Le Pont Neuf

The SELECT Study Makes One Thing Undeniable

Newly published in full, the results of the SELECT study of semaglutide for cardiovascular outcomes in persons with obesity but not diabetes makes one thing undeniable. Obesity is a chronic, treatable disease. Treating obesity requires more than just telling a person to change their lifestyle. It involves addressing the disease pathology that is at work, undermining a person’s health.

The SELECT study outcomes, appearing this morning in the New England Journal of Medicine, shows that obesity treatment with semaglutide results in longer, healthier lives.

Effect on Strokes, Heart Attacks, and Cardiovascular Deaths

This was a massive study. In total, 17,604 persons with cardiovascular disease and obesity received a random assignment to either semaglutide 2.4 mg weekly injections or a placebo. Researchers followed them for an average of 40 months, examining the rates of strokes, heart attacks, and cardiovascular deaths. SELECT was not a weight loss study. It was a study of cardiovascular outcomes. Thus, the participants in this study received lifestyle recommendations focused on cardiovascular risk reduction, not just weight. Average weight loss in the study was nine percent with semaglutide and one percent for the placebo group after two years.

The net result of treatment was a 20% reduction in strokes, heart attacks, and deaths. This is a clear indication of effectiveness for improving cardiovascular health by treating obesity. In a companion editorial, Amit Khera and Tiffany Powell-Wiley write:

“GLP-1 receptor agonist therapy with semaglutide joins the list of established therapies that form the basis of our pharmacologic strategies for reducing the risk of cardiovascular disease.”

Audience for the SELECT Results

Audience for the SELECT Results at the AHA Scientific Sessions

Caroline Apovian, a professor of medicine at Harvard and Co-Director of the Center for Weight Management and Wellness at Brigham and Women’s Hospital, moderated the presentation and discussion of this study’s results at the American Heart Association meeting today. She told us:

“Health care providers are beginning to hear from their patients with obesity that semaglutide has changed their lives. These results are going to change the way medicine is practiced in the United States. I foresee that physicians will increasingly SELECT obesity treatment for patients who need this. We will be treating obesity first before complications like diabetes and heart disease occur.”

Unmistakable Policy Implications

The SELECT study makes the medical benefits of obesity treatment undeniable. It will thus have profound implications for health policy. CEO Joe Nadglowski of the Obesity Action Coalition told us:

“These results make it clear that policy makers, insurers, employers, and pharmaceutical companies have a duty to guarantee equitable access to obesity care. Because we now know that these medicines are not only life changing. They are life saving.”

Plainly, denying people access to care for obesity adds up to a rationalization for denying people the opportunity to live healthier, longer lives. Excuses for this are no longer acceptable.

Click here for the study in NEJM and here for the companion editorial.

Le Pont Neuf, magic realism by Felix Vallotton / WikiArt

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November 11, 2023

3 Responses to “The SELECT Study Makes One Thing Undeniable”

  1. November 13, 2023 at 3:15 pm, Lise G Bjerregaard said:

    This is impressive.
    “This is a clear indication of effectiveness for improving cardiovascular health by treating obesity” – yes, in people with cardiovascular disease and obesity. But wegovy is approved for all with a BMI above 30 – independent of CVD – do we have any reasons to believe that people with BMI > 30 but no CVD (and no diabetes), will have cardiovascular benefits of semaglutide?

  2. November 20, 2023 at 8:49 am, Milind watve said:

    The absolute risk reduction in cardiovascular events is 1.5% and adverse events serious enough to discontinue trial are 8.4 % more. Is this a good sign? Why are the end points in those who discontinued the drug not reported?

    • November 21, 2023 at 8:24 am, Ted said:

      Yes, it is very definitely good to have 20% fewer cardiovascular deaths, strokes, and heart attacks. The endpoints in folks who discontinued semaglutide were all included in the calculation of outcomes for the group that initially received semaglutide. In other words, even though 17% of persons in the semaglutide group decided they could not continue taking it (mostly because of GI effects) the group as a whole – including those who stopped taking it – still enjoyed the benefit of 20% fewer major cardiovascular events.