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SELECT was a landmark cardiovascular-outcomes trial evaluating semaglutide 2.4 mg weekly in adults with established cardiovascular disease and overweight or obesity who did not have diabetes. More than 17,000 participants were followed for nearly four years. Semaglutide reduced the risk of major adverse cardiovascular events compared with placebo, extending the evidence base for GLP-1 receptor agonists beyond glucose lowering and into obesity-related cardiovascular risk reduction. For internists, the implication is important: obesity can be treated as a chronic disease with pharmacologic tools that may influence multiple risk pathways, not simply body weight. The magnitude of benefit cannot be assumed to be identical in every patient, and treatment remains dependent on appropriate selection, tolerability, access and long-term adherence. Gastrointestinal adverse effects are common, and therapy is most effective when integrated with nutrition, physical activity and management of other risk factors. SELECT therefore supports a more cardiometabolic approach to obesity care in which weight, blood pressure, glycemia, lipids and cardiovascular risk are addressed together.
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SELECT was a landmark cardiovascular-outcomes trial evaluating semaglutide 2.4 mg weekly in adults with established cardiovascular disease and overweight or obesity who did not have diabetes. More than 17,000 participants were followed for nearly four years. Semaglutide reduced the risk of major adverse cardiovascular events compared with placebo, extending the evidence base for GLP-1 receptor agonists beyond glucose lowering and into obesity-related cardiovascular risk reduction. For internists, the implication is important: obesity can be treated as a chronic disease with pharmacologic tools that may influence multiple risk pathways, not simply body weight. The magnitude of benefit cannot be assumed to be identical in every patient, and treatment remains dependent on appropriate selection, tolerability, access and long-term adherence. Gastrointestinal adverse effects are common, and therapy is most effective when integrated with nutrition, physical activity and management of other risk factors. SELECT therefore supports a more cardiometabolic approach to obesity care in which weight, blood pressure, glycemia, lipids and cardiovascular risk are addressed together.
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