S. Nicholls, Donna H. Ryan, John Deanfield, Daniel Ferreira, Chim C. Lang, A. Michael Lincoff, Ildiko Lingvay, Christopher Lübker, Paula Pérez Terns, S. Munkgaard Rasmussen, SIGNE STENSEN, Peter Weeke, Steven E. Kahn, SELECT Trial Investigators, Djamel E. Nibouche, Mohamed Chettibi, Naima Hammoudi, Alejandro Porto, Alejandra Oviedo, Hugo D. Sanabria, Marcelo Martín Casas, Eduardo Farias, Ernesto Duronto, Carolina Chacón, Adriana Villarino, Javier M. Farias, Cesar Javier Zaidman, Claire Morbey, David M. Colquhoun, Elif I. Ekinci, Melissa Leung, Maged William, Karam Kostner, Mitra Shirazi, David Cross, John Amerena, Peter Purnell, Margaret Arstall, Walter P. Abhayaratna, Hermann Toplak, Rudolf Prager, Bernhard Ludvik, ALEXANDRA KAUTZKY-WILLER, Ursula Hanusch, Elmar Aigner, Susanne Käser, Michel De Pauw, Philippe Vanduynhoven, Philippe Van De Borne, Chris Vercammen, Jan Verwerft, Mathias Vrolix, Luiz Alberto Andreotti Turatti, José Francisco Kerr Saraiva, Cíntia Cercato, Adrian Kormann, Silmara Oliveira Leite, Paulo Rossi, Flávia B. Arantes, Lilia N. Maia, Sérgio Kaiser, Alberto Fonseca, Hugo Lisboa, DENISE FRANCO, José Carlos Nicolau, Pedro Sílvio Farsky, Luiz Eduardo Fontelles Ritt, Assen Goudev, Dobrin Vassilev, Nikolay Runev, B. Georgiev, Tzvetana Katova, Ivo Petrov, Валери Гелев, Maria Milanova, Arman Postadzhiyan, Mariya Tokmakova, Yoto Yotov, Snezhanka T. Tisheva-Gospodinova, Dotska Minkova, Zhulieta R. Prakova-Teneva, Svetla Vasileva, Alan Egan, George Tsoukas, Subodh Verma, Ronald Bourgeois, Pierre Filteau, Ram Vijayaraghavan, Michael Hartleib, Tamara Spaic, John Stewart, Amritanshu- S. Pandey, Remi Rabasa-Lhoret, François St-Maurice, James W. Bo y, SUE PEDERSEN, Roy Allison, Paul Poirier, Marie‐France Langlois, David Lau
Importance: The primary analysis of the SELECT randomized clinical trial suggests that semaglutide reduced the rates of cardiovascular (CV) death, myocardial infarction, and stroke in patients with established CV disease (CVD) and overweight or obesity without diabetes. However, the effect of semaglutide on hospitalizations in this population remains unknown. Objective: To determine the impact of semaglutide on total hospital admissions and duration of hospital stay. Design, Setting, and Participants: The SELECT trial included patients aged 45 years or older with established CVD and a body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) of 27 or higher without diabetes at 804 clinical settings across North America, South America, Europe, Asia, Africa, and Australia. Patients were randomized from October 2018 to March 2021. This prespecified exploratory analysis was conducted from February 2024 to September 2025. Interventions: Once-weekly subcutaneous semaglutide, 2.4 mg, or placebo. Main Outcomes and Measures: The total number of hospital admissions and days in hospital between the semaglutide and placebo groups. Results: A total of 17 604 patients (median [IQR] age, 61.0 [55.0-68.0] years; 4872 female patients [27.7%]; median [IQR] BMI, 32.1 [29.7-35.7]) were followed up for a median (IQR) period of 41.8 (33.0-47.0) months. There were 11 287 hospital admissions. The number of total hospitalizations was lower in the semaglutide group vs placebo for any indication (18.3 vs 20.4 admissions per 100 patient-years; mean ratio [MR], 0.90; 95% CI, 0.85-0.95; P < .001) and for serious adverse events (15.2 vs 17.1 admissions per 100 patient-years; MR, 0.89; 95% CI, 0.84-0.94; P < .001). The number of days hospitalized for any indication per 100 patient-years was lower in the semaglutide group vs placebo (157.2 vs 176.2 days; rate ratio [RR], 0.89; 95% CI, 0.82-0.98; P = .01), as well as hospitalizations for serious adverse events (137.6 vs 153.9 days; RR, 0.89; 95% CI, 0.81-0.98; P = .02). No heterogeneity was observed for the reduction of hospital admissions with semaglutide in selected subgroups, including BMI, age, and sex. Conclusions and Relevance: In this prespecified exploratory analysis of the SELECT randomized clinical trial, the trial cohort had a high rate of hospital admissions. Treatment with once-weekly semaglutide was associated with significant reductions in hospital admissions and overall time spent in hospital, extending its benefits beyond CV risk reduction. Trial Registration: ClinicalTrials.gov Identifier: NCT03574597.