The Wegovy label (revised 06/2026) lists reduction of major adverse cardiovascular events (cardiovascular death, non-fatal heart attack, non-fatal stroke) in adults with established cardiovascular disease and either obesity or overweight. The basis is the SELECT trial of 17,604 adults without diabetes: the composite occurred in 6.5% on semaglutide 2.4 mg versus 8.0% on placebo (hazard ratio 0.80, 95% CI 0.72 to 0.90). The label also states that cardiovascular death on its own did not meet the prespecified superiority test, and that the effect on heart failure has not been established.
The indication that is not about weight
When Wegovy’s label added a cardiovascular indication, it became more than a weight-management drug on paper. The indication is specific, though, and it is easy to overstate. This guide walks through who the label describes, what SELECT measured, which results the label treats as confirmed and which it does not, and the safety signals from the same trial.
We read the Wegovy label (revised 06/2026), including sections 1, 2.2 and 14.1, on 14 October 2026, together with the NEJM report of SELECT as indexed on PubMed and the ClinicalTrials.gov record. Heart disease is managed by cardiologists and primary care clinicians; this article describes published data, not treatment advice.
What the label says
- Indication: in combination with a reduced-calorie diet and increased physical activity, to reduce the risk of major adverse cardiovascular events (CV death, non-fatal myocardial infarction, or non-fatal stroke) in adults with established cardiovascular disease and either obesity or overweight.
- Dose: the maintenance dosage for cardiovascular risk reduction in adults is either 2.4 mg (recommended) or 1.7 mg once weekly, selected on treatment response and tolerability.
- Tablets: the label also lists Wegovy tablets for the same cardiovascular indication and says patients taking the 2.4 mg injection may switch to the 25 mg tablet one week after stopping the injection. This article covers only the injection trial described in section 14.1.
- Children: the Medication Guide says it is not known whether Wegovy injection is safe and effective for cardiovascular risk reduction in people under 18.
Who was in SELECT
Section 14.1 describes Study 1 (NCT03574597), a multinational, placebo-controlled, double-blind trial run on top of standard care including management of cardiovascular risk factors and lifestyle counseling. It randomized 17,604 adults who were 45 or older, had a BMI of 27 or higher and had established cardiovascular disease, defined as prior heart attack, prior stroke or peripheral arterial disease. People with a history of type 1 or type 2 diabetes were excluded. At baseline, the mean age was 62, 72% were male, 76% had a prior myocardial infarction, 23% a prior stroke and 9% peripheral arterial disease, and heart failure was reported in 24%.
This population is narrower than “anyone with a high BMI”. The label’s indication follows it: established cardiovascular disease plus obesity or overweight. Nothing in the label or trial describes the drug as a primary-prevention treatment for people without established cardiovascular disease, and diabetes was an exclusion criterion, not a subgroup.
The results, and the label’s own caveats
| Endpoint (time to first event) | Placebo (n=8,801) | Wegovy (n=8,803) | Hazard ratio (95% CI) |
|---|---|---|---|
| Primary: CV death, non-fatal MI or non-fatal stroke | 701 (8.0%) | 569 (6.5%) | 0.80 (0.72 to 0.90) |
| CV death | 262 (3.0%) | 223 (2.5%) | 0.85 (0.71 to 1.01) |
| All-cause death | 458 (5.2%) | 375 (4.3%) | 0.81 (0.71 to 0.93) |
| Fatal or non-fatal myocardial infarction | 334 (3.8%) | 243 (2.8%) | 0.72 (0.61 to 0.85) |
| Fatal or non-fatal stroke | 178 (2.0%) | 160 (1.8%) | 0.89 (0.72 to 1.11) |
| Hospitalization for heart failure or urgent heart failure visits | 122 (1.4%) | 97 (1.1%) | 0.79 (0.60 to 1.03) |
The footnotes on the label’s results table are worth reading as closely as the numbers. The primary composite was statistically significant. CV death was the first confirmatory secondary endpoint in the testing hierarchy, and the label states superiority was not confirmed; its interval (0.71 to 1.01) crosses 1. All-cause death is labelled a confirmatory secondary endpoint that was not statistically significant based on the prespecified testing hierarchy. Myocardial infarction, stroke and heart failure outcomes were not included in the testing hierarchy, and the label says the effect on heart failure has not been established. The honest reading is that the composite was reduced, and that the component results are more tentative.
