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The SUPRPASS-4 trial (262), involving 2002 participants with high-risk cardiovascular profiles followed for up to 104 weeks, showed no difference in 4-MACE events (cardiovascular death, myocardial infarction, stroke, and hospitalization for unstable angina) with tirzepatide compared to insulin glargine (HR 0.74
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These effects were more noticeable in longer trials and when ALA was combined with dietary changes.29 A 2020 dose-response meta-analysis confirmed small but statistically significant reductions in weight and BMI across 18+ randomized controlled trials.30 However, waist circumference (WC) a marker of central obesity showed no consistent change, and the benefit appeared greater in women and with longer treatment durations
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