Generalizability of SELECT to cardiac surgical patients: analysis of the TRICS III randomized trial

Background: The SELECT (Semaglutide Effects on Cardiovascular Outcomes in People with Overweight or Obesity) trial reported a 20% reduction in risk of a 3-point major adverse cardiac and cerebrovascular endpoint (MACCE) in nondiabetic patients with established cardiovascular (CV) disease and a body mass index of ≥27 randomized to semaglutide 2.4 mg weekly.¹ Previous reports have estimated the prevalence of obesity to be ∼10% in patients undergoing cardiac surgery,² with a paradoxical protective benefit of overweight and obese phenotypes compared with underweight, normal weight, and morbidly obese patients. A recently published prespecified subanalysis of the SELECT trial demonstrated preserved efficacy of semaglutide in patients following coronary artery bypass grafting (CABG) surgery [HR: 0.72 (0.54-0.95)], with larger absolute risk reductions (ARRs) in patients with vs without a history of CABG (2.3% vs 1.0%).³ Given that patients undergoing cardiac surgery represent a high-risk subset of those with established CV disease, there may be a meaningful proportion that would benefit from treatment with semaglutide.