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Follow-up was intention-to-treat for 24\u2009months. Multiplicity was addressed with Benjamini\u2013Hochberg false discovery rate correction within two prespecified families: (i) clinical time-to-event endpoints (all-cause mortality, MACE, heart failure, MAKE, MALO, atrial fibrillation, stroke) within each comparator pairing, and (ii) window-level laboratory contrasts within each biomarker at baseline, 6, 12, and 24\u2009months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Versus empagliflozin, semaglutide was associated with lower all-cause mortality (hazard ratio [HR] 0.59, 95% confidence interval [CI] 0.51\u20130.69), major adverse cardiovascular events (MACE; HR 0.76, 95% CI 0.66\u20130.88), and heart failure (HR 0.62, 95% CI 0.54\u20130.70). Versus sitagliptin, semaglutide was associated with lower all-cause mortality (HR 0.34, 95% CI 0.27\u20130.42), MACE (HR 0.64, 95% CI 0.51\u20130.81), and heart failure (HR 0.54, 95% CI 0.43\u20130.67). Empagliflozin versus sitagliptin showed lower all-cause mortality (HR 0.48, 95% CI 0.40\u20130.58) and MACE (HR 0.74, 95% CI 0.59\u20130.92), whereas heart failure did not differ significantly.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>In matched cohorts with T2D and obesity, semaglutide was associated with lower 24-month mortality and heart failure risk than empagliflozin, and both semaglutide and empagliflozin were associated with lower mortality and MACE than sitagliptin.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration:<\/jats:title>\n                    <jats:p>Not applicable (retrospective cohort); Institutional Review Board approval CS2-24004, Chung Shan Medical University Hospital.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/20420188261460592","type":"journal-article","created":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T04:44:16Z","timestamp":1783140256000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative 24-month cardiovascular outcomes and biomarker trajectories with semaglutide, empagliflozin, and sitagliptin in people with obesity and type 2 diabetes: a multicenter real-world study"],"prefix":"10.1177","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-8786-5747","authenticated-orcid":false,"given":"Jo-Ching","family":"Chen","sequence":"first","affiliation":[{"name":"Division of Genetics and Endocrinology, Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan"},{"name":"School of Medicine, Chung Shan Medical University, Taichung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0632-3597","authenticated-orcid":false,"given":"Kai-Wen","family":"Liu","sequence":"additional","affiliation":[{"name":"Division of Genetics and Endocrinology, Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan"},{"name":"School of Medicine, Chung Shan Medical University, Taichung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1688-1685","authenticated-orcid":false,"given":"Yu-Nan","family":"Huang","sequence":"additional","affiliation":[{"name":"Division of Genetics and Endocrinology, Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan"},{"name":"School of Medicine, Chung Shan Medical University, Taichung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gideon","family":"Meyerowitz-Katz","sequence":"additional","affiliation":[{"name":"School of Health and Society, University of Wollongong, Wollongong, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsung-Hsun","family":"Tsai","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgery, Taichung Tzu Chi General Hospital, Taichung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4174-5036","authenticated-orcid":false,"given":"Pen-Hua","family":"Su","sequence":"additional","affiliation":[{"name":"Division of Genetics and Endocrinology, Department of Pediatrics, Chung Shan Medical University Hospital, Taichung 402306, Taiwan"},{"name":"School of Medicine, Chung Shan Medical University, Taichung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1111\/dom.15324"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12933-023-01937-x"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(25)00355-1"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.2337\/dci24-0003"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41573-025-01183-8"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1155\/2021\/9032378"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2021.10.033"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41392-024-01931-z"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-024-03015-5"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1111\/dom.15869"},{"key":"e_1_3_4_12_2","first-page":"373","article-title":"Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes","author":"Zinman B.","year":"2015","unstructured":"Zinman B. 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