SELECT-Eligible MI Risk in Western Denmark

A 2026 Western Denmark Heart Registry study estimated that about one in ten SELECT-eligible patients had a major adverse cardiovascular event within five years after a first myocardial infarction. These were observed registry outcomes among people with overweight or obesity and no diabetes. The paper's separate estimate of what semaglutide might postpone came from a scenario analysis, not from treating this cohort in a randomized trial^[1].

Who counted as SELECT-eligible

Researchers identified 21,777 patients without diabetes who had a first myocardial infarction recorded between 2010 and 2021. They applied the SELECT cardiovascular-outcomes trial's inclusion and exclusion criteria to the registry population. A total of 10,768 met those criteria and had a body mass index of at least 27 kg/m2^[2]. Their median age at the first heart attack was 65 years.

Trial eligibility does not equal enrollment. The registry patients did not necessarily receive the trial intervention. In this study, SELECT criteria defined a group whose later cardiovascular risk could be described using routine clinical data. The design helps estimate the size and risk profile of a potentially relevant population, while leaving treatment assignment outside the observed registry analysis.

What happened over five years

Within five years, 544 patients had a second myocardial infarction and 975 had a major adverse cardiovascular event, or MACE. Another 914 died from any cause. The corresponding cumulative incidences were 5.9% for another heart attack, 10.7% for MACE and 10.3% for all-cause death^[1]. The confidence interval around MACE ran from 10.1% to 11.4%.

The MACE result is a composite outcome. Composite endpoints can summarize several serious cardiovascular events, but the abstract does not provide a component-by-component breakdown of the 975 events. Nor does the five-year percentage predict what will happen to a particular patient. Age, heart damage, smoking history, other medicines and many clinical factors can change individual risk.

The semaglutide estimate was modeled

The authors then used results from SELECT to construct an assumption-dependent scenario for semaglutide. In that model, applying the trial effect was estimated to postpone the point when cumulative MACE incidence reached 5% by 12 months^[2]. This is a translation exercise. The registry did not randomly assign its patients to semaglutide or placebo and then observe a one-year delay directly.

Such scenarios can help clinicians and health systems consider preventive potential in a real-world population. Their validity depends on assumptions, including how well the SELECT treatment effect transfers to Danish patients after a first heart attack. Differences in care, adherence or baseline risk can alter that transfer. The estimate should not be presented as a guaranteed delay for every eligible person.

How this relates to the SELECT trial

SELECT previously randomized adults with established cardiovascular disease, overweight or obesity and no diabetes to semaglutide or placebo. The new Danish paper did not repeat that efficacy test. Instead, it used SELECT's eligibility framework to find a similar-looking registry group, measured that group's five-year risk and then explored preventive potential using the trial result as an input.

The eligibility overlap improves relevance, but it does not make the populations interchangeable. A registry cohort after a first heart attack can differ from trial participants in follow-up intensity and treatment persistence. Clinical practice also includes secondary-prevention medicines and procedures whose use may vary over time. Readers can place the modeled result beside our broader semaglutide cardiovascular research summary, while keeping this paper's observed and projected outcomes distinct.

That distinction separates three questions. The registry describes how often outcomes occurred after a first heart attack. SELECT supplies randomized evidence about semaglutide in its own trial population. The scenario estimates how that trial effect might shift the registry's MACE curve^[2]. Only the first two layers contain directly observed outcomes from their respective populations; the third depends on combining them.

Limitations and disclosure context

The study draws on one regional registry and on records collected across more than a decade. Changes in acute heart-attack care and secondary prevention during that period could affect later risk. Applying trial criteria to records also depends on whether each relevant inclusion or exclusion detail was captured accurately. The abstract does not establish that every eligible person would tolerate or choose the same treatment.

The PubMed record reports institutional support from the Novo Nordisk Foundation and additional author relationships that include research support, consulting, speaking fees or shareholdings involving several companies. Some disclosed relationships involved Novo Nordisk^[1]. Disclosures do not invalidate the analysis, but they are relevant when interpreting an assumption-dependent estimate involving a Novo Nordisk medicine.

What this study can support

The firm result is that SELECT-eligible Western Danish patients without diabetes faced substantial risk after a first heart attack: roughly one in ten had MACE within five years. The 12-month postponement estimate offers a modeled public-health scenario, not a measured patient outcome. It cannot decide who should receive semaglutide or replace a clinician's assessment of established post-heart-attack care.

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