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The efficacy and safety of tirzepatide, with a special focus on cardiovascular safety, were investigated in the 52-week SURPASS-4 trial testing tirzepatide versus insulin glargine in adults with T2D and a high cardiovascular risk under inadequate glycemic control at baseline on one to three oral glucose-lowering medications (metformin, sulfonylurea, SGLT-2 inhibitor) (54, 74)

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Clearly, those mechanisms can extend well beyond diabetes control or weight loss promotion

Studies show GLP-1-only agonists (like semaglutide) produce 15-17% weight loss at maximum doses, making it the foundation of the triple-agonist effect

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To that end, recently proposed metabolic biomarkers beyond HbA1c, such as AGEs, advanced oxidation protein products, thiobarbituric-acid reacting substances, fructosamine, and 1,5-anhydro-d-glucitol, might evolve into surrogate biomarkers for the risk stratification of AF populations with comorbid DM