In people who already have heart disease, yes. In 17,604 patients with existing cardiovascular disease and no diabetes, an event occurred in 6.5% on semaglutide against 8.0% on placebo. The hazard ratio was 0.80, over a mean 39.8 months.
Against another GLP-1 it is a tie rather than a win. Tirzepatide was randomized against dulaglutide in 13,299 people with type 2 diabetes and established heart disease [2]. Events ran 12.2% against 13.1%, hazard ratio 0.92. Noninferiority passed at P=0.003. Superiority did not, at P=0.09. So noninferior is not better.
Against surgery it loses clearly. A matched cohort put composite events at 4.4% after bariatric surgery against 6.6% on semaglutide in people without diabetes [3]. Heart failure showed the widest gap. Surgical patients pass a workup first, so the two groups were selected differently.
The heart itself changes shape. A cardiac MRI substudy found tirzepatide reduced left ventricular mass and paracardiac fat in obesity-related heart failure [4]. That is a structural change rather than an event count.
The cardiovascular result is the strongest thing anyone can say about this class. It is also the claim most likely to be repeated to you with a price attached. Worth knowing: what the trial found, how large the effect was, and what the thing sold shares with the thing tested. That last one is less than the sentence usually implies. It is the same question, asked of a harder endpoint, as is a GLP-1 worth what it costs.
What the trial found
SELECT enrolled 17,604 patients aged 45 or over. All had pre-existing cardiovascular disease and a BMI of 27 or greater, with no history of diabetes. They were randomized 1:1 to weekly semaglutide 2.4 mg or placebo [1]. The primary endpoint was a composite of cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke.
Follow-up ran a mean of 39.8 months. The endpoint occurred in 569 of 8,803 patients on semaglutide, or 6.5%. On placebo it was 701 of 8,801, or 8.0%. The hazard ratio was 0.80 (95% CI 0.72 to 0.90, p<0.001). The mean duration of exposure to the drug was 34.2 months.
What it cost the people in it
Adverse events leading to permanent discontinuation happened to 1,461 patients on semaglutide (16.6%) and 718 on placebo (8.2%). One in six people randomized to the drug stopped because of how it made them feel. That was in a trial, with study staff, at no cost to the participant. That figure belongs beside any three-year course. It is the same pattern we count in who is still taking it after a year.
What three years would cost here
The trial dosed for a mean of 34.2 months. Across the 407 injected semaglutide figures on this roster, the median billed rate is $179 a month. The range runs $76 to $449, a spread of 5.9×. At the median, 34 months comes to $6,086. At the cheapest published figure it is $2,584; at the dearest, $15,266. Roster read September 2026.
Those are the numbers. Here is the caveat that matters more than any of them. None of these sellers is selling the drug the trial used. SELECT ran on brand semaglutide at a fixed 2.4 mg. Most of this roster sells a compounded preparation, at a milligram usually not published. We count that silence in what happens at a higher dose. A cardiovascular outcome measured on one product is not a property of every product containing the same molecule name.
How to read a claim built on this trial
If a seller’s page says this drug reduces cardiovascular risk, the honest version carries four conditions. Brand semaglutide. 2.4 mg weekly. About three years. In people who already had cardiovascular disease. Strip any one and the result does not transfer. The price you are shown almost certainly assumes you will strip at least two.
The practical question is therefore not whether the trial is good. It is. The question is what you are buying, and for how long. That arithmetic is in what a GLP-1 actually costs. Whether your starting figure survives the second month is in the headline is not the bill.