The New England Journal of Medicine
A. Michael Lincoff, M.D., Kirstine Brown-Frandsen, M.D., Helen M. Colhoun, M.D., John Deanfield, M.D., Scott S. Emerson, M.D., Ph.D., Sille Esbjerg, M.Sc., Søren Hardt-Lindberg, M.D., Ph.D., G. Kees Hovingh, M.D., Ph.D., Steven E. Kahn, M.B., Ch.B., Robert F. Kushner, M.D., Ildiko Lingvay, M.D., M.P.H., Tugce K. Oral, M.D., Marie M. Michelsen, M.D., Ph.D., Jorge Plutzky, M.D., Christoffer W. Tornøe, Ph.D., and Donna H. Ryan, M.D., for the SELECT Trial Investigators*
Published on December 14, 2023
Introduction
A Global view of Cardiovascular risk
A Global view of Cardiovascular risk
Obesity is a growing global issue. More than half the world's population is projected to have overweight or obesity by 2035.
67% of 17.9 million deaths due to cardiovascular conditions.
High body-mass index (BMI) has been linked to 4 million deaths globally in 2015
Randomisation
Randomization and patient characteristics
Each filled circle below represents a participant.
One cluster represents Semaglutide group, while another cluster represents Placebo group.
In 2018, researchers launched the SELECT trial to investigate whether semaglutide, a drug used for diabetes, could also reduce heart risks in people with obesity but no diabetes.
This trial, involving over 17,604 participants across 41 countries, was designed to explore a new frontier in cardiovascular care.
Participants are randomly split into two groups, 8803 of them receiving semaglutide and the other 8801 participants receiving placebo.
The trial involved a diverse group of participants, primarily older males with cardiovascular disease and obesity, compared to females.
More than 80% of participants were White. The ethnic composition is similar in both the Semaglutide and Placebo groups.
Patient Completion
Patient completion based on inclusion or exclusion criteria
Each filled circle below represents a participants.
Hover over a cluster to view full breakdown of reasons for not completing trial or treatment.
A high majority of participants in both Semaglutide and Placebo groups completed the trial, with slighty less in Placebo completing the trial.
Compared to trial completion, less participants completed treatment.
Tracking Cardiovascular Events
Tracking Cardiovascular Events
Each filled circle below represents a participant. Red dot represents an end point type affecting the patient.
Hover over a cluster to view full breakdown of secondary end point events.
Participants experienced various forms of cardiovascular events, such as heart attacks and strokes.
6.5% of patients in Semaglutide group and 8.0% in Placebo group had a primary cardiovascular composite end point.
10.2% of patients in Semaglutide group and 12.3% in Placebo group had a confirmatory secondary end point.
35.2% of patients in Semaglutide group and 77.3% in Placebo group had a supportive secondary end point.
Weight Loss and Health Improvements
Weight Loss and Health Improvements
Each filled circle below represents a participant.
Hover over a cluster to view timeline of weight loss
On average, particpants in Semaglutide group experienced 9.39% weight loss, while Placebo group paricipatants experienced a relatively stable loss of 0.88%.
Semaglutide led to significant weight loss and improvements in other health markers beyond cardiovascular risk.
Adverse Events
Adverse Events
Each filled circle below represents a participant.
Hover over a cluster to view specific adverse events.
Participants also experienced specific adverse events of various severity levels. While semaglutide reduces cardiovascular risk, it comes with a higher rate of gastrointestinal side effects.
Conclusions: The Impact of Semaglutide
In patients, with preexisting cardiovascular disease and overweight or obesity but without diabetes, a weekly subcutaneous semaglutide at a dose of 2.4 mg was aupserior to placebo in reducing the incidence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke at a mean follow-up of 39.8 months.