The short answer
Large semaglutide trials found fewer serious heart or kidney events, but only in the specific groups they enrolled: SELECT in adults with existing heart disease and overweight or obesity but no diabetes, FLOW in adults with type 2 diabetes and chronic kidney disease.
Read each result narrowly: the product, the dose, the people, and the outcome. This article does not tell anyone to start, stop, or switch a medicine.
The three trials at a glance
| Trial | Who was studied | Studied dose | Result |
|---|---|---|---|
| SELECT | 17,604 adults 45 or older with cardiovascular disease and a BMI of 27 or more, no diabetes | Weekly 2.4 mg (Wegovy) | Major heart event in 6.5% vs. 8.0% on placebo, over a mean 39.8 months |
| FLOW | 3,533 adults with type 2 diabetes and chronic kidney disease | Weekly 1.0 mg (Ozempic) | Kidney failure, 50% or greater eGFR drop, or kidney or cardiovascular death: 331 vs. 410 people |
| SUSTAIN 6 | 3,297 adults with type 2 diabetes and established cardiovascular disease | Ozempic | Composite of cardiovascular death, nonfatal heart attack, nonfatal stroke: 6.6% vs. 8.9% on placebo |
SELECT: heart events with existing heart disease, without diabetes
In March 2024, FDA approved a new indication for Wegovy (semaglutide): to reduce the risk of cardiovascular death, heart attack, and stroke in adults with cardiovascular disease and either obesity or overweight.
The published trial gives more detail.
In absolute terms, that is 1.5 percentage points in the trial population over that follow-up. It is not a promise that any reader’s personal risk will fall by 20%.
SELECT does not tell you what happens in people without established cardiovascular disease. It does not evaluate tirzepatide, retatrutide, or compounded look-alikes.
FLOW: kidneys, in type 2 diabetes with chronic kidney disease
Ozempic is also semaglutide, but it is not the same approved product as Wegovy and has its own labeled uses.
The kidney indication rests on the FLOW trial.
Those participants were not a general middle-aged audience curious about healthy aging.
FLOW does not show that the same medicine prevents kidney disease in people who do not have type 2 diabetes and this degree of chronic kidney disease.
SUSTAIN 6: an older, separate finding in type 2 diabetes
Ozempic’s heart indication in people with type 2 diabetes and established cardiovascular disease comes from SUSTAIN 6.
The composite moved. That one component did not, in the numbers FDA reported. Precision is the point.
How to read a GLP-1 headline
If you are reading about “GLP-1s and the heart” or “GLP-1s and the kidneys,” ask which molecule, which approved product, which trial, and which patients.
SELECT and FLOW are substantial evidence in the groups they enrolled. They are not proof that every related compound shares those outcomes, and they are not a personal treatment plan.
Questions about whether any approved medicine belongs in your care belong with a clinician who knows your history, not with a headline that flattened several studies into one story.
This article does not diagnose any condition, recommend starting or stopping any medicine, or promote unapproved drugs. Personal decisions belong with you and a qualified clinician.
