Recommended Citation
Cecil A, Essien E, Amoako G, Agyekum A. Cardiovascular, Metabolic, and Mortality Outcomes With Semaglutide Versus Tirzepatide in Obese Patients With Hypothyroidism: A Real-World Analysis. Poster presentation at: American Association of Clinical Endocrinology; April 23, 2026; Las Vegas, NV.
Presentation Notes
Poster presentation at: American Association of Clinical Endocrinology; April 23, 2026; Las Vegas, NV.
Abstract
OBJECTIVE: Hypothyroidism coexists with obesity and increases cardiovascular risk. This study compared cardiovascular, metabolic, and mortality outcomes between semaglutide and tirzepatide in obese hypothyroid patients.
METHODS: This retrospective cohort study utilized the TriNetX Global Collaborative Network (155 healthcare organizations). Adults aged ≥18 years with BMI ≥30 kg/m² and hypothyroidism receiving semaglutide (n=104,138) or tirzepatide (n=45,772) were identified. After 1:1 propensity score matching for demographics, comorbidities, and medications, 42,940 patients per cohort were analyzed over 5 years. Outcomes included all-cause mortality, myocardial infarction, heart failure, pulmonary embolism, chronic kidney disease, hypertension, type 2 diabetes, osteoporosis, and cerebrovascular disease. Statistical analyses included risk ratios (RR), hazard ratios (HR), and Kaplan-Meier survival analysis.
RESULTS: Matched cohorts were well-balanced (mean age 57.8 vs 57.6 years; 78.9% vs 79.1% female). Tirzepatide demonstrated superior outcomes across multiple domains. All-cause mortality was significantly lower with tirzepatide (0.7% vs 1.2%; RR 1.725, p<0.001; HR 1.576). Heart failure incidence favored tirzepatide (1.7% vs 2.2%; RR 1.282, p<0.001; HR 1.166). Pulmonary embolism risk was reduced (0.4% vs 0.5%; RR 1.333, p=0.006). Chronic kidney disease incidence was lower (2.6% vs 2.9%; RR 1.141, p=0.003). New-onset hypertension was significantly reduced (6.1% vs 7.7%; RR 1.260, p<0.001; HR 1.127, p=0.013). Type 2 diabetes incidence was lower (3.9% vs 4.8%; RR 1.248, p<0.001). Cerebrovascular disease showed significant reduction (1.5% vs 1.9%; RR 1.282, p<0.001; HR 1.170, p=0.005). Myocardial infarction and osteoporosis outcomes were comparable (p>0.05).
DISCUSSION/CONCLUSIONS: In this large real-world cohort of obese patients with hypothyroidism, tirzepatide use was associated with lower rates of all-cause mortality and several adverse cardiometabolic outcomes compared with semaglutide over five years of follow-up. Notably, reduced incidences of heart failure, chronic kidney disease, hypertension, type 2 diabetes, pulmonary embolism, and cerebrovascular disease were observed, while myocardial infarction and osteoporosis outcomes were similar between groups. These findings suggest that dual GIP/GLP-1 receptor agonism may confer incremental cardiometabolic advantages in this high-risk population. However, given the retrospective observational design and potential for residual confounding, these associations should be interpreted cautiously. Prospective randomized studies are warranted to confirm these findings and to better define the comparative role of incretin-based therapies in patients with hypothyroidism and obesity.
Type
Poster