Who was in the SELECT trial
SELECT asked a question no earlier trial had answered: does a weight-loss dose of semaglutide reduce heart attacks and strokes in people who already have heart disease and carry extra weight, but do not have diabetes? Earlier heart data for this drug family came from people with type 2 diabetes.
The trial, published in the New England Journal of Medicine in December 2023, enrolled 17,604 adults aged 45 or older. Everyone had established cardiovascular disease and a BMI of 27 or higher, and no one had diabetes. Half took weekly semaglutide 2.4 mg, the Wegovy dose, and half took placebo. Both groups kept their usual care, including blood pressure and cholesterol treatment, and received lifestyle counseling, as the FDA describes.
That design makes SELECT especially relevant to the typical man who has had a heart attack or stent, is overweight, and has normal blood sugar.
What the trial found
The main measure was a combination of three events: death from cardiovascular causes, nonfatal heart attack and nonfatal stroke.
| Measure | Semaglutide | Placebo |
|---|---|---|
| Participants | 8,803 | 8,801 |
| Heart attack, stroke or cardiovascular death | 569 (6.5%) | 701 (8.0%) |
| Relative reduction | 20% (hazard ratio 0.80) | |
| Stopped treatment because of side effects | 16.6% | 8.2% |
| Average follow-up | 39.8 months |
In absolute terms, the difference was 1.5 percentage points over a little more than three years. Put another way, roughly 67 people would need to take semaglutide for about three years to prevent one of these events, a rough figure worked out from the trial’s averages. That sounds modest until you remember the events are heart attacks, strokes and deaths, in people already on standard heart treatment.
The effect also appeared on top of good care. Both groups received standard treatment such as blood pressure and cholesterol management, so the result is not a comparison against an untreated group.
One point is still debated: how much of the benefit came from weight loss and how much from other effects of the medicine on blood vessels, inflammation or blood pressure. The answer matters less to a patient than the result, but it is a reason not to assume that any route to the same weight loss would produce the same heart benefit.
The 2024 label change that followed
On March 8, 2024, the FDA approved a new use for Wegovy: reducing the risk of cardiovascular death, heart attack and stroke in adults with cardiovascular disease and either obesity or overweight. The FDA called it the first weight-loss medicine also approved to help prevent these events in that group, to be used alongside a reduced-calorie diet and more physical activity.
The current Wegovy label lists that heart-risk use first among its indications, ahead of long-term weight reduction. Some health plans that exclude weight-loss medicines look at a heart-risk indication differently, so if you have coverage elsewhere, it is worth asking your plan which use it recognizes.
Side effects and the trade-off
Twice as many people stopped semaglutide as stopped placebo because of side effects, 16.6% against 8.2%, mostly from stomach problems such as nausea, vomiting and diarrhea. The label also carries a boxed warning about thyroid C-cell tumors and warnings about pancreatitis, gallbladder disease, kidney injury from dehydration and a raised heart rate.
For men with heart disease, the heart rate point and the dehydration point deserve a mention to your cardiologist, especially if you take diuretics. Anyone with a personal or family history of medullary thyroid carcinoma or MEN 2 should not take semaglutide at all.
What SELECT does and does not mean for you
SELECT applies most directly to men who already have heart disease, such as a past heart attack, stroke or narrowed leg arteries, and who carry extra weight without diabetes. It did not test semaglutide as a way to prevent a first heart attack in men without heart disease, so it cannot promise that benefit.
It also does not replace the basics. The benefit was measured on top of statins, blood pressure control and other standard care. Our page for men with heart disease covers how weight, hormones and heart treatment fit together, and our shorter answer on semaglutide and heart attack risk is a quick reference.
If you do not have heart disease yet but worry you are heading that way, the useful first step is measuring your risk properly. An ApoB blood test counts the cholesterol-carrying particles that drive plaque, and men with a family history of early heart disease often benefit from that fuller picture. Men on testosterone therapy may also want to read about the TRAVERSE heart safety trial.
Questions to bring to your cardiologist
If you have heart disease and are carrying extra weight, SELECT gives you a concrete reason to raise semaglutide at your next cardiology visit. Useful questions include:
- Do I fit the group SELECT studied: established heart disease, a BMI of 27 or more, and no diabetes?
- Would semaglutide add to what my current medicines already do for my risk?
- Do any of my medicines, such as diuretics, need watching if I have stomach side effects?
- Is my heart rate a concern, given the label’s warning about increases?
- Who will manage the medicine and its dose, and how will you and that clinician share results?
Some warning signs cannot wait for any appointment. Chest pain or pressure that spreads 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 fits alongside your cardiologist
We do not replace cardiology care. For men with heart disease and excess weight, a medical weight loss evaluation at our San Gabriel or Downey clinic reviews your history, current heart medicines and labs, and your provider coordinates with your cardiologist before semaglutide is considered. Our targeted preventative panel includes ApoB, Lp(a) and hs-CRP for men who want a closer look at risk.
Bring your cardiologist’s latest notes and medicine list to the first visit. The free 10-minute call is the simplest way to find out whether an evaluation makes sense for you.
