Tirzepatide versus GLP-1 receptor agonists and stroke in patients with atrial fibrillation and type 2 diabetes.

Patients with atrial fibrillation and type 2 diabetes remain at high risk of stroke despite anticoagulation and glucose-lowering treatment. We examined whether tirzepatide was associated with lower cerebrovascular risk than established glucagon-like peptide-1 receptor agonists in a retrospective cohort from a large international federated electronic health-record network. Here we show that, among 14,118 matched pairs of adults initiating tirzepatide or another glucagon-like peptide-1 receptor agonist, tirzepatide use was associated with lower risks of any stroke, ischemic stroke, hemorrhagic stroke, and death from any cause. The absolute difference in stroke risk was 2.1 percentage points at one year, and the absolute difference in mortality was 6.2 percentage points. These observational findings support further assessment of tirzepatide as a potential option for people with both conditions, but randomized trials are required before treatment recommendations can change.