Trial review
SELECT: Semaglutide and Cardiovascular Outcomes, Explained
Does semaglutide reduce cardiovascular events in people with obesity and established cardiovascular disease, without diabetes?
Direct answer
SELECT was a randomised, double-blind, placebo-controlled, event-driven outcomes trial funded by Novo Nordisk. Approximately a 20% relative reduction in the primary composite; event rate fell from roughly 8.0% to roughly 6.5%. That figure belongs to the population, dose and Mean follow-up approximately 40 months shown below, and describes a group average rather than a prediction for any individual.
SELECT at a glancepublished, peer-reviewed
| Design | Randomised, double-blind, placebo-controlled, event-driven outcomes trial |
|---|---|
| Population | Adults 45 and over with overweight or obesity and established cardiovascular disease, without diabetes |
| Sample size | 17604 |
| Intervention | Semaglutide |
| Comparator | Placebo |
| Duration | Mean follow-up approximately 40 months |
| Primary endpoint | Composite of cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke |
| Main result | Approximately a 20% relative reduction in the primary composite; event rate fell from roughly 8.0% to roughly 6.5% |
NCT NCT03574597 · DOI 10.1056/NEJMoa2307563 · PMID 37952131Last source check: 2026-08-03
Show this figure as a table
| Step | Stage | What happens |
|---|---|---|
| 1 | Who was eligible | Adults 45 and over with overweight or obesity and established cardiovascular disease, without diabetes |
| 2 | What they received | Semaglutide |
| 3 | What it was compared against | Placebo |
| 4 | For how long | Mean follow-up approximately 40 months |
| 5 | What was measured first | Composite of cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke |
| 6 | What the group average was | Approximately a 20% relative reduction in the primary composite; event rate fell from roughly 8.0% to roughly 6.5% |
| 7 | What it does not tell you | A group average is not a prediction for any individual reader. |
Strip any step and the result stops meaning what the trial found.
Show this figure as a table
| Item | Weight change | Evidence |
|---|---|---|
| Semaglutide 2.4 mg | 6% | published, peer-reviewed |
| Placebo | 8% | published, peer-reviewed |
Group means under trial conditions with lifestyle intervention. Not a prediction for any individual reader.
Show this figure as a table
| Item | Mean reduction | Evidence |
|---|---|---|
| Tirzepatide 15 mg (SURMOUNT-1) | 21% | Verified |
| Oral semaglutide 25 mg, adherent (OASIS 4) | 17% | Verified |
| Injectable semaglutide 2.4 mg (SURMOUNT-5) | 14% | Verified |
| Oral semaglutide 25 mg, treatment-policy (OASIS 4) | 14% | Verified |
| Orforglipron 17.2 mg (ATTAIN-1) | 12% | Reported |
| Liraglutide (SCALE) | 8% | Reported |
These come from different trials and are not a head-to-head comparison. Durations differ (64 to 72 weeks) and estimands differ. Only SURMOUNT-5 compared two of these drugs directly.
| Product | Starting self-pay price | Reported mean reduction | Trial |
|---|---|---|---|
| Zepbound (tirzepatide) injectable | $299/mo direct | about 20.9% at 15 mg | SURMOUNT-1, 72 weeks |
| Wegovy pill (oral semaglutide 25 mg) | $149/mo starting dose | 13.6–16.6% depending on estimand | OASIS 4, 64 weeks |
| Wegovy injectable (semaglutide 2.4 mg) | $349/mo maintenance | about 13.7% | SURMOUNT-5, 72 weeks |
| Foundayo (orforglipron) | $149/mo starting dose | about 11–12.4% at 17.2 mg | ATTAIN-1, 72 weeks |
Both $149 products are the least effective approved options in this table. That does not make them bad choices — it makes a price comparison that omits efficacy an incomplete one.
Frequently asked questions
Does this apply to compounded versions?
No. The trial studied an FDA-approved product at studied doses.
Is this drug as effective as tirzepatide?
By mean reduction across separate trials, no. The efficacy ladder above sets out the figures with the trial that produced each one.
Related on this site
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Cite this pageCC BY 4.0
GLP-1 Tirzepatide Rank. “SELECT: Semaglutide and Cardiovascular Outcomes, Explained.” S.J Partners LLC, 2026-08-03. https://glp1tirzepatiderank.com/research/select/
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