Is It Time for Cardiologists to Treat Obesity?

This transcript has been edited for clarity.

Michelle L. O'Donoghue, MD, MPH: Hi. This is Dr Michelle O'Donoghue, reporting for Medscape. I'm here at the American Heart Association conference in Philadelphia, and one of the big breaking stories here is the primary results of the SELECT trial.

Joining me today to discuss the trial and its implications is Dr Nicholas Marston, who specializes in preventive medicine. He's a clinical trialist with the TIMI study group and a cardiologist at Brigham and Women's Hospital. Thank you for joining me.

Nicholas A. Marston, MD, MPH: Thanks, Michelle. It's huge news — really, a game changer on so many levels.

O'Donoghue: For those who are not yet familiar with the SELECT study, can you tell us what it looked at and who it studied?

SELECT Trial Findings

Marston: Absolutely. It was a phase 3 cardiovascular outcomes trial in 17,000 patients. Importantly, these patients all had a BMI of ≥ 27; they had obesity or they were overweight. They also had atherosclerotic cardiovascular disease (ASCVD), defined by a prior myocardial infarction, stroke, or peripheral artery disease, and, importantly, they did not have diabetes.

Previous studies were in patients with diabetes. These patients did not have diabetes; their hemoglobin A1c had to be below 6.5%. They then randomized these patients 1:1 to either semaglutide or placebo. The follow-up was over 3 years for a primary endpoint of myocardial infarction, stroke, or CV death as a composite outcome. And as you mentioned, these were very exciting results: They found a 20% reduction in the primary endpoint. It drew applause today at the late-breaking session.