Clinical trials
SELECT: semaglutide and cardiovascular outcomes
A landmark result: weight-directed therapy that reduced heart attacks and strokes, not just risk markers.
Quick Answer
SELECT (NEJM, 2023) enrolled about 17,600 adults with established cardiovascular disease and overweight or obesity, but without diabetes. Semaglutide 2.4 mg reduced major adverse cardiovascular events (cardiovascular death, heart attack or stroke) by about 20% versus placebo — the first time an obesity medication showed reduced cardiovascular events in this population. Compounded semaglutide is not FDA-approved.
Key Facts
- ~17,600 adults with cardiovascular disease + overweight/obesity, no diabetes
- Semaglutide 2.4 mg reduced major cardiovascular events by ~20% vs placebo
- First obesity drug to show cardiovascular event reduction in this group
- Supported a cardiovascular-risk-reduction indication
- Compounded semaglutide is not FDA-approved
Markers vs outcomes
Improving weight, blood pressure and lipids is encouraging, but it is not the same as proving fewer heart attacks and strokes. SELECT was designed to test hard cardiovascular outcomes — the standard for demonstrating real benefit.
Design and result
About 17,600 adults with established cardiovascular disease and overweight or obesity, without diabetes, received semaglutide 2.4 mg or placebo. Semaglutide reduced the primary composite of cardiovascular death, nonfatal heart attack or nonfatal stroke by approximately 20%.
Why it was a milestone
SELECT was the first trial to show that an obesity medication reduces cardiovascular events in people with obesity but not diabetes — reframing semaglutide as cardiometabolic therapy, not only weight loss, and supporting a cardiovascular-risk-reduction use. Whether the benefit is from weight loss alone or additional effects is still studied.
Caveats
Participants had established cardiovascular disease, so results may not generalize to lower-risk people. The branded product was studied. Compounded semaglutide is not FDA-approved. Cardiovascular care is individualized.
Frequently asked questions
Did SELECT show semaglutide prevents heart attacks?
SELECT showed semaglutide 2.4 mg reduced major cardiovascular events (cardiovascular death, heart attack or stroke) by about 20% in people with established cardiovascular disease and overweight/obesity, without diabetes.
Does this apply to everyone?
SELECT enrolled people with established cardiovascular disease, so the findings are strongest for that group; care is individualized.
References
- Lincoff AM, et al. Semaglutide and cardiovascular outcomes in obesity without diabetes (SELECT). N Engl J Med. 2023;389:2221-2232.
- Marso SP, et al. Semaglutide and cardiovascular outcomes in type 2 diabetes (SUSTAIN-6). N Engl J Med. 2016;375:1834-1844.
- U.S. Food and Drug Administration. Wegovy, Ozempic and Rybelsus (semaglutide) prescribing information. Novo Nordisk.
Citations are for educational reference; this article summarizes published research in plain language and is not medical advice.
Bottom Line
SELECT showed semaglutide 2.4 mg reduced major cardiovascular events by about 20% in people with cardiovascular disease and obesity without diabetes — a landmark beyond weight on a scale.