Danish Registry Study Estimates Heart-Attack Risk in Patients Who Would Qualify for SELECT

JACC Advances, a journal in the American College of Cardiology's JACC family, published a study online October 9, 2026 that measured how much cardiovascular risk exists in the kind of real-world patients who would have qualified for the SELECT trial, and modeled how much of that risk semaglutide might address. The study was led by Mette K. Hansen of Aarhus University Hospital and the Regional Hospital Central Jutland in Denmark, with co-authors including Naveed Sattar of the University of Glasgow.

SELECT (Semaglutide Effects on Cardiovascular Outcomes in People with Overweight or Obesity, ClinicalTrials.gov NCT03574597) was a completed, randomized, placebo-controlled trial of 17,604 adults with overweight or obesity and established cardiovascular disease but no diabetes, and previously reported that semaglutide reduced major adverse cardiovascular events (MACE) compared with placebo. The new study did not test semaglutide directly. Instead, researchers applied SELECT's inclusion and exclusion criteria to the Western Denmark Heart Registry, an observational database, to estimate how many real-world patients would qualify for treatment under those criteria and what their cardiovascular outlook looks like without it.

The registry included 21,777 adults with a first-time heart attack and no diabetes recorded between 2010 and 2021. Of these, 10,768 met SELECT's eligibility threshold of a body mass index of 27 kg/m2 or higher. Median age at first heart attack was 65 years among this SELECT-eligible group, compared with 69 years among a normal-weight comparison group (BMI 20 to 26 kg/m2).

Over 5 years of follow-up, the SELECT-eligible group had a 5.9% incidence of a second heart attack (544 patients), a 10.7% incidence of MACE (975 patients), and a 10.3% incidence of death from any cause (914 patients). The authors concluded that cardiovascular risk in this population was substantial, with roughly 1 in 10 patients experiencing a MACE event within 5 years of their first heart attack.

In a separate, assumption-dependent scenario analysis, the authors used the cardiovascular benefit semaglutide demonstrated in SELECT to estimate how treatment might change that trajectory in this registry population, projecting that it could postpone the point at which 5% of patients had experienced a MACE event by about 12 months. The authors described this as a modeled projection built on SELECT's trial results and the registry's observed risk, not a result of administering semaglutide to these registry patients, none of whom received the drug as part of this study.

The study was partly funded by an institutional research grant from the Novo Nordisk Foundation. Several co-authors disclosed financial relationships with drugmakers: Sattar reported consulting or speaking fees from multiple companies including Novo Nordisk and Eli Lilly; co-author Morten Schmidt Andersen disclosed a minor shareholding in Novo Nordisk; and co-author Michael Maeng disclosed a Novo Nordisk Foundation grant, lecture and advisory fees from Novo Nordisk, and minor shareholdings in both Eli Lilly and Novo Nordisk. Semaglutide is already approved by the FDA and the European Medicines Agency and registered with Australia's Therapeutic Goods Administration, marketed as Wegovy for chronic weight management and cardiovascular risk reduction and as Ozempic and Rybelsus for type 2 diabetes. This registry-based analysis does not change that regulatory status in any market. It describes a modeled projection from existing trial and registry data, not a new clinical trial, and is not treatment or dosing guidance; cardiovascular risk management decisions should be made with a qualified clinician.