Cardiovascular effects of tirzepatide in patients with type 2 diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials
M Saffi, M R C Clemente, L D Cancela Goncalves, L S Matzenbacher, G Heiden TeloAbstract
Background
The efficacy of tirzepatide, a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist, in improving metabolic parameters is well established in patients with type 2 diabetes and obesity. However, despite its rapidly expanding clinical use, the overall cardiovascular effects of tirzepatide remain uncertain.
Purpose
To assess the effects of tirzepatide on major adverse cardiovascular events (MACE) and all-cause mortality in adults with type 2 diabetes.
Methods
We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing tirzepatide with placebo or active glucose-lowering therapies in adults with type 2 diabetes. PubMed, Embase, and the Cochrane Library were systematically searched for RCTs published from inception to February 2026. Event counts were extracted from published reports, risk ratios (RRs) with 95% confidence intervals (CIs) were calculated and pooled using a random-effects model. Statistical analyses were performed using Review manager software version 10.0.1.
Results
We included 13 RCTs comprising 24,177 patients. Overall, 13,912 participants (57.5%) received tirzepatide, whereas the remaining participants received placebo (3.2%), long-acting insulin (9.5%), or GLP-1 receptor agonists (29.8%). There was no statistically significant difference between groups in MACE (RR 0.92; 95% CI 0.84–1.00; p=0.05; I²=0%; Figure 1). In contrast, tirzepatide was associated with a significant reduction in all-cause mortality (RR 0.84; 95% CI 0.76–0.93; p=0.0007; I²=0%; Figure 2).
Conclusions
In this meta-analysis of RCTs, tirzepatide was associated with a significant reduction in all-cause mortality in adults with type 2 diabetes compared with control therapies. No statistically significant difference was observed in MACE.Figure 1.MACEFigure2.All-cause mortality