Semaglutide breakthrough: new hope for heart health in the fight against obesity

Over 17,000 patients took part in the SELECT clinical trials which found that semaglutide (Wegovy / Ozempic) resulted in a 20% reduction in major cardiovascular events.

SELECT Semaglutide trial results

In a groundbreaking development, the SELECT clinical trial has unveiled evidence of semaglutide's remarkable impact on reducing cardiovascular events in individuals with overweight or obesity and preexisting cardiovascular disease (CVD) who are not diabetic. The results, released at the American Heart Association 2023 Scientific Sessions, were  hailed by obesity specialists and cardiologists alike, and present a significant stride toward addressing the global epidemic of obesity and its associated cardiovascular risks. 

GLP-1  benefits

Semaglutide is the active drug in Wegovy and Ozempic, the popular medications for the treatment of weight management and type 2 diabetes respectively.

The SELECT trial, comprising 17,604 patients, was conducted at 804 sites across 41 countries, focused on patients aged 45 or older with a BMI of at least 27 kg/m² and preexisting CVD but no history of diabetes.

The trial revealed a 20% relative reduction in the risk of major adverse cardiovascular events (MACE) with semaglutide compared to a placebo on top of standard care.

Obesity and overweight: “modifiable” risk factors

Dr. A. Michael Lincoff of the Cleveland Clinic highlighted during the American Heart Association 2023 Scientific Sessions that semaglutide is the first weight management therapy proven, through rigorous randomised controlled trials, to reduce the risk of cardiovascular events. This establishes overweight and obesity as modifiable risk factors for cardiovascular disease, marking a significant advancement in treatment options.

One noteworthy aspect of the trial is the early occurrence of the MACE reduction with semaglutide, which took place before substantial weight loss was achieved. This raises questions about the mechanism behind the cardiovascular benefit, with experts suggesting a combination of direct drug effects and indirect benefits from weight loss.

Cardiovascular disease - the leading global cause of death

Nonetheless, use of semaglutide could help address CVD, which remains the leading cause of mortality around the world, and obesity, which is still an epidemic,

Cynthia Jackevicius of Western University of Health Sciences emphasised the potential population impact of semaglutide, stating that it could have a profound effect on reducing morbidity and mortality from cardiovascular disease. However, she also acknowledged the need to address challenges related to cost and accessibility to ensure broad patient access.

Despite the promising results, challenges remain, including the well-known gastrointestinal side effects associated with semaglutide. These side effects led to a higher rate of permanent treatment discontinuation in the semaglutide group. Additionally, factors such as cost, accessibility, and varying insurance coverage in different parts of the world pose potential barriers to widespread adoption.

Dr. Martha Gulati, president of the American Society for Preventive Cardiology, expressed hope that the findings will lead to regulatory approval for semaglutide in treating cardiovascular risk in patients without diabetes who are overweight or obese. However, she highlighted existing barriers such as limited access and medication shortages.

The SELECT trial, while a significant milestone, also underscores the importance of ensuring diverse trial populations for more accurate generalizability. Dr. Ania Jastreboff of Yale School of Medicine emphasised the need for better representation of women and individuals from diverse ethnic backgrounds in such trials.


Published: 21 Nov  2023