A large study published this month in Nature Medicine helps answer a question many patients and clinicians have been asking: Do the newer diabetes medications, semaglutide and tirzepatide, actually protect the heart? The study provides strong real-world evidence that both medications offer cardiovascular protection. [1]
In this large real-world observational study, researchers from Mass General Brigham examined health records from nearly one million adults with type 2 diabetes in the United States. They compared outcomes in people taking semaglutide (sold as Ozempic and Wegovy), tirzepatide (sold as Mounjaro and Zepbound), and older diabetes medications. The findings were presented at the American Heart Association Scientific Sessions 2025. [2]
What did the study find?
Both medications were associated with reduced risk of heart attack, stroke, and death from any cause. Semaglutide was associated with an 18 percent lower combined risk of heart attack and stroke compared with sitagliptin, an older diabetes drug with no known effect on heart outcomes. Tirzepatide was associated with a 13 percent lower risk of heart attack, stroke, and death compared with dulaglutide, another GLP-1 medication that has been available for several years.
These benefits appeared early, within the first year of treatment. That timing is consistent with mechanisms beyond weight loss alone. Weight typically takes longer to change significantly.
When the researchers compared tirzepatide directly against semaglutide, they found only small differences between the two. Both offered meaningful protection. This contradicts some manufacturer-sponsored analyses, which had suggested larger advantages for each company’s own product.
Why this research matters
GLP-1 receptor agonists (the drug class that includes both medications) were first developed to help control blood sugar in type 2 diabetes. The weight loss was initially considered a side effect. Over time, that changed. These medications are now widely prescribed for weight management, with or without diabetes.
Heart disease remains the leading cause of death in people with diabetes. Any treatment associated with reduced cardiovascular risk while also improving blood sugar control and supporting weight loss offers real value. These findings reflect routine practice data, complementing results from randomized trials.
Lifestyle still matters
A separate observational study presented at the same conference reinforces another point. Medication alone is not the whole story. Researchers looked at data from more than 63,000 military veterans with type 2 diabetes who were taking GLP-1 medications.
Lifestyle adherence was associated with about a 50 percent lower risk of serious heart problems compared with people receiving standard diabetes care without these medications. The habits studied included healthy eating, regular physical activity, not smoking, adequate sleep, moderate or no alcohol, stress management, and social connection.
Even those who managed just six of these eight factors saw substantial benefit. The message is straightforward. These medications appear to work better when combined with healthy routines.
Prediabetes: timing matters
A new study published in The Journal of Diabetes and Metabolic Disorders examined data from over 10,000 people in India. It found that people who took action to control their prediabetes within two years of diagnosis were more likely to avoid progression to type 2 diabetes. [3]
Prediabetes means blood sugar is higher than normal but not yet in the diabetic range. The condition affects more than one in three adults in the United States. Research from the Diabetes Prevention Programme has shown that lifestyle changes, modest weight loss of around 7 percent, and 150 minutes of physical activity per week can reduce the risk of developing type 2 diabetes by 58 percent.
The earlier someone acts, the better the outcomes. Waiting too long makes reversal harder.
Updated clinical guidelines
The 2025 American Diabetes Association Standards of Care were released earlier this year. The ADA Standards now more broadly recommend GLP-1 receptor agonists for people with type 2 diabetes and chronic kidney disease, with the goal of lowering heart disease risk and slowing kidney damage. [4]
The guidelines also specifically endorse GLP-1 medications for those with type 2 diabetes, obesity, and heart failure with preserved ejection fraction (HFpEF) to improve symptoms and quality of life.
The updated guidance also emphasises plant-based protein, fibre from a variety of sources, limiting saturated fat, and choosing water over sweetened drinks.
The bottom line
For people living with type 2 diabetes, the cardiovascular benefits of medications like semaglutide and tirzepatide now have strong support from real-world evidence. These drugs do more than improve blood sugar. They are associated with reduced risk of heart attack, stroke, and death.
That said, no medication replaces the basics. Regular physical activity, a balanced diet, adequate sleep, and not smoking remain the foundation of good metabolic health. The best outcomes appear to come from combining both approaches.
If you have diabetes or prediabetes and have not discussed these options with your doctor, it may be worth raising the topic at your next appointment.
References and Further Reading
- Krüger, N., et al. (2025). Cardiovascular outcomes of semaglutide and tirzepatide for patients with type 2 diabetes in clinical practice. Nature Medicine.
- American Heart Association. (n.d.). Scientific Sessions 2025.
- The Journal of Diabetes and Metabolic Disorders.
- American Diabetes Association. (2025). Standards of Care in Diabetes—2025. Diabetes Care, 48(Supplement_1).
This article is for general information only and does not replace advice from your healthcare provider.
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