What's the difference between Ozempic, Wegovy, Mounjaro, and Zepbound? Do they all have the same cardiac data?

These are distinct drugs in related classes, with different evidence bases. Ozempic and Wegovy are both semaglutide (same molecule, different doses and indications): Ozempic at 0.5–2 mg weekly is FDA-approved for type 2 diabetes; Wegovy at 2.4 mg weekly is FDA-approved for chronic weight management. The SELECT trial used the 2.4 mg Wegovy dose. Mounjaro and Zepbound are tirzepatide, a dual GIP/GLP-1 receptor agonist that activates both the GLP-1 receptor and the glucose-dependent insulinotropic polypeptide receptor, producing greater weight loss than semaglutide in head-to-head studies (approximately 15–22% body weight reduction vs. 9–15% for semaglutide).

Tirzepatide's cardiovascular outcomes trial (SURMOUNT-MMO) is currently underway. Early surrogate data is very promising, tirzepatide produces greater improvements in blood pressure, hs-CRP, and lipids than semaglutide in comparative studies. But the definitive MACE reduction data that SELECT provided for semaglutide does not yet exist for tirzepatide. The cardiovascular conversation about these drugs should always start with: "Which specific drug, and which specific trial?" Right now, semaglutide has the strongest cardiovascular outcomes evidence. Tirzepatide has the strongest weight and metabolic data. (Jastreboff et al., NEJM, 2022)

Cardiologist's calibrated position, Solid (1) for semaglutide MACE data. Early (3) for tirzepatide MACE data (evidence expected from ongoing trial).

What to do: When evaluating any GLP-1 or dual agonist for cardiovascular purposes, ask your cardiologist specifically which clinical trial evidence supports the cardiac indication for that specific drug.

For the full picture, read The Drug That Surprised Cardiologists.