Positive Results From SELECT Begins a New Era in Cardiology

The positive press release regarding the performance of the glucagon-like peptide 1 (GLP-1) agonist semaglutide in the SELECT trial did not exaggerate.

SELECT Trial Results

In this multicenter, placebo-controlled trial of more than 17,000 patients with overweight/obesity and established atherosclerotic disease, semaglutide reduced a composite endpoint of cardiovascular death, myocardial infarction (MI), and stroke.

In the semaglutide arm, 6.5% of patients experienced a first primary outcome event vs 8.0% in the placebo arm. This 1.5% absolute risk reduction translates to a 20% relative risk reduction (hazard ratio = 0.80; 95% CI, 0.72 - 0.90; P < .001). Adverse events leading to stopping the drug occurred in 16.6% of those taking semaglutide (weekly dose of 2.4 mg) vs 8.2% on placebo.

There were many other notable and positive findings for semaglutide:

• Patients lost about 8.5% more body weight than those in the placebo arm.

• The Kaplan-Meier curves for the primary endpoint began to separate early, well before weight loss took effect, suggesting multiple ways the drug may confer its benefit.

• Each component of the primary endpoint was lower.

• Overall death was nearly 1% lower.

• These positive findings occurred in the setting of robust baseline care, including statins and antiplatelet agents in approximately 90% of patients.