Released · Last reviewed
SELECT: semaglutide and cardiovascular outcomes in obesity without diabetes
Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. · New England Journal of Medicine · December 2023 · NCT03574597
A 20% relative reduction in major adverse cardiovascular events (6.5% versus 8.0% absolute). This is the trial that moved semaglutide from a weight-loss drug to a cardiovascular one.
Study record
| Field | Detail |
|---|---|
| Study design | Phase 3, randomised, double-blind, placebo-controlled outcomes trial |
| Population | 17,604 adults ≥45 with established cardiovascular disease and BMI ≥27, without diabetes |
| Sample size | 17,604 |
| Intervention | Semaglutide 2.4mg once weekly, subcutaneous |
| Comparator | Placebo |
| Duration | Mean follow-up approximately 40 months |
| Primary endpoint | Composite of cardiovascular death, non-fatal myocardial infarction or non-fatal stroke (MACE) |
| Trial registration | NCT03574597 |
| Publication | New England Journal of Medicine, December 2023 |
| Funding | Novo Nordisk. |
Results
A 20% relative reduction in major adverse cardiovascular events (6.5% versus 8.0% absolute). This is the trial that moved semaglutide from a weight-loss drug to a cardiovascular one.
Limitations
Secondary-prevention population with established cardiovascular disease — the result does not necessarily transfer to primary prevention in healthy people. Relative risk reduction of 20% corresponds to an absolute reduction of about 1.5 percentage points over roughly three years, which is the number that matters for an individual patient.
What this study does not prove
This section exists on every study page we publish, because the most common way clinical evidence is misused is not by misquoting the result — it is by stretching the result past the population, dose, duration or dosage form that was actually tested.
Absolute versus relative: reading the number correctly
Trial results are usually reported as relative figures, because relative figures are larger and therefore more persuasive. A "20% reduction in cardiovascular events" sounds transformative. The absolute reduction in SELECT was from 8.0% to 6.5% — about 1.5 percentage points over roughly three years. Both statements describe the same result honestly; only one of them tells you what to expect for yourself.
The same applies to weight-loss figures. A mean reduction of 20.9% is a mean. Individual results in these trials ranged from substantial loss to none at all, and a mean tells you nothing about where you personally would land. Anyone quoting a trial average as a promise is misusing it.
Funding and conflicts of interest
Every pivotal trial in this field was funded by the company that manufactures the drug it tested. That is normal in pharmaceutical research and it does not make the results false — these are large, well-conducted, peer-reviewed studies. It does mean the funding belongs in the citation every time, particularly for head-to-head trials where the funder makes the winning drug. SURMOUNT-5 was funded by Eli Lilly and found Lilly's drug superior. The result is plausible and consistent with the separate trial programmes; the disclosure still belongs beside it.
Where this sits against the other evidence
No single trial should be read alone. The strength of the GLP-1 evidence base is that multiple independent trial programmes — SURMOUNT for tirzepatide, STEP for semaglutide, SCALE for liraglutide, SELECT for cardiovascular outcomes — point in a consistent direction across tens of thousands of participants. That consistency is what makes the class credible.
What that consistency does not do is extend to products the trials never tested. Every one of those programmes studied an FDA-approved subcutaneous injection. None studied a compounded preparation, a microdose regimen, or an orally disintegrating tablet. The evidence is strong exactly where it was collected and silent everywhere else, and the gap between those two things is where most of the marketing in this industry operates.
How to read a trial result without being misled
Three habits will protect you from most of the misuse of this literature.
Ask what was actually administered. Not the molecule — the product. Every trial on this page tested an FDA-approved subcutaneous injection. If you are being sold a compounded preparation, a microdose, or an orally disintegrating tablet, this trial is evidence about a related product, not about yours.
Ask who was studied. SURMOUNT-1 and STEP 1 enrolled people without type 2 diabetes and gave every arm a lifestyle intervention. SELECT enrolled people who already had cardiovascular disease. A result in one population is not automatically a result in another, and the further you are from the enrolled population, the less the number tells you.
Ask for the absolute figure. Relative reductions are larger and therefore more persuasive. The absolute figure is the one that tells you what to expect.
Relevance to patients
The trial tested an FDA-approved subcutaneous injection. If you are considering a compounded product, a microdose programme, or an orally disintegrating tablet, this trial is not evidence for what you are buying. It is evidence about a related but different product. That distinction is the single most important thing to carry away from any GLP-1 trial page, including this one.
Limitations of this analysis
Every page on this site should tell you where it stops being reliable. This one stops here.
Prices decay quickly. This is the fastest-moving data we publish. Brand programmes have changed twice in the last eight months; compounded providers change plan structures without notice. Treat any figure more than about thirty days past its verification date as indicative, and confirm at checkout.
