Key takeaways
- The SELECT trial proved Wegovy (semaglutide) reduces heart attacks, strokes, and cardiovascular death by 20%
- This benefit was seen in people with obesity and established heart disease, regardless of diabetes status
- It's the first obesity medication to demonstrate cardiovascular mortality benefit in non-diabetic patients
- NICE recommended Wegovy for cardiovascular risk reduction in the UK in April 2026
- Mounjaro's cardiovascular trial is ongoing — no equivalent data yet
The relationship between GLP-1 medications and heart health has become one of the most important stories in medicine. The SELECT trial changed how we think about these drugs.
The SELECT trial
Published in the New England Journal of Medicine in 2023, SELECT was a massive trial enrolling 17,604 adults aged 45 and older who had obesity (BMI ≥27) and established cardiovascular disease but did NOT have Type 2 diabetes. Participants received either semaglutide 2.4mg (the Wegovy dose) or placebo weekly, and were followed for a mean of nearly 3 years.1
The results: semaglutide reduced major adverse cardiovascular events (MACE) — a composite of heart attack, stroke, and cardiovascular death — by 20% compared to placebo. This was the first time any obesity medication had demonstrated this benefit in a non-diabetic population.
Why this matters
Before SELECT, the cardiovascular benefits of GLP-1 medications were only established in people with Type 2 diabetes. SELECT proved that the heart protection extends to people with obesity who don't have diabetes — a much larger population. In April 2026, NICE recommended Wegovy specifically for reducing cardiovascular risk in eligible patients.
What about Mounjaro?
Mounjaro (tirzepatide) does not yet have equivalent cardiovascular outcomes data. Eli Lilly's dedicated trial (SURPASS-CVOT) is ongoing. Post-hoc analysis of SURMOUNT-5 suggests tirzepatide may provide greater predicted cardiovascular risk reduction than semaglutide based on its greater weight loss and metabolic improvements, but predicted risk is not the same as proven outcomes.2
For patients with established cardiovascular disease, Wegovy currently has the stronger evidence base for heart protection.