Four trials went into this. One of them is almost all of it.
Where the weight sits
The headline number is 14,348 participants. Of those, 13,165 came from a single 2025 trial. [1] The remaining three studies contributed 1,183 people between them.
So this is one large trial with three small ones attached. That is not a criticism of the method. It is a description of what the method had to work with, and it changes how much a seven-node network can tell you — the same reason one famous trial and a whole evidence base give different answers.
The results, with their reference arm
Every difference is published against tirzepatide 5 mg. At week 16, tirzepatide 15 mg took off 2.68 kg more, 95% CI −4.98 to −0.38. Tirzepatide 1 mg took off 4.39 kg less and dulaglutide 0.75 mg 3.10 kg less.
On HbA1c at week 24, tirzepatide 15 mg gave 0.40 points more reduction and 10 mg gave 0.23 more. Dulaglutide 1.5 mg came in at +0.67%, which reads as a worse reduction, not a better one. Drop the reference arm from any of those sentences and they stop meaning anything.
What did not differ
All-cause mortality and major cardiovascular events showed no significant difference between any treatment in the network.
With 446 fewer events than you would want, that null is uninformative rather than reassuring. The authors say as much when they flag limited event counts, and a pooled figure built this way carries the same problem as two poolings of the same trials disagreeing.
The split the title promises
The paper is titled for patients with and without established atherosclerotic cardiovascular disease. The abstract reports no such split.
The full text may carry it and we have not read the full text. What can be said is that anyone quoting this as evidence about the ASCVD subgroup is quoting something the abstract does not contain.
What to take
More tirzepatide does more, and costs more nausea. That is the finding, and it was not much in doubt.
The dose-by-dose ranking is the new part, and it is the part resting on indirect comparisons and pre-maintenance doses — so read it as an ordering to test rather than one to buy on, the way a pooled average almost nobody experienced is a summary rather than a forecast.