Dulaglutide emerges as the only GLP-1 receptor agonist demonstrating statistically significant reduction in major adverse cardiovascular events (MACE) in predominantly primary prevention populations, with benefits sustained over five years in the REWIND trial. While newer agents like tirzepatide and semaglutide achieve superior HbA1c reductions and weight loss, dulaglutide's cardiovascular advantage represents a critical distinction in therapeutic selection. This finding challenges the assumption that newer necessarily means better in diabetes care. The drug's once-weekly, no-titration dosing and proven real-world persistence offer practical advantages, particularly for healthcare systems with resource constraints. The cardiovascular protection in primary prevention is especially significant, as most diabetes patients haven't yet experienced major cardiac events. This positions dulaglutide as potentially superior for preventing first cardiovascular events, while newer agents may excel in metabolic optimization. The SURPASS-CVOT trial's establishment of tirzepatide as merely non-inferior to dulaglutide for cardiovascular outcomes reinforces this perspective. Rather than viewing these medications as competing, the evidence suggests complementary roles based on patient priorities: cardiovascular protection versus metabolic optimization.