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SELECT found fewer cardiovascular events with semaglutide 2.4 mg. The population was narrow.
In adults with cardiovascular disease and overweight or obesity, and without diabetes, weekly semaglutide 2.4 mg reduced a composite of cardiovascular death, heart attack, or stroke.
Lincoff and colleagues reported the SELECT trial in the New England Journal of Medicine. Adults 45 or older with established cardiovascular disease and a body-mass index of 27 or higher, and with no history of diabetes, were assigned to once-weekly subcutaneous semaglutide 2.4 mg or placebo. The paper enrolled 17,604 patients: 8,803 semaglutide and 8,801 placebo.
The primary count
The primary endpoint was the first of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. That event occurred in 569 of 8,803 patients on semaglutide (6.5 percent) and 701 of 8,801 on placebo (8.0 percent). The hazard ratio was 0.80, with a 95 percent confidence interval of 0.72 to 0.90. Mean follow-up was 39.8 months. Those figures belong to this dose, this analysis, and this population.
What left the trial
Adverse events leading to permanent discontinuation were more common on semaglutide: 16.6 percent, against 8.2 percent on placebo. A cardiovascular result that ignores who stopped the drug is an incomplete reading. The registry number is NCT03574597. A research-supply vial is not the product that was randomized.