Evidence-graded answer
Does GLP-1 prevent heart attacks?
Yes for semaglutide — SELECT (NEJM 2023) showed a 20% reduction in major adverse cardiovascular events (MACE: heart attack, stroke, CV death) in adults with obesity + established cardiovascular disease, even without diabetes. Tirzepatide data is pending (SURMOUNT-MMO trial reports 2026-2027).
SELECT enrolled 17,604 adults with overweight/obesity (BMI ≥27) + established CVD but no diabetes. Semaglutide 2.4 mg weekly, mean follow-up 39.8 months. MACE 6.5% vs 8.0% placebo (HR 0.80).
This was the first weight-loss medication trial powered to detect CV outcomes — landmark result that changed indication labeling (FDA added cardiovascular risk reduction to Wegovy in 2024).
Practical: many patients with CVD + obesity now have a strong indication for GLP-1 independent of A1c or BMI cutoffs commonly used by insurance.
Source: SELECT NEJM 2023, NEJM