Semaglutide and Cardiovascular Outcomes by Baseline and Change in HbA1c in People With Overweight or Obesity but Without Diabetes in SELECT

OBJECTIVE To evaluate the cardiovascular (CV) effects of semaglutide by baseline and change in HbA1c in a prespecified analysis of SELECT. RESEARCH DESIGN AND METHODS In SELECT, people with overweight/obesity and atherosclerotic CV disease (ASCVD) without diabetes were randomized to weekly semaglutide 2.4 mg or placebo. The primary endpoint of first MACE (CV mortality, non-fatal myocardial infarction MI, or stroke) was reduced by 20% with semaglutide versus placebo. First MACE, its individual components, expanded MACE (CV mortality, non-fatal MI or stroke, coronary revascularization, or hospitalization for unstable angina), a heart failure (HF) composite (HF hospitalization or urgent medical visit, or CV mortality), coronary revascularization, and all-cause mortality were analyzed by baseline HbA1c subgroup and categories of HbA1c change (0.3 %-points) from baseline to 20 weeks using the intention-to-treat principle using Cox proportional hazards. RESULTS Among 17,604 participants (mean age 61.6 years, 72.3% male), 33.5% had baseline HbA1c of