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Semaglutide and Hospitalizations in Patients With Obesity and Established Cardiovascular Disease: An Exploratory
Stephen J Nicholls1, Donna H Ryan2, John Deanfield3
1Monash Victorian Heart Institute and Monash University, Melbourne, Victoria, Australia.
Insights
Semaglutide significantly reduced hospital admissions and hospital stay duration for patients with cardiovascular disease and obesity. This finding extends the benefits of semaglutide beyond cardiovascular risk reduction.
Area of Science:
- Cardiology
- Endocrinology
- Clinical Trials
Background:
- The SELECT trial demonstrated semaglutide's efficacy in reducing cardiovascular events in patients with established cardiovascular disease (CVD) and overweight or obesity without diabetes.
- The impact of semaglutide on hospitalization rates in this population was previously unknown.
Purpose of the Study:
- To investigate the effect of semaglutide on total hospital admissions and duration of hospital stay.
- To assess the impact of semaglutide on hospitalizations for any indication and for serious adverse events.
Main Methods:
- A prespecified exploratory analysis of the SELECT randomized clinical trial (NCT03574597).
- 17,604 patients aged 45+ with established CVD and BMI ≥27 without diabetes were randomized to once-weekly subcutaneous semaglutide (2.4 mg) or placebo.
- Follow-up occurred for a median of 41.8 months, analyzing total hospital admissions and days in hospital.
Main Results:
- Semaglutide significantly reduced total hospitalizations for any indication (18.3 vs 20.4 per 100 patient-years; P<.001) and for serious adverse events (15.2 vs 17.1 per 100 patient-years; P<.001).
- Hospitalization duration was also lower with semaglutide for any indication (157.2 vs 176.2 days per 100 patient-years; P=.01) and for serious adverse events (137.6 vs 153.9 days per 100 patient-years; P=.02).
- No significant heterogeneity in the reduction of hospital admissions was observed across subgroups (BMI, age, sex).
Conclusions:
- Once-weekly semaglutide treatment led to significant reductions in hospital admissions and overall time spent hospitalized in patients with established CVD and overweight or obesity without diabetes.
- These findings suggest that semaglutide offers additional benefits by reducing healthcare utilization beyond its established cardiovascular risk reduction effects.
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.
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