JACC Adv. 2026 Oct 9;5(11 Pt 2):103311. doi: 10.1016/j.jacadv.2026.103311. Online ahead of print.
ABSTRACT
BACKGROUND: In the SELECT (Semaglutide Effects on Cardiovascular Outcomes in People with Overweight or Obesity) trial, treatment with semaglutide reduced the risk of major adverse cardiovascular events (MACE) in patients with cardiovascular disease, overweight or obesity, and no diabetes.
OBJECTIVES: The purpose of this study was to estimate cardiovascular risk in first-time myocardial infarction (MI) patients meeting the SELECT-eligibility criteria and the preventive potential for treatment with semaglutide.
METHODS: We conducted an observational cohort study applying the SELECT trial's inclusion and exclusion criteria to patients with first-time MI recorded between 2010 and 2021 in the Western Denmark Heart Registry. Five-year incidence of second MI, MACE, and all-cause death was estimated for SELECT-eligible patients with a body mass index (BMI) ≥27 kg/m2. In an assumption-dependent scenario analysis the preventive potential for semaglutide was estimated as the postponement of MACE incidence.
RESULTS: In 21,777 first-time MI patients without diabetes, 10,768 patients were SELECT-eligible with BMI ≥27 kg/m2. Median age at first-time MI was 65 years for the SELECT-eligible MI patients and 69 years for normal-weight (BMI 20-26 kg/m2) comparisons. Five-year incidence of second MI (n = 544), MACE (n = 975), and all-cause death (n = 914) was 5.9% (95% CI: 5.4%-6.4%), 10.7% (95% CI: 10.1%-11.4%), and 10.3% (95% CI: 9.7%-11.0%) in SELECT-eligible MI patients, respectively. Among these, treatment with semaglutide was estimated to postpone a 5% MACE incidence by 12 months.
CONCLUSIONS: In SELECT-eligible first-time MI patients with overweight or obesity and no diabetes, the cardiovascular risk was substantial with 1 in 10 having a MACE event within 5 years after first-time MI. Based on the SELECT trial results, semaglutide may markedly postpone MACE incidence in these patients.
PMID:42858539 | DOI:10.1016/j.jacadv.2026.103311