A major clinical trial has found that semaglutide, best known as a diabetes and weight-loss medicine, may also meaningfully lower the risk of heart attack, stroke and cardiovascular death.
The SELECT trial
Published in the New England Journal of Medicine, the SELECT trial followed 17,604 adults aged 45 and over with overweight or obesity and existing cardiovascular disease, but no diabetes, for around three years. Participants received either weekly 2.4 mg semaglutide or a placebo.
What the trial found
Those taking semaglutide had a 20% lower overall risk of major cardiac events, a 28% reduction in heart attacks (among those already on cholesterol medication), a 7% decrease in non-fatal strokes, and a 15% drop in cardiovascular deaths. The all-cause death rate was also 19% lower in the semaglutide group.
Researchers noted this level of benefit across both cardiovascular and non-cardiovascular deaths is unusual, and not something typically seen with medications like statins that target cardiovascular risk specifically.
What's still unclear
Exactly how semaglutide produces this cardiovascular benefit, whether through weight loss alone or some additional mechanism, isn't yet fully understood. The trial also didn't test whether the same benefit would apply to people with overweight or obesity who don't yet have diagnosed cardiovascular disease.
Semaglutide is currently approved in Australia for managing type 2 diabetes. Any broader use for cardiovascular risk reduction outside of diabetes management would need further regulatory consideration; this is an evolving area, not a current prescribing pathway.
