard ratio 0.79 95% CI 0.69–0.91Authors' conclusion
Among adults with T2D and established ASCVD or high CV risk, class-level analysis demonstrated that tirzepatide significantly reduced the risk of cardiovascular events compared to placebo; at the agent-level, tirzepatide demonstrated comparable efficacy to individual GLP-1RAs. These findings suggest that tirzepatide provides cardiovascular benefit at least comparable to established GLP-1RAs, supporting its emerging role in cardiovascular risk reduction in T2D.
Study context
- Population
- Adults with T2D and established atherosclerotic CVD or high cardiovascular (CV) risk, in RCTs11 RCTs
- Comparison
- Tirzepatide vs placebo and GLP-1 RAs
- Outcome
- Class-level NMA: Major adverse cardiovascular events (MACE)
Methodological detailsfrequentist, class-level and agent-level network meta-analysis (NMA), subgroup and leave-one-out sensitivity analyses
- Frequentist
- Class-level and agent-level NMA
- Subgroup and leave-one-out sensitivity analyses
Pooled result
As reported in the abstract
Hazard ratio
0.79
95% CI 0.69–0.91
Tirzepatidevs Placebo
HR 0.79 (95% CI 0.69–0.91)
Further pooled results
| Outcome | HR (95% CI) | |
|---|---|---|
| Class-level NMA: CV mortalityTirzepatidevs Placebo | 0.77 (0.66–0.90) | |
| Class-level NMA: all-cause mortalityTirzepatidevs Placebo | 0.74 (0.65–0.83) | |
| Class-level NMA: non-fatal MITirzepatidevs Placebo | 0.77 (0.61–0.97) | |
| Class-level NMA: non-fatal strokeTirzepatidevs Placebo | 0.79 (0.64–0.97) | |
| Agent-level NMA: MACETirzepatidevs Placebo | 0.81 (0.70–0.94) | |
| Agent-level NMA: MACETirzepatidevs Lixisenatide | 0.79 (0.65–0.97) | |
| 0.512Hazard ratio (log scale) |
Tirzepatide vs GLP-1RA class
- Formal comparisons could not be performed; point estimates numerically favored tirzepatide
Subgroup and sensitivity analyses
- Did not substantially change point estimates
Original publication
Comparative efficacy of tirzepatide and glucagon-like peptide-1 receptor agonists on cardiovascular outcomes in patients with type 2 diabetes: a systematic review and network meta-analysis. Cardiovasc Diabetol. Published 27 February 2026. doi:10.
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