A study showed that semaglutide may reduce major adverse cardiovascular events in patients with obesity and heart failure, regardless of heart failure subtype.

In a prespecified analysis of the Semaglutide Effects on Heart Disease and Stroke in Patients with Overweight or Obesity (SELECT) trial, published in The Lancet, investigators assessed the impact of once weekly semaglutide 2.4 mg on cardiovascular outcomes in patients with obesity and established atherosclerotic cardiovascular disease (ASCVD), focusing on those with concurrent heart failure. The randomized, double-blind, placebo-controlled study enrolled 17,604 patients, including 4,286 with heart failure at baseline, classified into heart failure with preserved ejection fraction (HFpEF), reduced ejection fraction (HFrEF), or unclassified heart failure.

The analysis demonstrated that semaglutide was associated with a reduction in major adverse cardiovascular events (MACE)—comprising nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death—compared with placebo. The hazard ratio (HR) for MACE was 0.72 (95% confidence interval [CI] = 0.60–0.87) in patients with heart failure and 0.84 (95% CI = 0.74–0.97) in those without heart failure. Additionally, semaglutide was associated with a reduction in all-cause mortality (HR = 0.81, 95% CI = 0.67–0.97).

In subgroup analyses, patients with HFrEF treated with semaglutide had a HR of 0.65 (95% CI = 0.49–0.87) for MACE, while those with HFpEF had an HR of 0.69 (95% CI = 0.51–0.91). Semaglutide’s benefits were consistent across all heart failure subtypes, including HFpEF and HFrEF.

Semaglutide was also linked to a 19% decrease in overall mortality among the entire study population, with a HR of 0.81 (95% CI = 0.66–1.00). In the heart failure subgroup, semaglutide treatment resulted in a reduction in the risk of cardiovascular death, with a HR of 0.76 (95% CI = 0.59–0.97).

Moreover, the therapy reduced the composite heart failure endpoint, defined as cardiovascular death, hospitalization, or urgent hospital visits for heart failure. Semaglutide was associated with fewer serious adverse events compared with placebo.

The findings suggested that semaglutide may be a therapeutic option for reducing cardiovascular risk in patients with ASCVD and obesity, regardless of heart failure subtype. 

Full disclosures can be found in the published study.