SELECT

SELECT is the trial that changed what a GLP-1 prescription is for. Published in 2023, it enrolled 17,604 patients aged 45 or older who had established cardiovascular disease and a BMI of 27 or greater but no diabetes, and randomized them to once-weekly semaglutide 2.4 mg or placebo. Mean follow-up was 39.8 months.

The primary endpoint — cardiovascular death, non-fatal heart attack or non-fatal stroke — occurred in 6.5% of the semaglutide group versus 8.0% on placebo, a hazard ratio of 0.80. In plainer terms, a 20% relative reduction, or about 15 fewer events per 1,000 people treated over roughly three and a half years. That result is why Wegovy’s label now includes reducing the risk of major adverse cardiovascular events in adults with established heart disease and obesity or overweight.

The practical significance is about coverage as much as biology. A medication that prevents heart attacks is a different conversation with an insurer than a medication that reduces weight, and cardiovascular indications have driven real formulary movement. If you have documented heart disease, that history belongs in your prior authorization file.

The important caveat is what SELECT could not show. It was not designed to prove that the benefit comes from weight loss rather than from some direct vascular effect, and the two are hard to untangle. It also reported meaningful discontinuation: 16.6% of the semaglutide group stopped the study drug permanently for adverse events versus 8.2% on placebo. A benefit you stop taking is not a benefit.

Ask a clinician whether your cardiac history meets the labeled indication, and whether that changes which product gets prescribed. Our SELECT breakdown and prior-auth letter generator help translate it into paperwork.