速递｜最大、最长CVOT出炉，替尔泊肽改写糖尿病心血管证据链

Core Viewpoint - The article discusses the significant findings from the SURPASS-CVOT study, which demonstrates that Tirzepatide is non-inferior to Dulaglutide in cardiovascular outcomes for patients with type 2 diabetes and atherosclerotic cardiovascular disease (ASCVD), while also showing potential advantages in various clinical indicators [4][8][12]. Study Design and Population - SURPASS-CVOT is a rigorously designed cardiovascular outcomes trial (CVOT) that included 13,299 patients from 30 countries, with an average age of 64.1 years and a high cardiovascular risk profile [7][12]. - The study involved a 1:1 randomization to receive either Tirzepatide or Dulaglutide, with a median follow-up of approximately 4 years [7]. Primary and Secondary Outcomes - Tirzepatide achieved its non-inferiority goal with 12.2% of patients experiencing primary cardiovascular events compared to 13.1% in the Dulaglutide group, indicating an 8% reduction in risk (HR 0.92; 95.3% CI 0.83–1.01) [8][10]. - In secondary outcomes, Tirzepatide showed a significant 16% reduction in all-cause mortality risk (HR 0.84; 95% CI 0.75–0.94) and a reduction in major adverse cardiovascular events (MACE) (HR 0.88; 95% CI 0.88–0.96) [10][11]. Metabolic Improvements - Patients treated with Tirzepatide experienced an average weight loss of 11.6%, significantly higher than the 4.8% in the Dulaglutide group. Additionally, HbA1c levels decreased by 1.66% for Tirzepatide compared to 0.88% for Dulaglutide, and triglyceride levels dropped by 24.2% versus 10.2% [10][12]. Safety Profile - The overall incidence of adverse events was similar between the two groups, although Tirzepatide had a slightly higher discontinuation rate due to adverse events (13.2% vs 10.1%), primarily related to gastrointestinal issues [10][11]. Significance of the Study - The choice of Dulaglutide as an active comparator is significant, as it has previously been shown to improve cardiovascular outcomes in high-risk patients, reinforcing the cardiovascular protective evidence for Tirzepatide [11][12]. - The study's findings position Tirzepatide as a potential first-line treatment option for patients with type 2 diabetes and cardiovascular disease, moving beyond its initial role as a glucose-lowering and weight-loss medication [12].