The SELECT trial: a game-changer
The SELECT trial was a landmark study involving 17,604 adults with obesity/overweight and established cardiovascular disease. Over a mean follow-up of 3.3 years, semaglutide 2.4mg (Wegovy) demonstrated:
- 20% reduction in major adverse cardiovascular events (MACE) — heart attacks, strokes, and cardiovascular death
- Average weight loss of 9.4% maintained over the study period
- Significant improvements in blood pressure, inflammatory markers, and lipid profiles
This is the first and only weight loss medication to demonstrate direct cardiovascular risk reduction in a large outcomes trial. It fundamentally changed how obesity in patients with heart disease is treated.
PBS eligibility (pending)
The PBAC recommended Wegovy for PBS listing specifically based on SELECT trial data. The pending criteria:
- BMI ≥35 (≥32.5 for Asian, Aboriginal, Torres Strait Islander populations)
- AND established cardiovascular disease: prior heart attack, prior stroke, or symptomatic peripheral arterial disease
If listed, the cost would drop from $400–460/month to approximately $31.60/script ($7.70 concession).
Full PBS guide with timeline →
Which medications are safe with heart disease?
| Medication | Heart disease safety | Notes |
|---|---|---|
| Wegovy | Recommended | SELECT trial showed 20% MACE reduction. Actively beneficial. |
| Mounjaro | Likely safe | CV outcomes trial ongoing. No concerns in existing data. |
| Contrave | Caution | May increase blood pressure. Not first-line with CVD. |
| Duromine | Contraindicated | Increases heart rate and blood pressure. Do NOT use with CVD. |
| Xenical | Safe | Works in the gut only. No cardiovascular effects. |
What to discuss with your cardiologist
- Whether Wegovy is appropriate given your specific cardiac history
- Potential for PBS access (when listing is confirmed)
- Interactions with cardiac medications (blood thinners, beta-blockers, statins — generally no issues with GLP-1s)
- Weight loss targets and monitoring plan