Competitor pricing is reported, not captured by us. We hold dated captures for brand pricing and for NexLife. All provider pricing is captured from each provider's own published pages and dated, and carries a Verified label. Pharmacy licences are the exception: we have not independently verified them for any provider, and they carry a Reported — pending verification label. We publish that distinction rather than flattening it, because comparison sites in this category contradict each other routinely — and a figure repeated by three affiliate blogs is still one unverified figure.
We have not audited pharmacy licences. Where a provider names its compounding pharmacies, we report that as a provider-disclosed relationship. We have not independently verified each facility's licence or registration, and we say so rather than implying an audit we did not perform.
Advertised availability is not your availability. Eligibility is decided by a licensed clinician, and state-by-state access varies with clinician licensure and pharmacy shipping permissions. No page can promise you a price you will actually be offered.
We are commercially funded. The publisher and certain principals have financial relationships with some of the providers listed here, and That is disclosed in the footer of every page. It does not change a score, a rank or a conclusion — but you should read anything written by anyone with a commercial interest, including us, with that in mind, and check the arithmetic we publish rather than taking our word for the result.
Frequently asked questions
What did SELECT show?
A 20% relative reduction in major adverse cardiovascular events (6.5% versus 8.0% absolute). This is the trial that moved semaglutide from a weight-loss drug to a cardiovascular one.
What does SELECT NOT prove?
Does not show cardiovascular benefit in people without established cardiovascular disease. Does not transfer to compounded semaglutide, or to tirzepatide, which has its own separate outcomes programme.
Who funded it?
Novo Nordisk.
Sources
- Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. SELECT: semaglutide and cardiovascular outcomes in obesity without diabetes. New England Journal of Medicine, December 2023.
- ClinicalTrials.gov registration: NCT03574597.
- Our source hierarchy and evidence-grading policy.
Jastreboff AM et al., N Engl J Med 2022 (NCT04184622), n=2,539. Dose-response is real: the effect rises with dose. These are FDA-APPROVED SUBCUTANEOUS INJECTION doses — they do not transfer to compounded, microdose or ODT products. Trial means are not individual promises.
The numbers behind this page
Checking the figures in this evidence summary
Every price quoted in this evidence summary comes from the programme's own pricing page and carries the date it was captured. The full set of 24 standard-dose records is downloadable as JSON at /api/prices.json, with molecule and dose class stated on every record. Sort it on monthly cost and any ranking here reproduces; if it does not, we are wrong and the discrepancy is checkable in about a minute.
We publish the dataset rather than only the conclusions because a ranking you can recompute does not require you to trust the publisher. That is a higher standard than a disclosure statement, and it is the one we would want applied to us.
Reading the price against the market
Where this sits in the market
The figures in this summary sit inside a market with a measurable shape, and that shape is what makes any single price readable.
21 programmes print a price for both molecules on their own pages. Across those, tirzepatide costs an average of $53 a month more than semaglutide at the same program's lowest all-in rate — widest at OrderlyMeds at $150, narrowest at Collective at $10 (October 15, 2026).
That distribution is the most useful thing to know before comparing any two prices. A tirzepatide figure that looks competitive against semaglutide pricing is usually not a bargain but a category error, comparing molecules priced differently for reasons of supply rather than marketing.
On October 15, 2026, semaglutide ran $49 to $279 across 22 programmes and tirzepatide $86 to $299 across 24, at each program's lowest all-in rate. Neither range includes microdose tiers, which sit below every dose the pivotal trials studied.
Questions this page answers
Where do these prices come from?
Each is read from the program's own pricing page and carries its read date. The October 15, 2026 file at /api/prices.json holds 106 records, 49 of them verified standard-dose prices, with molecule, dose class and evidence status on every record.
Which tracked programs charge less than NexLife?
Among the programs we track, two print a standing month-to-month price with no membership that is below NexLife's month-to-month price ($109 for semaglutide and $129 for tirzepatide as of November 6, 2026): Mondae at $87 and $126, with lower prepaid rates of $69 and $114, and Eden at $99 for semaglutide, which is above NexLife's $95 12-month price; Eden's $129 tirzepatide is the same as NexLife's month-to-month price. Competitor prices were read on October 15, 2026. Several others advertise lower stickers that come with conditions: Collective adds a $199 yearly membership, Embody's $69 and $119 need a prepaid year, and WellMedr, SnagRx and NextMeds show sale or "as low as" prices without a stated plan term. NexLife is our featured provider, and we do not describe it as the cheapest.
Are compounded GLP-1 medicines FDA-approved?
No. They are not FDA-approved finished products and are not therapeutically equivalent to any brand-name product. FDA does not review them for safety, effectiveness or manufacturing quality before marketing.
Why do the same programmes quote two different prices?
Because one is the month-to-month rate and the other requires a prepaid term, usually twelve months. We compare programs on their lowest all-in monthly price and print the plan term beside every figure, so a rate that needs a commitment is labelled as one.