Cardiovascular Risk in SELECT-Eligible MI Patients With Overweight or Obesity: The Western Denmark Heart Registry
- Design
- Retrospective cohort · 10768 participants · Hard outcome
- Match to healthy normal-weight adults aged 55–75
- Different populationINDIRECT: all had overweight or obesity (BMI ≥27) and a first myocardial infarction, without diabetes; median age 65.
- Could weight loss explain it?
- PossiblyPossibly: no one in the cohort was treated, and the projected semaglutide effect is borrowed from SELECT, where weight loss was not separated from the drug effect; no weight or glycaemic data are reported.
- Study tier
- Not ratedNOT_RATED: the registry data describe cardiovascular risk but contain no observed GLP-1 outcome; the semaglutide estimate is an assumption-dependent projection.
- Assessment
- Version 3 · Two reviewers differed; settled by a recorded ruling · Oct 19, 2026
Study facts come from the paper. Population match, weight-loss explanation and study tier are our judgments, made against the reference group of healthy normal-weight adults aged 55–75.
This Danish registry study looked at 10,768 people without diabetes who had a first heart attack and would have qualified for the SELECT semaglutide trial because of overweight or obesity. Within five years, 10.7% had a major cardiovascular event and 10.3% died. Nobody in the study was given semaglutide: the authors' estimate that it could delay such events by about 12 months is a projection from the SELECT trial, not an observed result.
01Findings
What the study reported
- Drugs
- Semaglutide
- Comparator
- none observed: no patient received semaglutide; its effect was projected from SELECT trial results; normal-weight MI patients were a descriptive comparison
- Primary outcome
- five-year incidence of second MI, MACE and all-cause death
- Effect
- Five-year incidence 5.9% second MI, 10.7% MACE and 10.3% all-cause death in SELECT-eligible patients; semaglutide estimated (scenario, not observed) to postpone a 5% MACE incidence by 12 months
- 95% confidence interval
- 95% CI: 10.1%-11.4% (five-year MACE incidence)
- Follow-up
- five-year incidence
- Adverse events
- not reported in abstract
- Limitations
- Registry cohort with no semaglutide exposure; the semaglutide benefit is an assumption-dependent projection from SELECT, not an observed result; single registry.
Who was studied
- Bmi min
- 27
- Obesity status
- overweight or obesity required (BMI ≥27)
- Diabetes status
- excluded
- Cvd status
- required (first-time myocardial infarction)
- Ckd status
- not reported in abstract
- Baseline condition
- first-time myocardial infarction with overweight or obesity and no diabetes
- Sample size
- 10768
- Inclusion exclusion
- first-time MI 2010-2021, no diabetes, SELECT criteria, BMI ≥27 kg/m2
- Normal weight included
- true
Study quality details
- Study design
- Retrospective cohort
- Sample size
- 10768
- Randomization
- no
- Blinding
- n/a
- Comparator
- none observed: no patient received semaglutide; its effect was projected from SELECT trial results; normal-weight MI patients were a descriptive comparison
- Follow up duration
- five-year incidence
- Outcome type
- hard
- Replication
- not assessed
- Consistency with other evidence
- not assessed
- Population applicability
- INDIRECT
- Statistical precision
- CIs reported for incidence (e.g. MACE 95% CI: 10.1%-11.4%); 975 MACE events
- Risk of bias
- not assessed
- Funding conflicts
- no
- Peer review status
- yes
02Funding
Funding and conflicts
- Funding
- Novo Nordisk Foundation institutional research grant (part of a larger project)
- Industry funded
- No
- Manufacturer
- not stated in source
- Sponsor role
- not reported in abstract
- Author conflicts
- Several authors report Novo Nordisk Foundation or Novo Nordisk-funded grants, Novo Nordisk shareholdings, and fees from Novo Nordisk, Eli Lilly and other companies; the rest report none.
- Independent replication
- unknown
- Notes
- Authors declare relationships with the drug's manufacturer: Novo Nordisk (shareholdings, lecture and advisory fees, research grants)
Funding is shown on every study and never used to score it.
04Source
The source, as retrieved
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.