Semaglutide 2.4 mg reduced major adverse cardiovascular events (MACE) 20% in adults with obesity (BMI ≥27) and established CVD without diabetes — the SELECT trial. This led to the March 2024 Wegovy CV indication and the April 2026 Medicare Part D coverage expansion. The first weight-management drug ever approved for a CV outcome.
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 BMI ≥27 + established CVD (March 2024). Medicare Part D coverage expanded April 2026 under SELECT-aligned pathway. Commercial plans increasingly covering under SELECT-mirroring PA criteria.
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. SURPASS-CVOT (tirzepatide) reads out 2026.
See also
SELECT trial detailed · Medicare Part D Wegovy coverage · Wegovy