In short

The SELECT trial studied semaglutide in adults with established cardiovascular disease and overweight or obesity, without diabetes, and examined major.

By Alsen Walker · Updated September 22, 2026

By Alsen Walker · Editorially reviewed on 25 August 2026 · Not medically reviewed by a clinician

The SELECT trial studied semaglutide in adults with established cardiovascular disease and overweight or obesity, without diabetes, and examined major adverse cardiovascular events rather than weight. Its result led to an approved cardiovascular risk reduction indication, and that indication changed coverage in ways weight management alone never did.

For how this fits alongside the other comparisons, and what actually decides the choice, see Comparing GLP-1 Medications: How to Actually Choose.

Why this trial mattered

Weight loss drugs had historically been judged on weight. SELECT asked a different question: whether treating obesity with this drug reduced cardiovascular events in people who already had cardiovascular disease.

The trial enrolled adults with established cardiovascular disease and overweight or obesity, and specifically excluded people with diabetes, which matters because it separated the cardiovascular effect from glycaemic treatment.

Verify the specific endpoint definitions and results against the published paper rather than relying on summaries, including this one.

What the indication changed

An approved cardiovascular risk reduction indication is not a weight loss indication. That distinction sounds technical and is the entire difference between coverage and refusal in several settings.

Most importantly under Medicare Part D, which is barred by statute from covering agents used for weight loss. A separate approved indication sits outside that exclusion, which opened a route that had not existed.

Commercial plans that exclude anti-obesity medication as a benefit category may also cover a drug prescribed for an approved cardiovascular indication. This is worth checking specifically rather than assuming your exclusion covers everything.

Who this applies to

The indication generally requires established cardiovascular disease, meaning diagnosed disease rather than risk factors.

High blood pressure and high cholesterol are risk factors. Prior heart attack, stroke or peripheral arterial disease is established disease. That distinction decides whether this route is available to you, and your prescriber can tell you how your record is coded.

What it does not establish

That everyone with obesity should take this for cardiovascular prevention. The trial studied a specific population, and extending its findings beyond that is extrapolation.

That other drugs in the class share the effect. Indications are product-specific, and a finding for one molecule is not automatically a finding for another.

How the benefit compares against established cardiovascular treatments, or what happens after stopping.

How to use this in a coverage conversation

If you have established cardiovascular disease alongside obesity, make sure the cardiovascular diagnosis is coded and supported in your record, because that diagnosis is doing the work in the request.

Ask your prescriber to request under the cardiovascular indication where it applies, rather than under weight management, since the criteria and the coverage differ.

This indication is what opened Medicare access, covered in Medicare Part D and Wegovy. It requires established disease rather than risk factors, and the documentation side is getting conditions coded properly.

Frequently asked questions

Does this mean it protects everyone’s heart?
The trial studied people with established cardiovascular disease and overweight or obesity. Extending beyond that population is not supported.

Do I qualify with high blood pressure alone?
Generally not. Risk factors are not established disease.

Does Medicare cover it now?
A separate approved indication sits outside the weight loss exclusion. Coverage still depends on your plan’s formulary. Check directly.

Does this apply to tirzepatide?
Indications are product-specific. Check the prescribing information for what you take.

Should I take it instead of my statin?
No. This is not a replacement for established cardiovascular treatment, and stopping anything is a prescriber decision.

What if I stop taking it?
The trial studied ongoing treatment. Effects after stopping were not what it measured.

Sources and further reading

  1. Lincoff AM, et al. Semaglutide and cardiovascular outcomes in obesity without diabetes (SELECT). N Engl J Med. 2023. pubmed.ncbi.nlm.nih.gov
  2. US Food and Drug Administration. FDA approves first treatment to reduce risk of serious heart problems specifically in adults with obesity or overweight (Wegovy), March 2024. www.fda.gov
  3. MedlinePlus (US National Library of Medicine). Semaglutide injection: drug information. medlineplus.gov
  4. MedlinePlus (US National Library of Medicine). Tirzepatide injection: drug information. medlineplus.gov
  5. National Institute of Diabetes and Digestive and Kidney Diseases (NIH). Prescription medications to treat overweight and obesity. www.niddk.nih.gov

GLP1Hub content is for general information and is not medical advice. Prices and coverage rules change often, so confirm current details with the provider, your insurer and your prescriber. See our editorial standards and medical disclaimer.

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Alsen Walker is a health writer and researcher at GLP1Hub with five years of experience researching and writing health and medical content. He works in a medical-field role alongside his undergraduate studies. At GLP1Hub he researches GLP-1 weight loss programs, pricing and insurance rules, and checks claims against FDA prescribing information, published clinical trials and official government sources. Alsen is not a physician, and his articles are general information, not medical advice.