American College of Cardiology Congress 2026 – Dr Steven Nissen (Cleveland Clinic, Cleveland, OH, US) joins us to discuss the effects of tirzepatide compared with dulaglutide on expanded cardiorenal outcomes from the SURPASS-CVOT trial (NCT04255433; Eli Lilly and Company).

This international, double-blind, randomised, phase III cardiovascular outcomes trial enrolled 13,299 patients aged 40 and older with type 2 diabetes, established cardiovascular disease and HbA1c between 7% and 10.5%. Participants were randomised to subcutaneous tirzepatide or dulaglutide, administered once weekly, with follow-up extending up to 54 months. The primary endpoint was time to first occurrence of 3-point MACE comprising cardiovascular death, myocardial infarction or stroke. A comprehensive secondary programme was also implemented evaluating all-cause mortality, heart failure hospitalisation, renal outcomes, weight loss and lipid and glycaemic parameters.

Findings showed that in patients with diabetes and ASCVD, tirzepatide was associated with a lower incidence of a composite endpoint of all-cause mortality, myocardial infarction, stroke, coronary revascularization, heart failure and adverse renal outcomes. 

Interview Questions:

1. What was the rationale for this expanded cardiorenal outcomes analysis and what additional endpoints did it encompass beyond 3-point MACE?
2. What were the key findings?
3. How did the cardiorenal benefits align with the metabolic differences observed between the 2 agents — specifically weight reduction, HbA1c lowering and changes in urinary albumin-to-creatinine ratio?
4. Based on the cardiorenal outcomes, how should clinicians prioritise tirzepatide relative to other GLP-1 receptor agonists and SGLT2 inhibitors in patients with type 2 diabetes and established cardiovascular or renal disease?
5. What are your key take-home messages for clinicians and what are the next steps?

Recorded on-site at ACC 2026, New Orleans.

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Editor: Jordan Rance
Videographer:

Support: This is an independent interview produced by Radcliffe Cardiology.