Lower Risk of Cardiovascular Events in Patients With Clinical Atherosclerotic Cardiovascular Disease Who Initiated Semaglutide 2.4 mg in the Real-World: Results From the SCORE-Clinical ASCVD Study

Diabetes, Obesity and Metabolism (DOM), 2026

Aims

To evaluate the association between semaglutide 2.4 mg and major adverse cardiovascular events (MACE) among adults with clinical atherosclerotic cardiovascular disease (ASCVD) and overweight/obesity without diabetes in real-world clinical practice.

Materials and methods

Adults aged ≥ 45 years with overweight/obesity and clinical ASCVD were identified from a United States database (2016-2024). Patients initiating semaglutide 2.4 mg were matched 1:2 with individuals not treated with semaglutide 2.4 mg through a propensity score model including > 70 demographic and clinical covariates. Primary outcomes were revised 3-point MACE (rMACE-3: myocardial infarction [MI], stroke, all-cause mortality) and revised 5-point MACE (rMACE-5: rMACE-3, heart failure [HF] hospitalisation, coronary revascularization). Secondary outcomes included 3-point MACE and 5-point MACE (replacing all-cause mortality with cardiovascular-related mortality) and HF composite outcomes; exploratory outcomes were incident type 2 diabetes (T2D), major adverse kidney events (MAKE) and major obesity-related adverse events (MORAE). Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models.

Results

The final sample comprised 38 308 patients with semaglutide 2.4 mg use propensity-score matched to 76 615 patients without. Over a mean follow-up of 8.6 months, semaglutide 2.4 mg significantly reduced the risk of rMACE-3 (HR: 0.55; 95% CI: 0.47-0.65), rMACE-5 (0.63; 0.56-0.71), MACE-3 (0.66; 0.56-0.78) and MACE-5 (0.69; 0.62-0.77). Semaglutide 2.4 mg also significantly reduced the risk of HF composite outcomes, T2D, MAKE and MORAE.

Conclusions

Semaglutide 2.4 mg was associated with a significantly reduced risk of MACE and other obesity-related outcomes, extending prior evidence of benefits to a broader clinical ASCVD population.

Authors

Nanna MG, Mena-Hurtado C, Divino V, Zhao Z, Chen Y, Boland J, Song J, Traina A, Ozer K, Knop FK, Smolderen KG