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The SELECT cardiovascular outcomes trial actually demonstrated cardiovascular benefit rather than harm, which was reassuring

In SURPASS 4 The risk of suffering from any major adverse cardiovascular event MACE-4 and MACE-3 (including myocardial infarction, stroke, hospitalization for angina, and all-cause death) with the highest dose of tirzepatide (15 mg per week) has been estimated at 050 (026095), which was intended to provide initial proof of the cardiovascular safety of tirzepatide [2, 5]

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Hedonic hunger: a new dimension of appetite

And I think its probably both