Novo Nordisk reports semaglutide 2.4 mg cut cardiovascular events by 20% in SELECT

Novo Nordisk said on Aug. 8, 2023 that semaglutide 2.4 mg lowered the risk of major adverse cardiovascular events by 20% in adults with overweight or obesity who already had cardiovascular disease ^[1]. The finding came from a trial called SELECT. Semaglutide 2.4 mg is sold as Wegovy ^[1].

The 20% figure covers the combined risk of cardiovascular death, nonfatal heart attack or nonfatal stroke, the three events the FDA later used to define the drug's cardiovascular indication ^[1]. The detailed results were presented on Nov. 11, 2023 at the American Heart Association Scientific Sessions and published the same day in the New England Journal of Medicine ^[1].

Other numbers from SELECT, including the absolute risk reduction, hazard ratios, how many people were enrolled and how long they were followed, have not been reported ^[1]. The 20% relative reduction is the figure the company released ^[1].

On March 8, 2024, the FDA approved Wegovy for cardiovascular risk reduction in people with overweight or obesity and established cardiovascular disease ^[1]. The approved indication now covers both the once-weekly Wegovy injection and the Wegovy tablets, and describes the goal as reducing the risk of major adverse cardiovascular events, defined as cardiovascular death, nonfatal heart attack or nonfatal stroke ^[1].

SELECT-related findings have continued to appear. On May 13, 2025, Novo Nordisk reported an analysis in which the reduction in cardiovascular events was seen early, before clinically meaningful changes in body weight ^[1]. On Aug. 31, 2025, the company reported a real-world study in which Wegovy was associated with a 57% lower risk of heart attack, stroke or death compared with tirzepatide, sold as Mounjaro and Zepbound, in people with obesity and cardiovascular disease ^[1]. That study was described as real-world rather than a randomized head-to-head trial, and its size, design and follow-up have not been disclosed ^[1].

Why it matters for patients

The FDA-approved cardiovascular use is narrower than the weight-loss use. It applies to adults who already have established cardiovascular disease and who also have obesity or overweight ^[1]. Adults using semaglutide only to lose weight do not fall under that indication unless they also have heart disease ^[1].

For people who do fit that description, the label treats the heart benefit as a distinct effect of the drug, separate from weight loss. The 2025 SELECT analysis reported that cardiovascular events fell early, before body weight changed meaningfully, which suggests the two effects are not simply the same thing ^[1].

Access has also shifted since the trial result. Novo Nordisk introduced a pharmacy program in March 2025 that lowered the cost of all FDA-approved Wegovy doses to $499 per month ^[1]. In February 2026 the company announced a significant reduction in US list price for Wegovy, Ozempic and Rybelsus, all semaglutide medicines ^[1], and in March 2026 it launched a multi-month subscription program for Wegovy that it said offers savings of up to $1,200 a year ^[1].

Safety information on the Wegovy label has not changed with the cardiovascular indication. The label carries a boxed warning for an increased risk of thyroid C-cell tumors and lists warnings for acute pancreatitis, acute gallbladder disease, hypoglycemia, acute kidney injury and other conditions ^[1]. Common side effects reported in at least 5% of adults or patients aged 12 and older include nausea, diarrhea, vomiting, constipation, abdominal pain and headache ^[1].

What happens next

No further dated SELECT milestones have been announced. The trial's cardiovascular outcomes data were presented and published in November 2023, the FDA approved the cardiovascular indication in March 2024, and later analyses and a real-world comparison have followed in 2025 ^[1].