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Based on this review, evidence from head-to-head and insulin-comparator trials demonstrates that dual GIP/GLP-1 co-agonism consistently overcomes metabolic plateaus that result from single-pathway therapy, producing superior glycated hemoglobin reduction, bariatric-level weight loss (up to 25.3%), and robust macrovascular and heart failure protection, including a 38% reduction in composite cardiovascular risk among patients with heart failure with preserved ejection fraction (HFpEF)