How strong is the cardiovascular evidence for someone like you? Type 2 diabetes
glp1-diabetesNo one has reached this rule yetOutcome benefit across the class; SURPASS-CVOT tested tirzepatide against an active comparator
No clinician has signed off this rule yet. It reflects our reading of the guidelines cited below, which has not been independently checked.
Word for word, as generated for the example person below. Figures in the text are theirs.
With type 2 diabetes, a GLP-1 receptor agonist is one of the two drug classes that lower cardiovascular risk beyond their effect on blood sugar — and guidelines now favour it for that reason.
Proven in trialsTrials counted real events, like heart attacks, strokes, or deaths, and this changed them.
Semaglutide, liraglutide and dulaglutide each reduced cardiovascular events in people with type 2 diabetes at raised risk, and oral semaglutide reproduced it in SOUL. Tirzepatide was tested differently and more informatively: SURPASS-CVOT compared it head-to-head against dulaglutide — an active drug, not placebo — in people with diabetes and cardiovascular disease, and met non-inferiority for major events while producing markedly more weight loss and better A1c, blood pressure and lipids. Which of these suits you depends on your kidney function, whether weight loss is a goal, and cost.
ACC/AHA (US)
ACC/AHA rates either an SGLT2 inhibitor or a GLP-1 receptor agonist with proven cardiovascular benefit Class 1, Level A in chronic coronary disease with type 2 diabetes. The 2024 PAD guideline gives liraglutide and semaglutide the same grade in PAD with type 2 diabetes. Tirzepatide is not named in either, so this grade covers the drug class, not tirzepatide itself.
2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Pati… · Recommendation behind this rule · class and level read from the guideline tables on 2026-09-30
ESC (Europe)
The ESC grade of I, A is for SGLT2 inhibitors with proven benefit in type 2 diabetes with chronic coronary syndrome. The ESC's GLP-1 agonist recommendation for this group was not separately read.
2024 ESC chronic coronary syndromes guidelines · Recommendation tables · class and level read from the guideline tables on 2026-09-30
SURPASS-CVOT — tirzepatide vs dulaglutide, active-comparator cardiovascular outcomes trial · Class 1 · Level A
“Diabetes, already on a statin” — an illustrative profile, not a real user.
Asked after: BMI 27 or above, or type 2 diabetes
Cited by the recommendations above.
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Runs in lib/engine/glp1Pathway.ts as glp1-diabetes.