Generalizability of SELECT to cardiac surgical patients: analysis of the TRICS III randomized trial

<p dir="ltr"><b>Background:</b> The SELECT (Semaglutide Effects on Cardiovascular Outcomes in People with Overweight or Obesity) trial reported a 20% reduction in risk of a 3-point major adverse cardiac and cerebrovascular endpoint (MACCE) in nondiabetic patients with established cardiovascular (CV) disease and a body mass index of ≥27 randomized to semaglutide 2.4 mg weekly.<a href="https://www.sciencedirect.com/science/article/pii/S2772963X25000146?via=ihub#bib1" target="_blank">¹</a> Previous reports have estimated the prevalence of obesity to be ∼10% in patients undergoing cardiac surgery,<a href="https://www.sciencedirect.com/science/article/pii/S2772963X25000146?via=ihub#bib2" target="_blank">²</a> with a paradoxical protective benefit of overweight and obese phenotypes compared with underweight, normal weight, and morbidly obese patients. A recently published prespecified subanalysis of the SELECT trial demonstrated preserved efficacy of semaglutide in patients following coronary artery bypass grafting (CABG) surgery [HR: 0.72 (0.54-0.95)], with larger absolute risk reductions (ARRs) in patients with vs without a history of CABG (2.3% vs 1.0%).<a href="https://www.sciencedirect.com/science/article/pii/S2772963X25000146?via=ihub#bib3" target="_blank">³</a> Given that patients undergoing cardiac surgery represent a high-risk subset of those with established CV disease, there may be a meaningful proportion that would benefit from treatment with semaglutide.