This is the study that changed Wegovy®‘s status: from “weight-loss drug” to a treatment that cuts major cardiovascular events by 20%. Published in the New England Journal of Medicine in late 2023, SELECT is one of the largest trials ever run in obesity. But you have to look at who was in it — because SELECT is often made to say more than it does.
The trial in brief
- 17,604 participants across 41 countries.
- Profile: aged 45 or over, BMI ≥ 27, established cardiovascular disease (prior heart attack, stroke or peripheral artery disease), and no diabetes.
- Weekly semaglutide 2.4 mg (the Wegovy® dose) versus placebo, on top of usual cardiovascular care, with an average follow-up of more than 3 years.
- Primary endpoint: “MACE” — cardiovascular death, non-fatal heart attack or non-fatal stroke.
The headline result: −20%
A major cardiovascular event occurred in 6.5% of participants on semaglutide versus 8.0% on placebo: a 20% relative reduction (hazard ratio 0.80; 95% confidence interval 0.72–0.90). In practice, treating about 67 people with this profile for the trial’s duration prevented one major event — in the same league as well-established cardiovascular treatments.
Average weight loss, meanwhile, settled around 9% (versus ~1% on placebo) — noticeably less than in classic weight-loss trials, because the population and the goal were different.
The most interesting detail: weight doesn’t explain everything
A prespecified analysis of SELECT showed the cardiovascular benefit was largely independent of how much weight was lost: participants who lost little benefited too. The exact mechanisms (inflammation, blood pressure, lipids, direct vascular effects and more) are still being explored — but it changes how to think about the medication: the effect isn’t just the number on the scale.
What SELECT changed in practice
On the strength of these results, Wegovy® gained a cardiovascular indication extension in 2024, first in the United States and then in Europe. Data of this kind also weighs on coverage discussions — in France, established cardiovascular disease is among the comorbidities in the reimbursement rules.
What SELECT doesn’t say
- It doesn’t apply to everyone: all participants had established cardiovascular disease and were 45 or over. SELECT does not demonstrate the same benefit in a young person with no cardiac history.
- No diabetes: people with diabetes were excluded (other trials cover that population).
- A trial, not an individual guarantee: −20% is a population average; your own situation is your doctor’s call, especially with a cardiovascular history.
Day to day, what you can measure yourself is your consistency and your progress: the Doza app keeps your injections and weight curve up to date in a few seconds a week, so you arrive at your appointment with clear data — the rest is a conversation with your doctor.
FAQ — the SELECT trial
What is the SELECT trial?
A randomised trial of 17,604 people with overweight or obesity (BMI ≥ 27), aged 45 and over, with established cardiovascular disease and no diabetes, comparing weekly semaglutide 2.4 mg with placebo over more than 3 years on average.
Does Wegovy protect the heart?
In the profile SELECT studied, yes: 20% fewer major cardiovascular events (6.5% versus 8.0%). The result led to a cardiovascular indication extension in 2024. It doesn’t automatically carry over to people without established heart disease.
Do you need to lose a lot of weight to get the heart benefit?
According to SELECT’s prespecified analysis, no: the benefit was largely independent of the amount of weight lost. The precise mechanisms are still under study.
Does SELECT apply to people with diabetes?
No — they were excluded from this trial. Semaglutide has been studied separately in type 2 diabetes (as Ozempic®, at other doses).
Sources: Lincoff et al., NEJM 2023 (SELECT) · American College of Cardiology — SELECT summary · prespecified SELECT analysis of adiposity and cardiovascular outcomes (2025). General information only: your cardiovascular situation is your doctor’s call.