SELECT (Semaglutide effects on cardiovascular outcomes in people with overweight or obesity) rationale and design

Abstract Cardiovascular disease (CVD) is a major cause of morbidity and mortality. While it has been widely appreciated that obesity is a major risk factor for CVD, treatments that produce effective, durable weight loss, and the impact of weight reduction in reducing cardiovascular risk, have been elusive. Instead, progress in CVD risk reduction has been achieved through medications indicated for controlling lipids, hyperglycemia, blood pressure, heart failure, inflammation and/or thrombosis. Obesity has been implicated as promoting all these issues, suggesting that sustained, effective weight loss may have independent cardiovascular benefit. GLP-1 receptor agonists (RAs) reduce weight, improve glycemia, decrease cardiovascular events in those with diabetes and may have additional cardioprotective effects. The GLP-1 RA semaglutide is in phase 3 studies as a medication for obesity treatment at a dose of 2.4 mg subcutaneous (s.c.) once weekly. SELECT (Semaglutide Effects on Heart Disease and Stroke in Patients with Overweight or Obesity) is a randomized, double-blind, parallel-group trial testing if semaglutide 2.4 mg s.c. once weekly is superior to placebo when added to standard of care for preventing major adverse cardiovascular events (MACE) in patients with established CVD and overweight or obesity but without diabetes. SELECT is the first cardiovascular outcomes trial to evaluate superiority in MACE reduction for an antiobesity medication in such a population. As such, SELECT has the potential for advancing new approaches to CVD risk reduction while targeting obesity.