Wegovy and Heart Health: What the SELECT Trial Actually Found

One of the biggest shifts in GLP-1 research is that some studies now measure outcomes beyond the scale. The SELECT trial is a great example. It studied semaglutide 2.4 mg (the dose used in Wegovy) in adults with overweight or obesity who already had cardiovascular disease and did not have diabetes. Its main question wasn't "how much weight do people lose?" but "do fewer people have a heart attack, stroke or cardiovascular death?"

Who was in SELECT?

SELECT enrolled 17,604 people aged 45 or older with a body-mass index (BMI) of 27 or higher and established cardiovascular disease, such as a previous heart attack, stroke or symptomatic peripheral artery disease. People with diabetes were excluded. Participants were randomly assigned to weekly semaglutide 2.4 mg or placebo, on top of their usual care.

What did SELECT report?

Over an average follow-up of about 40 months, a major cardiovascular event (cardiovascular death, nonfatal heart attack or nonfatal stroke) happened to 6.5% of people on semaglutide and 8.0% of people on placebo. That's a relative risk reduction of about 20% (hazard ratio 0.80).

It helps to look at that two ways:

• Relative risk: about 20% fewer events in the semaglutide group.
• Absolute risk: a difference of about 1.5 percentage points over roughly three and a half years.

Both numbers are true; they just answer different questions. Side effects mattered too: 16.6% of people on semaglutide stopped treatment because of adverse events, compared with 8.2% on placebo, mostly because of gastrointestinal symptoms.

What did the FDA approve?

In March 2024, the US FDA approved Wegovy to reduce the risk of major adverse cardiovascular events in adults with established cardiovascular disease and either obesity or overweight, used alongside a reduced-calorie diet and more physical activity. As of October 2026, the current US label lists this indication for both Wegovy injection and Wegovy tablets. Other countries may word or approve it differently.

The specific indication matters. SELECT is not evidence that every GLP-1 medicine, or every product containing semaglutide, protects every person from a heart attack.

Why the details matter

Everyone in SELECT already had cardiovascular disease and was followed closely within a clinical trial. The results shouldn't be automatically stretched to people without established heart disease, to other doses or brands, or to the GLP-1 family as a whole. The trial was funded by Novo Nordisk, the manufacturer. That's worth knowing, though it isn't a reason on its own to dismiss a large, randomized, placebo-controlled study.

If you're curious how heart benefits compare with other outcomes researchers are studying, our overview of GLP-1 benefits beyond weight loss puts them side by side.

Does this replace other heart care?

No. Blood-pressure management, cholesterol treatment, quitting smoking where relevant, diabetes care, movement and other prescribed treatments remain important. A medication decision needs to account for a person's history, contraindications, side effects, other medicines and local labeling. Please don't start, stop or change any heart medicine based on a headline; that's a conversation for your prescriber.

Questions to ask a clinician

• Does the SELECT population resemble my health history?
• What benefits and risks would you expect for me specifically?
• How would this fit with my other cardiovascular prevention?
• Which side effects should I report, and when?

The key takeaway is impressive but specific: SELECT supports a cardiovascular benefit for semaglutide 2.4 mg in adults with overweight or obesity and established heart disease. It isn't a universal promise attached to every product in the GLP-1 family.