Landmark trials, explained with the numbers

One page per trial: who was enrolled, what was compared, the primary outcome with absolute event rates and the effect estimate, the harms, the limitations, and where the result sits in European guidelines. Reported results link to the main trial publication and, where relevant, companion publications. Guideline context is a dated orientation.

• DAPA-HF (2019)In 4,744 patients with symptomatic heart failure and an ejection fraction of 40% or less, dapagliflozin 10 mg daily on top of recommended therapy reduced worsening heart failure or cardiovascular death from 21.2% to 16.3% over a median of 18.2 months, with and without diabetes.
• EMPEROR-Reduced (2020)In 3,730 patients with heart failure and an ejection fraction of 40% or less, empagliflozin 10 mg daily reduced cardiovascular death or heart failure hospitalisation from 24.7% to 19.4% over a median of 16 months, and slowed the decline in kidney function.
• DELIVER (2022)In 6,263 patients with heart failure and an ejection fraction above 40%, dapagliflozin 10 mg daily reduced worsening heart failure or cardiovascular death from 19.5% to 16.4% over a median of 2.3 years, extending the SGLT2 inhibitor benefit to HFmrEF and HFpEF.
• FIDELIO-DKD (2020)In 5,734 patients with chronic kidney disease and type 2 diabetes already on maximal RAS blockade, finerenone reduced the composite of kidney failure, sustained 40% eGFR decline, or renal death from 21.1% to 17.8% over a median of 2.6 years, at the cost of more hyperkalaemia.
• STEP 1 (2021)In 1,961 adults with obesity but without diabetes, once-weekly semaglutide 2.4 mg plus lifestyle intervention produced a mean weight change of -14.9% at 68 weeks against -2.4% with placebo, a difference of 12.4 percentage points, with gastrointestinal effects the main adverse events.
• SURPASS-2 (2021)In 1,879 patients with type 2 diabetes on metformin, tirzepatide at 5, 10, and 15 mg weekly lowered HbA1c by 2.01 to 2.30 percentage points over 40 weeks versus 1.86 with semaglutide 1 mg, and produced 1.9 to 5.5 kg more weight loss, with similar gastrointestinal side effects.
• SELECT (2023)In 17,604 adults with established cardiovascular disease and a BMI of 27 or more but no diabetes, once-weekly semaglutide 2.4 mg reduced cardiovascular death, nonfatal MI, or nonfatal stroke from 8.0% to 6.5% over a mean follow-up of 39.8 months.
• RECOVERY (dexamethasone) (2021)In 6,425 hospitalised COVID-19 patients, dexamethasone 6 mg daily for up to 10 days reduced 28-day mortality from 25.7% to 22.9%, with the benefit concentrated in patients on invasive ventilation or oxygen and no benefit, possibly harm, in those needing no respiratory support.
• COLCOT (2019)In 4,745 patients enrolled within 30 days of a myocardial infarction, colchicine 0.5 mg daily reduced a composite of ischaemic cardiovascular events from 7.1% to 5.5% over a median of 22.6 months, driven mainly by fewer strokes and urgent revascularisations, with a small excess of pneumonia.
• ASPREE (2018)In 19,114 healthy community-dwelling adults aged 70 or older, daily aspirin 100 mg did not reduce cardiovascular disease (10.7 versus 11.3 events per 1,000 person-years) but increased major haemorrhage (8.6 versus 6.2 per 1,000 person-years) over a median of 4.7 years, and all-cause mortality was higher with aspirin.

For literature search, education, and professional evidence review only. Not for diagnosis, treatment selection, triage, monitoring, prognosis, or patient-specific clinical decision-making.