TY - JOUR
T1 - Semaglutide and Hospitalizations in Patients With Obesity and Established Cardiovascular Disease
T2 - An Exploratory Analysis of the SELECT Randomized Clinical Trial
AU - Nicholls, Stephen J.
AU - Ryan, Donna H.
AU - Deanfield, John
AU - Ferreira, Daniel
AU - Lang, Chim C.
AU - Lincoff, A. Michael
AU - Lingvay, Ildiko
AU - Lübker, Christopher
AU - Terns, Paula Pérez
AU - Rasmussen, Søren
AU - Stensen, Signe
AU - Weeke, Peter E.
AU - Kahn, Steven E.
N1 - Publisher Copyright:
© 2026 American Medical Association. All rights reserved, including those for text and data mining, AI training, and similar technologies. American Medical Association.
PY - 2025/12/23
Y1 - 2025/12/23
N2 - Importance The primary analysis of the SELECT randomized clinical trial suggests that semaglutide reduced the rates of cardiovascular (CV) death, myocardial infarction, and stroke in patients with established CV disease (CVD) and overweight or obesity without diabetes. However, the effect of semaglutide on hospitalizations in this population remains unknown. Objective To determine the impact of semaglutide on total hospital admissions and duration of hospital stay. Design, Setting, and Participants The SELECT trial included patients aged 45 years or older with established CVD and a body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) of 27 or higher without diabetes at 804 clinical settings across North America, South America, Europe, Asia, Africa, and Australia. Patients were randomized from October 2018 to March 2021. This prespecified exploratory analysis was conducted from February 2024 to September 2025. Interventions Once-weekly subcutaneous semaglutide, 2.4 mg, or placebo. Main Outcomes and Measures The total number of hospital admissions and days in hospital between the semaglutide and placebo groups. Results A total of 17 604 patients (median [IQR] age, 61.0 [55.0-68.0] years; 4872 female patients [27.7%]; median [IQR] BMI, 32.1 [29.7-35.7]) were followed up for a median (IQR) period of 41.8 (33.0-47.0) months. There were 11 287 hospital admissions. The number of total hospitalizations was lower in the semaglutide group vs placebo for any indication (18.3 vs 20.4 admissions per 100 patient-years; mean ratio [MR], 0.90; 95% CI, 0.85-0.95; P <.001) and for serious adverse events (15.2 vs 17.1 admissions per 100 patient-years; MR, 0.89; 95% CI, 0.84-0.94; P <.001). The number of days hospitalized for any indication per 100 patient-years was lower in the semaglutide group vs placebo (157.2 vs 176.2 days; rate ratio [RR], 0.89; 95% CI, 0.82-0.98; P =.01), as well as hospitalizations for serious adverse events (137.6 vs 153.9 days; RR, 0.89; 95% CI, 0.81-0.98; P =.02). No heterogeneity was observed for the reduction of hospital admissions with semaglutide in selected subgroups, including BMI, age, and sex. Conclusions and Relevance In this prespecified exploratory analysis of the SELECT randomized clinical trial, the trial cohort had a high rate of hospital admissions. Treatment with once-weekly semaglutide was associated with significant reductions in hospital admissions and overall time spent in hospital, extending its benefits beyond CV risk reduction. Trial Registration ClinicalTrials.gov
AB - Importance The primary analysis of the SELECT randomized clinical trial suggests that semaglutide reduced the rates of cardiovascular (CV) death, myocardial infarction, and stroke in patients with established CV disease (CVD) and overweight or obesity without diabetes. However, the effect of semaglutide on hospitalizations in this population remains unknown. Objective To determine the impact of semaglutide on total hospital admissions and duration of hospital stay. Design, Setting, and Participants The SELECT trial included patients aged 45 years or older with established CVD and a body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) of 27 or higher without diabetes at 804 clinical settings across North America, South America, Europe, Asia, Africa, and Australia. Patients were randomized from October 2018 to March 2021. This prespecified exploratory analysis was conducted from February 2024 to September 2025. Interventions Once-weekly subcutaneous semaglutide, 2.4 mg, or placebo. Main Outcomes and Measures The total number of hospital admissions and days in hospital between the semaglutide and placebo groups. Results A total of 17 604 patients (median [IQR] age, 61.0 [55.0-68.0] years; 4872 female patients [27.7%]; median [IQR] BMI, 32.1 [29.7-35.7]) were followed up for a median (IQR) period of 41.8 (33.0-47.0) months. There were 11 287 hospital admissions. The number of total hospitalizations was lower in the semaglutide group vs placebo for any indication (18.3 vs 20.4 admissions per 100 patient-years; mean ratio [MR], 0.90; 95% CI, 0.85-0.95; P <.001) and for serious adverse events (15.2 vs 17.1 admissions per 100 patient-years; MR, 0.89; 95% CI, 0.84-0.94; P <.001). The number of days hospitalized for any indication per 100 patient-years was lower in the semaglutide group vs placebo (157.2 vs 176.2 days; rate ratio [RR], 0.89; 95% CI, 0.82-0.98; P =.01), as well as hospitalizations for serious adverse events (137.6 vs 153.9 days; RR, 0.89; 95% CI, 0.81-0.98; P =.02). No heterogeneity was observed for the reduction of hospital admissions with semaglutide in selected subgroups, including BMI, age, and sex. Conclusions and Relevance In this prespecified exploratory analysis of the SELECT randomized clinical trial, the trial cohort had a high rate of hospital admissions. Treatment with once-weekly semaglutide was associated with significant reductions in hospital admissions and overall time spent in hospital, extending its benefits beyond CV risk reduction. Trial Registration ClinicalTrials.gov
UR - https://www.scopus.com/pages/publications/105026405909
U2 - 10.1001/jamacardio.2025.4824
DO - 10.1001/jamacardio.2025.4824
M3 - Article
C2 - 41433034
AN - SCOPUS:105026405909
SN - 2380-6583
JO - JAMA cardiology
JF - JAMA cardiology
ER -
