Guide

The SELECT Trial Deep Dive: Why the 20% Heart Attack Reduction Matters

Updated January 2026

-----------|----------------| | Statins (high-intensity) | 25-35% | | Blood pressure control | 20-25% | | SELECT (semaglutide) | 20% | | Aspirin (secondary prevention) | 15-20% | | Bariatric surgery (observational) | 30-40% |

Semaglutide's cardiovascular protection is in the range of established first-line interventions.

What About Tirzepatide?

Tirzepatide (Mounjaro/Zepbound) doesn't have equivalent data yet. The SURPASS-CVOT trial is ongoing, with results expected 2027.

Based on mechanism, many experts expect similar benefits. But until the data exists, semaglutide remains the only GLP-1 with proven cardiovascular outcomes.

If cardiovascular protection is your priority: Semaglutide has the evidence. Tirzepatide does not yet.

Practical Implications

For men with existing heart disease

SELECT provides direct evidence. Discuss GLP-1s with your cardiologist — this is now cardiovascular treatment, not just weight management.

For men with high cardiovascular risk (no prior event)

SELECT enrolled secondary prevention patients. But the mechanisms apply to primary prevention too. Many cardiologists are prescribing for high-risk primary prevention.

For medication choice

If cardiovascular protection matters most, semaglutide > tirzepatide until SURPASS-CVOT data arrives.

For insurance coverage

SELECT data may help with prior authorization. "Cardiovascular risk reduction" is a medical indication beyond "weight loss."

The Bigger Picture

SELECT fundamentally changed how we think about GLP-1s: - Before SELECT: Weight loss drugs with some cardiac benefits - After SELECT: Cardiovascular protection drugs that also cause weight loss

For men — who face higher cardiac risk and die of heart disease more than anything else — this reframe matters. You're not taking a "weight loss drug." You're taking a medication that reduces your risk of dying from the #1 cause of male death.

That's a different conversation.


Related Articles: - GLP-1s Cut Heart Attack Risk 20% - Semaglutide vs Tirzepatide: Which Is Better for Men? - GLP-1 Medications for Men: Complete Guide


Last updated: January 2026

Sources: SELECT trial (NEJM 2023); Lancet mediation analysis 2025

Medical disclaimer: This content is for informational purposes only. Discuss cardiovascular risk management with your healthcare provider.

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