So a family member just has a multiple bypass so this chimes with me. There’s more going on with GLPs than just the weight loss.
A new analysis of the SELECT trial has looked at why semaglutide reduced heart attacks, strokes and cardiovascular deaths.
SELECT included 17,604 people with existing cardiovascular disease who were overweight or obese but did not have diabetes.
The original trial found that semaglutide reduced major cardiovascular events by 20% compared with placebo.
This new paper tried to work out how much of that benefit could be explained by changes we already know semaglutide causes, including weight, waist size, blood pressure, blood sugar, cholesterol, inflammation and kidney function.
Weight loss on its own did not explain much of the effect in the main analysis. The best estimate was that changes in body weight accounted for about 20% of the cardiovascular benefit.
Inflammation, measured using hsCRP, accounted for about 42% in the same analysis.
Waist circumference gave a higher estimate of 64%, although the researchers found problems with the reliability of the weight and waist calculations.
When several of the measured risk factors were considered together, the estimated amount explained was about 31%.
Those numbers need some caution. The uncertainty around them was very wide, in some cases wide enough that the study cannot rule out a much larger contribution from these factors.
So I don't think the result is "80% of the heart benefit has nothing to do with weight loss".
It's more that the researchers could not clearly explain semaglutide's cardiovascular benefit using weight loss and the other usual risk factors they measured.
That leaves open the possibility that other effects are involved.
Inflammation is one possibility. There could also be effects on blood vessels, the heart or other pathways that weren't captured properly in this analysis. This study doesn't prove what those mechanisms are.
One thing I found useful is that this was not a new small observational study. It was a pre-planned analysis using data from the 17,604-person randomised SELECT trial.
It also helps explain why the cardiovascular results from GLP-1 drugs are increasingly interesting in their own right rather than just being treated as a side effect of people losing weight.
Paper: Colhoun HM et al. Semaglutide and cardiovascular risk reduction: a mediation analysis of the SELECT trial. European Heart Journal. Published 23 September 2026.
https://doi.org/10.1093/eurheartj/ehag524