Wegovy and heart protection: what the SELECT trial showed

The question SELECT asked

The trial enrolled 17,604 adults with existing cardiovascular disease and a BMI of at least 27. They received semaglutide or placebo on top of usual care. The main outcome combined cardiovascular death, non-fatal heart attack and non-fatal stroke.

This was secondary prevention: everyone in the trial already had cardiovascular disease. Giving a medicine to a healthy person to prevent a first event is a different situation. The trial also left out people with diabetes. Keep both points in mind when comparing the trial evidence with wider clinical advice.

Relative and absolute benefit

A main cardiovascular event happened in 6.5% of the semaglutide group and 8.0% of the placebo group over an average follow-up of about 40 months. The hazard ratio was 0.80, usually described as a 20% relative reduction. The absolute difference was about 1.5 percentage points.

These figures describe groups over the study period. They do not give your personal yearly drop in risk. A 20% relative reduction does not mean 20 in every 100 people treated avoided an event. The absolute benefit depends on your starting risk and how long you take the treatment.

Limits of the SELECT result

SELECT does not show the higher 7.2 mg dose gives more heart protection. Nor does it show every form of semaglutide has the same outcome evidence, or that everyone using Wegovy for weight management gets the same benefit. Each of those needs its own evidence.

Standard heart treatments still matter. Keep up cholesterol treatment, blood pressure treatment, stopping smoking, antiplatelet therapy where indicated, activity and rehabilitation. The trial tested Wegovy on top of usual care, as an addition to those treatments.

UK licence and NHS guidance

The UK heart indication covers adults with established cardiovascular disease and overweight or obesity. NICE TA1152, published in May 2026, covers use up to 2.4 mg weekly to lower the risk of major events. Its criteria differ from the specialist obesity pathway in TA875, so check each set on its own terms.

A clinician must confirm your heart history meets the recommendation. They also assess how well you tolerate the medicine, your other medicines and local prescribing arrangements. A family history of heart disease or a high cholesterol result alone does not count as established disease.

Weigh benefits against side effects

Stomach and bowel side effects lead some people to stop treatment. Ask how your symptoms will be managed. If cardiology, diabetes care and a private weight-management service are all involved, ask which team coordinates your prescriptions. Avoid duplicate semaglutide prescriptions under different brand names.