The weight-loss drug semaglutide, best known as the active ingredient in Wegovy, lowers the risk of heart attack and stroke regardless of how much weight people lose, according to new research published in The Lancet.
The SELECT trial, led by researchers at University College London, involved 17,604 adults aged 45 and over who were overweight or obese. Participants were given weekly semaglutide injections or a placebo for several years. Results showed a 20% reduction in major cardiac events – including heart attacks, strokes, and cardiovascular deaths – among those taking semaglutide, even when weight loss was minimal.
Interestingly, while overall weight loss wasn’t tied to the heart benefits, a smaller waist circumference — indicating less abdominal fat — was associated with better outcomes. Researchers estimated that about one-third of the drug’s cardiovascular benefit was linked to waist reduction, with the remaining effects coming from other mechanisms.
Lead author Prof John Deanfield said abdominal fat is particularly harmful to heart health, but added that “two-thirds of semaglutide’s heart benefits remain unexplained,” suggesting the drug acts directly on cardiovascular and metabolic processes.
Deanfield said the findings challenge current prescribing guidelines: “You don’t need to have a high BMI or lose a lot of weight to see benefits. If the goal is preventing heart disease, limiting its use only to those with severe obesity doesn’t make sense.”
He also noted that while the results expand the potential use of semaglutide, doctors must continue weighing benefits against possible side effects as its use broadens.
