01
What the evidence says
The industry-funded trial randomized 17,604 participants to semaglutide or placebo and followed them for about 40 months on average. Cardiovascular death, nonfatal heart attack, or nonfatal stroke occurred in 6.5% versus 8.0%, a hazard ratio of 0.80 and an absolute difference of 1.5 percentage points over the study period. The trial also assessed safety and other outcomes.
Sources for this section: [1]
02
How to use the finding
Eligibility matters: participants were at least 45, had a body-mass index of 27 or higher, established cardiovascular disease, and no diabetes. For a similar person, the result supports a conversation about absolute benefit, injection burden, gastrointestinal effects, gallbladder and other risks, access, cost, long-term treatment, and alternatives. It does not justify prescribing from body size alone.
Sources for this section: [1]
03
Limits and open questions
Adverse events leading to permanent discontinuation were more frequent with semaglutide, and trial follow-up cannot establish every rare or very long-term effect. The sponsor designed and analyzed the study with academic investigators, so protocol, prespecified analyses, data access, and independent replication matter. Generalization to people without established cardiovascular disease remains uncertain.
Sources for this section: [1]
Sources
- Semaglutide and Cardiovascular Outcomes in Obesity without DiabetesNew England Journal of Medicine · 2023DOI 10.1056/NEJMoa2307563