Can a GLP-1 lower heart disease risk after menopause?

Key takeaways

Dr. Linda's take

Women are often surprised to learn that heart disease, not breast cancer, is the thing most likely to end their lives. That surprise is the whole problem. For decades the heart was studied mostly in men, and women were told to worry about other things. Then the estrogen of the reproductive years fades, and a layer of protection goes with it.

So when a patient asks whether one of these medicines could protect her heart after menopause, I hear a good and serious question underneath it. My job is to answer it honestly, which means holding two things at once. There is genuinely encouraging trial data here. And that data was not gathered in women defined by menopause, so I have to tell you where the evidence is solid and where I am reasoning across a gap. Let me walk through both.

Why does heart disease risk climb after menopause?

Because the loss of ovarian estrogen coincides with a cluster of changes that all push in the wrong direction for the heart.

Cardiovascular disease is the leading cause of death in women, who have a notable increase in the risk for this disease after menopause and typically develop coronary heart disease several years later than men.

That lag matters. It is part of why women, and sometimes their clinicians, underestimate the risk until it is closer than expected. The transition itself is not a neutral passage. The menopause transition is a time of accelerating cardiovascular disease risk.

Body composition, blood pressure, and lipids tend to shift during these years, and we cover the weight side of that story in what happens to weight after menopause. The point for the heart is simple. Midlife is not too early to think about cardiovascular risk. It may be the most important window there is.

What did the SELECT trial actually show?

SELECT is the trial that turned this from a hopeful idea into something with numbers behind it.

In the SELECT trial, investigators enrolled patients 45 years of age or older who had preexisting cardiovascular disease and a body-mass index of 27 or greater but no history of diabetes, and randomly assigned them to receive once-weekly subcutaneous semaglutide at a dose of 2.4 mg or placebo. A total of 17,604 patients were enrolled, and the mean duration of follow-up was 39.8 months.

The headline result was a reduction in major adverse cardiovascular events. In SELECT, a primary cardiovascular end-point event occurred in 6.5% of the patients in the semaglutide group and in 8.0% of the patients in the placebo group, with a hazard ratio of 0.80 and a 95% confidence interval of 0.72 to 0.90. Put in plainer terms, the effect can be summarized simply. In SELECT, the primary end point of first major adverse cardiovascular event, defined as cardiovascular mortality, nonfatal myocardial infarction, or stroke, was reduced by 20% with semaglutide versus placebo.

Here is the part that makes this specifically interesting. In patients with preexisting cardiovascular disease and overweight or obesity but without diabetes, weekly subcutaneous semaglutide at a dose of 2.4 mg was superior to placebo in reducing the incidence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke at a mean follow-up of 39.8 months. Before this trial, whether semaglutide can reduce cardiovascular risk associated with overweight and obesity in the absence of diabetes was unknown. SELECT is what changed that.

Does SELECT apply to women after menopause specifically?

This is where I slow down, because the honest answer is that it was not designed to.

SELECT was a trial of adults with established heart disease, and men were the majority. In the SELECT study, 72.5% of the 17,605 enrolled participants were male. So women made up roughly a quarter of the participants, and the trial did not select or analyze people by menopausal status. It was not built around the menopause transition, and its results were not isolated to postmenopausal women.

What that means in practice is that I can tell you the cardiovascular benefit was studied in a large mixed population that included women, and I cannot tell you it was proven separately in women after menopause. Applying the finding to a postmenopausal woman is a reasonable extrapolation, not a measured result. It also matters who was enrolled. Everyone in SELECT already had cardiovascular disease. This was not a study of preventing a first heart problem in an otherwise healthy midlife woman.

If you are weighing the broader picture of these medicines in these years, the trade-offs extend beyond the heart, and things like how these medicines affect bone density after menopause belong in the same conversation.

So should anyone take a GLP-1 just to protect the heart?

That is exactly the wrong way to read this, and I want to be direct about it.

