What did the SELECT trial find?
SELECT found that semaglutide lowered the risk of serious heart events by about one fifth in people who already had heart disease and excess weight. The trial, published in the New England Journal of Medicine in December 2023, followed its participants for an average of 39.8 months.
| Measure | Semaglutide 2.4 mg weekly | Placebo |
|---|---|---|
| People randomized | 8,803 | 8,801 |
| Heart attack, stroke or cardiovascular death | 569 (6.5%) | 701 (8.0%) |
| Hazard ratio | 0.80 (95% CI 0.72 to 0.90) | Reference |
| Stopped the study drug because of side effects | 16.6% | 8.2% |
The 20 percent figure is a relative reduction. In absolute terms, the gap was 1.5 percentage points over a little more than three years. Both numbers are true; the absolute one tells you how many events were actually avoided in a group of people like those in the trial.
Who was in the trial, and who was left out?
SELECT enrolled adults aged 45 or older with established cardiovascular disease, such as a prior heart attack or stroke, and a BMI of 27 or higher. No one in the trial had diabetes. Everyone kept their usual care, including blood pressure and cholesterol treatment.
That design shapes who the result applies to:
- It applies most directly to a man who has had a heart attack, a stent or a stroke, is overweight, and does not have diabetes.
- It does not answer whether semaglutide prevents a first heart attack in someone without known heart disease, because those people were not studied.
- It does not replace statins, blood pressure medicine, quitting smoking or exercise. The benefit was measured on top of those.
What changed on the label in 2024?
On March 8, 2024, the FDA approved a new indication for Wegovy: reducing the risk of cardiovascular death, heart attack and stroke in adults with cardiovascular disease and either obesity or overweight, alongside a reduced-calorie diet and more physical activity. The agency described it as the first weight-loss medicine approved to help prevent these events in that group.
The current Wegovy label lists that heart-risk use among its indications. The label’s warnings still apply to everyone using it, including a boxed warning about thyroid C-cell tumors seen in rodents, plus warnings on pancreatitis, gallbladder disease, kidney injury from dehydration and an increased heart rate.
What if you do not have heart disease yet?
Then SELECT is encouraging but not proof for you. Losing excess weight improves blood pressure, blood sugar and cholesterol in many men, and those are routes to lower heart risk, but the trial cannot tell you how much semaglutide would lower a first-event risk.
A better first step is to measure where you stand. An ApoB blood test counts the particles that carry cholesterol into artery walls, and a lipoprotein(a) test checks an inherited risk factor that routine cholesterol panels miss. Our answer on blood tests for heart attack risk explains how those pieces fit together.
Should men with heart disease ask their cardiologist about it?
Yes, if you fit the SELECT profile. Bring the trial to your next cardiology visit and ask whether you match the group studied, whether semaglutide would add to what your current medicines already do, and how a faster heart rate or stomach side effects would interact with your other treatment. Our page for men with heart disease and the longer SELECT trial article go deeper.
Some symptoms cannot wait for any appointment. Chest pain or pressure, pain spreading to the arm or jaw, sudden shortness of breath, or stroke signs such as face drooping, arm weakness or slurred speech are emergencies: call 911.
How Ultimate Male works alongside your heart care
Ultimate Male does not replace your cardiologist. For a man with heart disease and excess weight, our medical weight loss evaluation in San Gabriel or Downey starts with your history, current heart medicines and labs, and your provider can share findings with your cardiologist before semaglutide is considered.
If semaglutide is a fit, the plan includes a gradual dose climb, check-ins and repeat labs. Our semaglutide medication guide covers dosing and side effects in more detail. Bring your most recent cardiology notes and medicine list to the free 10-minute call so the conversation starts with the full picture.
