Superior Cardiorenal Protection With Tirzepatide Over Dulaglutide in Heart Failure With Preserved Ejection Fraction: A Large-Scale Propensity Score-Matched Real-World Analysis.
I, K., MI, H., MM, A., F, W., AA, K., SA, P., MA, S., MT, R., & P, S. (2026). Superior Cardiorenal Protection With Tirzepatide Over Dulaglutide in Heart Failure With Preserved Ejection Fraction: A Large-Scale Propensity Score-Matched Real-World Analysis.. Clinical cardiology. https://doi.org/10.1002/clc.70441
I K, MI H, MM A, F W, AA K, SA P, et al. Superior Cardiorenal Protection With Tirzepatide Over Dulaglutide in Heart Failure With Preserved Ejection Fraction: A Large-Scale Propensity Score-Matched Real-World Analysis.. Clinical cardiology. 2026; doi: 10.1002/clc.70441
I K, MI H, MM A, et al. Superior Cardiorenal Protection With Tirzepatide Over Dulaglutide in Heart Failure With Preserved Ejection Fraction: A Large-Scale Propensity Score-Matched Real-World Analysis.[J]. Clinical cardiology. 2026. DOI: 10.1002/clc.70441.
@article{i2026,
author = {Khalil I and Hossain MI and Akter MM and Wahid F and Khalid AA and Promi SA and Sayed MA and Rahman MT and Sarker P},
title = {Superior Cardiorenal Protection With Tirzepatide Over Dulaglutide in Heart Failure With Preserved Ejection Fraction: A Large-Scale Propensity Score-Matched Real-World Analysis.},
journal = {Clinical cardiology},
year = {2026},
doi = {10.1002/clc.70441},
note = {PMID: 42573026},
}
TY - JOUR AU - Khalil I AU - Hossain MI AU - Akter MM AU - Wahid F AU - Khalid AA AU - Promi SA AU - Sayed MA AU - Rahman MT AU - Sarker P TI - Superior Cardiorenal Protection With Tirzepatide Over Dulaglutide in Heart Failure With Preserved Ejection Fraction: A Large-Scale Propensity Score-Matched Real-World Analysis. T2 - Clinical cardiology PY - 2026 DO - 10.1002/clc.70441 AN - PMID:42573026 ER -
BACKGROUND: No direct head-to-head trials compare tirzepatide and dulaglutide in heart failure with preserved ejection fraction (HFpEF), though tirzepatide shows superior weight loss and potential cardiovascular benefits in recent trials like SURPASS-CVOT. METHODS: This retrospective, propensity score-matched cohort study used de-identified electronic health records from the TriNetX US Collaborative Network (as of December 2025). Adults ≥ 18 years with HFpEF (ICD-10: I50.3) initiating tirzepatide (n = 35 174) or dulaglutide (n = 52 999), without prior exposure to the comparator, were identified. One-to-one greedy nearest-neighbor matching (caliper 0.1) on demographics, comorbidities, medications, and laboratory/echocardiographic data produced balanced cohorts of 24 305 patients each. Kaplan-Meier and Cox proportional hazards models evaluated 1-year and 3-year risks of all-cause mortality, acute heart failure events, all-cause hospitalization, myocardial infarction, stroke, atrial fibrillation, MACE, MAKE, acute pancreatitis, and hypoglycemia. RESULTS: Post-matching, cohorts were well-balanced. Tirzepatide linked to lower 1-year risks of all-cause mortality (HR: 0.66, 95% CI: [0.59-0.74]), all-cause hospitalization (HR: 0.85, 95% CI: [0.82-0.88]), stroke (HR: 0.92, 95% CI: [0.87-0.97]), MACE (HR: 0.89, 95% [CI: 0.84-0.93]), MAKE (HR: 0.85, 95% CI: [0.79-0.91]), and acute pancreatitis (HR: 0.78, 95% CI: [0.63-0.96]). Benefits amplified at 3 years, especially mortality (HR: 0.60, [0.55-0.65]). Tirzepatide showed slightly higher 1-year atrial fibrillation risk (HR: 1.04, [1.00-1.07]). No differences in myocardial infarction or hypoglycemia. CONCLUSIONS: In this large real-world propensity-matched analysis, tirzepatide demonstrated superior reductions in mortality, hospitalizations, and cardiorenal outcomes versus dulaglutide in HFpEF patients, with a favorable safety profile.