Semaglutide has the strongest cardiovascular outcome data. The SELECT trial demonstrated 20% reduction in major adverse cardiovascular events (MACE) for semaglutide 2.4mg in patients with established cardiovascular disease. The SUSTAIN-6 trial showed similar benefits for semaglutide 0.5mg and 1.0mg in type 2 diabetes patients. Liraglutide (LEADER trial) showed 13% MACE reduction. Tirzepatide cardiovascular outcome trials are ongoing. These benefits appear independent of weight loss, suggesting direct cardiovascular protective effects. The American Heart Association now recommends GLP-1 agonists with proven cardiovascular benefit as preferred add-on therapy for type 2 diabetes patients with atherosclerotic cardiovascular disease.
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