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About 10% of tirzepatide participants had a heart-rate increase above 20 bpm during escalation, compared with 3% on placebo. A lean Japanese cohort reached +10 to +13 bpm, and 23% of Japanese participants at 15 mg crossed the abnormal-pulse threshold versus 7% of other participants, despite only 17% higher exposure. Lean and East Asian bodies showed greater cardiovascular sensitivity than exposure alone predicted