Follow-up and persistence also matter. Median follow-up was 41.8 months in the label. A total of 31% of Wegovy-treated and 27% of placebo-treated patients permanently discontinued study drug. Of patients still on treatment at one year, 76% were on the 2.4 mg dose, 8% on 1.7 mg and 16% on lower doses. The trial’s average weight change was -9.4 kg on Wegovy versus -0.9 kg on placebo at week 104 (Table 7 of the label), but weight was not the primary question of SELECT.
Reading a hazard ratio
A hazard ratio of 0.80 compares how quickly first events occurred in the two groups over the trial. It is not the same as saying 20% of patients were protected. The absolute difference is what the event counts show: 569 first events among 8,803 Wegovy patients (6.5%) versus 701 among 8,801 placebo patients (8.0%), a gap of about 1.5 percentage points over a median follow-up of roughly three and a half years. Both ways of describing the result are accurate, and a prescriber can help you understand what they mean for an individual with a particular history. Everyone in SELECT also received standard-of-care cardiovascular management, so the result describes Wegovy added to that care, not instead of it. The label notes that concomitant cardiovascular therapies could be adjusted at the investigator’s discretion; lipid-lowering therapy was used by 90% of participants, platelet aggregation inhibitors by 86%, ACE inhibitors or ARBs by 74% and beta blockers by 70%.
Safety signals from the trial publication
The NEJM abstract reports that adverse events leading to permanent discontinuation of the trial product occurred in 16.6% of semaglutide patients versus 8.2% on placebo (P below 0.001). The label’s general warnings apply to people with cardiovascular disease just as they do to others: the boxed warning on thyroid C-cell tumors, increases in resting heart rate (relevant for people with heart conditions to discuss with their cardiologist), severe gastrointestinal reactions, allergic reactions and pulmonary aspiration before procedures. People on many cardiovascular medicines should also read what the labels say about absorption and interactions.
Mechanism, pregnancy and what the label does not explain
The label says plainly that the exact mechanism of semaglutide in cardiovascular risk reduction in adults has not been established. SELECT also produced meaningful weight loss, with mean body weight down 9.4 kg on Wegovy versus 0.9 kg on placebo at week 104 and waist circumference down 7.6 cm versus 1 cm, so it is not possible from the label to say how much of the cardiovascular effect travels through weight. We do not speculate beyond that.
For people who could become pregnant, the label says to discontinue Wegovy when pregnancy is recognized when it is used for cardiovascular risk reduction or weight reduction, and to stop at least 2 months before a planned pregnancy because of semaglutide’s long half-life. Our guide to pregnancy and contraception on GLP-1 labels goes through the wording across products.
Practical navigation
Having a labelled cardiovascular indication can change how a prior authorization is framed, but we did not verify any plan’s rules or any current price, so we do not quote them. Our guide to prior authorization and appeals explains the general process. To compare programs, see providers that accept insurance, brand-name GLP-1 telehealth and the manufacturer’s own routes under official manufacturer programs. For the pill-versus-injection question raised by the label, see oral GLP-1 versus injection. These are editorial resources, not recommendations.
Questions to ask your care team
- Do I meet the label’s description: established cardiovascular disease plus obesity or overweight, and no diabetes in the trial sense?
- How would this fit with the cardiovascular medicines I already take?
- Which dose, 2.4 mg or 1.7 mg, is appropriate if I cannot tolerate the higher dose?
- What would we monitor, and when would we reassess?
Frequently asked questions
Does Wegovy have a heart indication?
Yes: reducing major adverse cardiovascular events in adults with established cardiovascular disease and obesity or overweight.
Was SELECT done in people with diabetes?
No. A history of type 1 or type 2 diabetes was an exclusion criterion.
Did Wegovy reduce heart attacks?
Fatal or non-fatal myocardial infarction was 2.8% versus 3.8% (hazard ratio 0.72), but the label notes this endpoint was outside the formal testing hierarchy.
Does the label say it treats heart failure?
No. It states the effect on heart failure has not been established.
Sources
- Novo Nordisk, Wegovy (semaglutide) injection and tablets prescribing information, revised 06/2026, sections 1, 2.2, 14.1 and Medication Guide, fetched 14 October 2026.
- Lincoff AM, et al. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes. N Engl J Med, 14 December 2023 (PubMed 37952131), abstract read 14 October 2026.
- ClinicalTrials.gov NCT03574597: SELECT, completed, 17,604 enrolled, record read 14 October 2026.
Medical disclaimer. This article is informational, was prepared by the GLP-1.Reviews editorial team from the public sources listed above, and has not been reviewed by a physician. It is not medical advice. Label wording can change; confirm the instructions for your product with the Medication Guide that came with it. Talk to your prescriber or pharmacist about your own treatment, and see our medical disclaimer and editorial standards.
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