Wegovy And Your Heart: What The SELECT Trial Found And Who It Applies To
Most people think of Wegovy as a weight-loss shot. Since 2024 it has also carried an FDA approval to lower the risk of heart attack, stroke, and cardiovascular death in certain adults. That approval rests on one large trial, and it's worth knowing exactly who was in it.
What The SELECT Trial Tested
SELECT, published in the New England Journal of Medicine in 2023, enrolled 17,604 adults aged 45 and older who already had heart disease (a prior heart attack, a prior stroke, or symptomatic peripheral artery disease), a BMI of 27 or higher, and no diabetes. They took weekly semaglutide 2.4 mg, the Wegovy dose, or a placebo, and were followed for a little over three years on average. About seven in ten participants were men.
What It Found
Heart attack, stroke, or death from cardiovascular causes happened in 6.5% of the semaglutide group and 8.0% of the placebo group, a 20% lower relative risk. Based on that, in March 2024 the FDA approved Wegovy, along with a reduced-calorie diet and more physical activity, to reduce the risk of those events in adults with established cardiovascular disease and either obesity or overweight.
Who It Applies To, And Who It Doesn't
The heart benefit was shown in people who already had heart disease. SELECT didn't test whether Wegovy prevents a first heart attack in people without it, and it left out people with diabetes. Ozempic has its own heart-risk approval for adults with type 2 diabetes and heart disease; our guide to Ozempic vs. Wegovy and Mounjaro vs. Zepbound covers the differences. The results also belong to semaglutide specifically. They don't automatically carry over to tirzepatide, which is studied and labeled separately.
Compounded Semaglutide Is A Different Product
Compounded semaglutide is not FDA-approved, and the FDA has not evaluated it for safety or effectiveness. It isn't what SELECT studied, and Wegovy's heart-risk approval applies to Wegovy, not to compounded versions. If lowering heart risk is a main reason you're considering treatment, that difference matters when you and your provider choose.
Side Effects And Who Shouldn't Take It
In SELECT, more people stopped semaglutide than placebo because of side effects (16.6% vs. 8.2%), mostly digestive ones like nausea, vomiting, and diarrhea. Wegovy carries a boxed warning about thyroid C-cell tumors seen in rodents, and it shouldn't be used by anyone with a personal or family history of medullary thyroid cancer or MEN 2. The label also warns about pancreatitis, gallbladder problems, kidney injury from dehydration, a faster resting heart rate, and low blood sugar when combined with insulin or a sulfonylurea. Get care quickly for severe stomach pain that won't go away, a lump or swelling in your neck, trouble swallowing, or thoughts of harming yourself.
Where To Start
A licensed provider reviews your heart history, current medications, and labs, and decides whether Wegovy or another option fits. If you've had a heart attack, stroke, or a diagnosis of artery disease, say so up front, because it's exactly the history SELECT was about.
This guide explains general information and is not medical advice. It doesn't replace a licensed provider reviewing your own history.