Objective:

To compare the 1-year risk of major adverse cardiovascular events (MACE) between tirzepatide and sitagliptin in patients with type 2 diabetes and established atherosclerotic cardiovascular disease.

Approach:

• Study Design: A population-based cohort study analyzing de-identified administrative claims data from Optum Clinformatics and Merative MarketScan from May 2022 to May 2025.
• Participants: 52,971 patients aged 40 years or older who initiated tirzepatide (n = 35,353) or sitagliptin (n = 17,618).
• Eligibility Criteria: Patients had a documented previous myocardial infarction, ischemic stroke, or coronary, carotid, or peripheral arterial disease.
• Outcome Measures: Primary outcome was MACE, defined as myocardial infarction, stroke, or all-cause mortality, with follow-up until MACE occurrence or 1 year.
• Analysis Method: Propensity scores were estimated and overlap weighting was applied to balance baseline characteristics between treatment groups.

Key Findings:

• At 1 year, weighted MACE risk was about 3% with tirzepatide vs. 4% with sitagliptin.
• The risk of myocardial infarction or stroke was approximately 2% with tirzepatide and 3% with sitagliptin.
• Tirzepatide was associated with lower risks of myocardial infarction and all-cause mortality compared to sitagliptin.
• Fewer infection-related hospital admissions were noted with tirzepatide compared to sitagliptin.

Limitations:

• Relatively short follow-up with mean on-treatment follow-up of 182 days.
• Reliance on sitagliptin as a proxy for placebo.
• Possible residual confounding and treatment or outcome misclassification in claims data.
• Findings may not generalize to uninsured patients or non-US health care systems.

Conclusion:

The study found that tirzepatide was associated with a lower risk of MACE compared to sitagliptin in the studied population.

Sources:

• The BMJ