Mandrola's Top Trials to Look for at AHA 2023

My prediction: a new chapter in medicine starts this weekend at the 2023 American Heart Association (AHA) Scientific Sessions.

SELECT Trial

In recent years, a novel virus distracted us from one of the greatest threats to human health — obesity. AHA refocuses our attention to this side effect of modern living.

The glucagon-like peptide 1 (GLP-1) agonist semaglutide has shown its ability to induce weight loss in patients with obesity and reduce cardiac outcomes in patients with diabetes. The SELECT trial is slated for the first late-breaking trial presentation at AHA. We already know, from a press release, that the trial shows that the drug reduces cardiac outcomes in patients with obesity who do not have diabetes.

I am no fan of the early press release pattern of anchoring us to a positive result. In this case, however, the degree of absolute risk reduction matters less than in other trials. Given the drug’s ability to induce serious weight loss, any amount of reduction in cardiac outcomes will change practice patterns.

Compare semaglutide with statins, for instance. We know that statins reduce cardiac outcomes by about 20%-25%. That is meaningful but patients cannot feelit. Patients who take semaglutide will be able to feel the CV benefits — because losing weight enhances quality of life.