How strong is the cardiovascular evidence for someone like you? Established cardiovascular disease
glp1-ascvd-yesFewer than 5 people have reached this rule so farSELECT: 8.0% → 6.5% major events; semaglutide approved for CV risk reduction
No clinician has signed off this rule yet. It reflects our reading of the guidelines cited below, which has not been independently checked.
Word for word, as generated for the example person below. Figures in the text are theirs.
Semaglutide is approved specifically to reduce cardiovascular events in your situation, and the evidence behind that is unusually good. Worth raising directly.
Proven in trialsShown: 20% fewer heart attacks, strokes, and heart deaths in 17,604 people with heart disease.
SELECT randomised 17,604 people with established cardiovascular disease and a BMI of 27 or above, none of whom had diabetes, to semaglutide 2.4 mg or placebo for about three and a half years. Heart attacks, strokes and cardiovascular deaths fell from 8.0% to 6.5% — a 20% relative reduction, and about 15 events avoided per 1000 people treated. The effect appeared early, before most of the weight was lost, and a prespecified analysis found it only partly tracked how much weight people lost, which suggests the drug is doing something beyond the scale. Your BMI is 25.8.
ACC/AHA (US)
The ACC/AHA chronic coronary disease guideline rates a GLP-1 receptor agonist as Class 2a, Level B-R when drug treatment for weight is warranted, and prefers semaglutide over liraglutide. It was written before SELECT reported, so it does not cite the trial. No guideline read here gives this indication a Class 1.
2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Pati… · Recommendation behind this rule · class and level read from the guideline tables on 2026-09-30
ESC (Europe)
Semaglutide should be considered in people with chronic coronary syndrome and a BMI above 27 without diabetes, to reduce cardiovascular death, heart attack or stroke.
2024 ESC chronic coronary syndromes guidelines · Recommendation tables · class and level read from the guideline tables on 2026-09-30
SELECT trial — semaglutide 2.4 mg in overweight/obesity with established CVD, without diabetes · Class 2a · Level B-R
“Prior heart attack and stroke, diabetes” — an illustrative profile, not a real user.
Asked after: BMI 27 or above, or type 2 diabetes
Cited by the recommendations above.
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Runs in lib/engine/glp1Pathway.ts as glp1-ascvd-yes.