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Compared with placebo or other active glucose\u2010lowering drugs, tirzepatide had a neutral effect on the overall risk for heart failure (risk ratio [RR] 0.63 [95% confidence interval (CI) 0.35\u20131.13]), but the effect was neither statistically nor clinically meaningful (absolute risk reduction [ARR] 0.17%, number needed to treat [NNT] 588; Food and Drug Administration (FDA) minimal important difference [MID] 1.5%). The certainty of evidence was rated as moderate according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.628;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a00.0%). Subgroup analysis revealed different pooled estimates for heart failure outcomes in the\u00a0\u2264\u00a058\u00a0years of age subgroup (RR 0.40 [95% CI 0.17\u20130.96]) compared with the &gt;\u00a058\u00a0years' subgroup (RR 0.86 [95% CI 0.39\u20131.90]) (\n                      <jats:italic>p<\/jats:italic>\n                      for interaction\u00a0=\u00a00.201). Additionally, subgroup analysis comparing tirzepatide alone with tirzepatide in combination with other agents revealed different pooled estimates (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.661;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a00.0%), with an RR 0.43 (95% CI 0.20\u20130.88) and 2.25 (95% CI 0.51\u20139.87), respectively (\n                      <jats:italic>p<\/jats:italic>\n                      for interaction\u00a0=\u00a00.05). Subgroup analyses stratified according to different doses of tirzepatide, baseline body weight, body mass index, fasting plasma glucose, glycated haemoglobin, T2DM, obesity, or overweight, and intervention time indicated no association between tirzepatide use and the risk for heart failure.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Tirzepatide had no overall effect on heart failure outcomes in patients with T2DM or obesity. However, among patients\u00a0\u2264\u00a058\u00a0years of age, tirzepatide yielded a 60% relative risk reduction (i.e.,\u00a0RR\u00a0=\u00a00.40), while in patients undergoing monotherapy, it yielded a 57% relative risk reduction (i.e.,\u00a0RR\u00a0=\u00a00.43). Results of this systematic review and meta\u2010analysis of RCTs support the safety of tirzepatide as a therapeutic option for the clinical management of T2DM or obesity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>PROSPERO registration number, CRD42024620051<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/dmrr.70097","type":"journal-article","created":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T19:35:20Z","timestamp":1760643320000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Effect of Tirzepatide on Heart Failure in Type 2 Diabetes Mellitus and Obesity: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1002","volume":"41","author":[{"given":"Yi\u2010Meng","family":"He","sequence":"first","affiliation":[{"name":"Department of Endocrinology and Metabolism the 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