A benefit measured in a trial is not the same as an approval to prevent heart disease across the board. The people in SELECT already had cardiovascular disease and carried overweight or obesity without diabetes. That is a specific clinical situation, decided with a clinician who knows your history, your risk factors, and everything else you have going on. It is not a reason for a healthy person to reach for one of these medicines as a heart supplement.

The useful takeaway is smaller and truer. For some people who already have both excess weight and established heart disease, there is now trial evidence of a cardiovascular benefit, and that can be one input among many in a real medical decision. Whether any of it fits you is not something an article can answer. If you want a starting point, our eligibility quiz is general education, not a plan for your specific situation.

The honest bottom line

Can a GLP-1 lower heart disease risk after menopause? The most accurate answer is a careful yes with conditions. The cardiovascular benefit shown in SELECT came from a trial of people who already had heart disease and carried overweight or obesity without diabetes, and that group included women but was mostly men. The result is real and was measured carefully. What was not measured is a menopause-specific effect, so applying it to women after menopause is a fair extrapolation rather than a proven result.

I would rather you leave with that precision than with either false comfort or false fear. After menopause the heart deserves more attention, not less. Whether a particular medicine belongs in that plan is a conversation for you and a clinician who can see the whole of you, not a decision to make from a headline about a trial.

Frequently asked questions

Did the SELECT trial include people without diabetes?

Yes, that was the point of it. In patients with preexisting cardiovascular disease and overweight or obesity but without diabetes, weekly subcutaneous semaglutide at a dose of 2.4 mg was superior to placebo in reducing the incidence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke at a mean follow-up of 39.8 months. Before this trial, whether semaglutide can reduce cardiovascular risk associated with overweight and obesity in the absence of diabetes was unknown.

How much did semaglutide lower cardiovascular events in SELECT?

In SELECT, the primary end point of first major adverse cardiovascular event, defined as cardiovascular mortality, nonfatal myocardial infarction, or stroke, was reduced by 20% with semaglutide versus placebo. In absolute terms, a primary cardiovascular end-point event occurred in 6.5% of the patients in the semaglutide group and in 8.0% of the patients in the placebo group, with a hazard ratio of 0.80 and a 95% confidence interval of 0.72 to 0.90.

Was SELECT a study of women after menopause?

No. In the SELECT study, 72.5% of the 17,605 enrolled participants were male. The trial was not designed around menopause and did not analyze participants by menopausal status, so its results are extrapolated to postmenopausal women rather than measured in them.

Why does heart disease matter more after menopause?

Because risk rises during and after the transition. Cardiovascular disease is the leading cause of death in women, who have a notable increase in the risk for this disease after menopause and typically develop coronary heart disease several years later than men. The menopause transition is a time of accelerating cardiovascular disease risk.

Should I take a GLP-1 just to prevent a heart attack?

That is not what the evidence supports for a healthy person. The people in SELECT already had established cardiovascular disease along with overweight or obesity, so the cardiovascular finding applies to that specific group and is one input in a decision made with a clinician, not a general heart-disease preventive.

References

1. Circulation (2020). Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association. PubMed PMID 33251828. https://pubmed.ncbi.nlm.nih.gov/33251828/ (Accessed 2026-07-19).
2. The New England journal of medicine (2023). Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes. PubMed PMID 37952131. https://pubmed.ncbi.nlm.nih.gov/37952131/ (Accessed 2026-07-19).
3. Diabetes care (2024). Semaglutide and Cardiovascular Outcomes by Baseline HbA1c and Change in HbA1c in People With Overweight or Obesity but Without Diabetes in SELECT. PubMed PMID 38907684. https://pubmed.ncbi.nlm.nih.gov/38907684/ (Accessed 2026-07-19).
4. Obesity (Silver Spring, Md.) (2023). Semaglutide for cardiovascular event reduction in people with overweight or obesity: SELECT study baseline characteristics. PubMed PMID 36502289. https://pubmed.ncbi.nlm.nih.gov/36502289/ (Accessed 2026-07-19).

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*This article is general education and is not medical advice. It cannot tell you what is right for your body. Talk with a licensed clinician about your own situation.*

*Written and clinically reviewed by Dr. Linda Moleon, MD. Last reviewed 2026-07-19.*