Semaglutide 2.4 mg reduced major adverse cardiovascular events (MACE) by 20% in adults with established CVD and overweight or obesity without diabetes (SELECT), leading to Wegovy's March 2024 CV indication. In August 2026 Mounjaro gained a CV indication for type 2 diabetes.
The evidence
SELECT (NEJM 2023): 17,604 adults with BMI ≥27 + established CVD, no diabetes. 20% MACE reduction (HR 0.80, p<0.001). CV death HR 0.85; non-fatal MI HR 0.72; non-fatal stroke HR 0.93. Median follow-up 39.8 months. Benefit emerged within 6 months and persisted.
FDA-approved labeling status
Wegovy FDA-approved for CV event reduction in adults with established CVD and obesity or overweight (March 2024). Mounjaro FDA-approved on August 27, 2026 to reduce major CV events in adults with type 2 diabetes at high CV risk (SURPASS-CVOT: non-inferior to Trulicity, HR 0.92). Ozempic, Trulicity and Victoza carry CV indications in type 2 diabetes. On Medicare, the $50 GLP-1 Bridge (July 2026 to December 2027) covers Wegovy for eligible Part D enrollees.
Practical considerations
Eligible patients: BMI ≥27 AND prior MI, prior ischemic or hemorrhagic stroke, or symptomatic PAD. Primary prevention in obesity without established CVD was not studied. For tirzepatide, SURPASS-CVOT (type 2 diabetes) led to the 2026 Mounjaro CV indication; SURMOUNT-MMO in obesity without diabetes is still running, with no results reported.
See also
SELECT trial detailed · Medicare Part D and the GLP-1 Bridge · Wegovy