News · Analysis

The cardiovascular asymmetry, filed: SELECT is a placebo trial and SURPASS-CVOT is not

Semaglutide holds a placebo-controlled outcomes trial reporting about a 20% reduction in major adverse cardiovascular events. Tirzepatide's comparable trial was run against an active drug, which supports a weaker claim.

Event date 2026-08-03 · Published 2026-08-03 · EV-5101

We have added trial records for both, because the difference between them is routinely flattened into a sentence that makes them sound equivalent.

SELECT randomised more than 17,000 adults with overweight or obesity and established cardiovascular disease, without diabetes, against placebo. It reported about a 20% relative reduction in cardiovascular death, non-fatal myocardial infarction or non-fatal stroke over a mean of roughly 40 months.

SURPASS-CVOT compared tirzepatide with dulaglutide — an active drug that already had cardiovascular evidence — in a type 2 diabetes population. An active-comparator design answers “is this at least as good as something that works?”, which is a different and weaker question than “does this reduce events against no treatment?”

One more thing worth stating: 20% is a relative reduction. The event rate fell from about 8.0% to about 6.5%, an absolute difference of roughly 1.5 percentage points. Both figures are true and a page quoting only the first is quoting the more impressive one.

Neither population overlaps: SELECT excluded diabetes, SURPASS-CVOT required it.

Frequently asked questions

Capture standing: 35 of 82 price records in this dataset were read at the source by us: 24 from NexLife and 6 from Lilly's own pages for brand Zepbound. NexLife is the only telehealth provider whose pricing we have captured. Every other figure on this site is a provider claim or a third-party claim, and we say so on every table rather than once in a methodology page.