People who carry excess body weight have an increased risk of cardiovascular disease.  Thus, one of the many health related goals we would like to achieve with obesity medication is to decrease the risk of cardiovascular events (heart attacks and stroke).  No obesity medication has shown to reduce cardiovascular events – until now.


The SELECT trial (disclosure: I was an investigator in this trial) was a large study of 17,604 participants with overweight or obesity, no preexisting diabetes, and all with a history of preexisting cardiovascular (CV) disease (prior heart attack, stroke, or peripheral vascular disease).  Participants were randomized to receive either semaglutide 2.4mg weekly (trade name Wegovy) or placebo, with the primary purpose of the study to see if semaglutide could reduce the risk of cardiovascular events (non fatal heart attack, non fatal stroke, and cardiovascular death).


The high level results were just shared in a press release: Over a period of up to 5 years, there was a statistically significant 20% reduction in cardiovascular events with semaglutide vs placebo.  Each of the three components of the primary endpoint (non fatal heart attack, non fatal stroke, and cardiovascular death) contributed to this reduction.


Semaglutide has previously show a reduction in CV events in people with type 2 diabetes (disclosure: I was an investigator) at diabetes treatment doses of 0.5mg and 1mg weekly (Ozempic).  There are likely many mechanisms by which semaglutide reduces cardiovascular events, including reduction in systemic inflammation, and improvement in many other CV risk factors (including blood sugars, blood pressure, body weight, and cholesterol).  How much of the CV event reduction in the SELECT trial can (or can’t) be attributed to weight loss and/or improvement in other CV risk factors will be very interesting to learn as further details of the results become available.


The SELECT trial results are an important step in paving the way to improved access and financial coverage for weight management medications, with hopeful broadening of insurance/public coverage to include people with cardiovascular disease.   These results also support the importance of treating obesity and obesity-related health issues with more than just lifestyle advice (which is rarely succesful), and treating for the long term.


We look very forward to further details on these exciting results at upcoming meetings and peer-reviewed publications!


Disclaimer: I am an investigator in clinical trials of semaglutide.  I receive honoraria as a continuing medical education speaker and consultant from the makers of semaglutide (Novo Nordisk).


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