RCT2023 · NEJM · Lincoff AM, Ryan DH et al.
SELECT: semaglutide cuts cardiovascular events 20% in overweight non-diabetics
Who, how long
17,604 adults (45+), BMI ≥ 27, with existing cardiovascular disease and no diabetes, 41 countries, 3.3 years
What they found
Weekly 2.4 mg semaglutide gave –20% heart attack/stroke/CV death, –19% all-cause mortality; –9.4% body weight. The benefit appeared before substantial weight loss — part of the effect isn't via weight.
⚠ Caveat
Secondary prevention (already heart patients); 16.6% stopped for side effects (mostly gastrointestinal); 25–40% of lost weight is lean mass — sarcopenia risk without strength training and protein. Funded by Novo Nordisk.
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Last reviewed: 6 September 2026
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