GLP-1 heart benefits: which drugs are proven to cut heart attack and stroke risk

Q: Do GLP-1 drugs protect the heart?

Some are proven to lower heart attack, stroke and cardiovascular death in the people they were tested in. Six brands carry that FDA indication: Wegovy, Ozempic, Rybelsus, Mounjaro, Trulicity and Victoza. Only Wegovy has it for people without diabetes, based on the SELECT trial.

Q: How much did Wegovy lower heart risk in the SELECT trial?

In 17,604 adults aged 45 or older with heart disease, overweight or obesity and no diabetes, a first heart attack, stroke or cardiovascular death occurred in 6.5% on semaglutide 2.4 mg and 8.0% on placebo, a hazard ratio of 0.80, over a median follow-up of 41.8 months. Novo Nordisk funded the trial.

Q: Is Ozempic approved to reduce heart attack risk?

Yes, for adults with type 2 diabetes and established cardiovascular disease, based on SUSTAIN 6 (hazard ratio 0.74). Ozempic also has a kidney indication in type 2 diabetes with chronic kidney disease that includes cardiovascular death. Without diabetes, the semaglutide brand with a heart indication is Wegovy.

Q: Does Zepbound or Mounjaro have heart benefits?

Mounjaro is approved to reduce heart events in adults with type 2 diabetes at high risk, after it matched Trulicity in SURPASS-CVOT (hazard ratio 0.92, not proven better). Zepbound has no heart indication; its obesity outcomes trial, SURMOUNT-MMO, lists October 2027 for results. In HFpEF heart failure, tirzepatide lowered worsening heart failure events in SUMMIT.

Q: Does compounded semaglutide have the same heart benefits?

Nobody has tested it. Every heart outcome trial used an approved brand, such as Wegovy in SELECT, and compounded semaglutide carries no FDA indication. It contains the same molecule, but the trial results belong to the brand products.

Q: Will Medicare pay for Wegovy for heart disease?

It can. Medicare cannot cover drugs used only for weight loss, but Part D plans can cover a GLP-1 used for an FDA-approved indication other than obesity, and KFF names cardiovascular disease risk reduction as one. Your plan's formulary and prior authorization rules still apply.

Six GLP-1 brands carry an FDA-approved heart indication: Wegovy, Ozempic, Rybelsus, Mounjaro, Trulicity and Victoza. Only Wegovy has it without diabetes. In the SELECT trial of 17,604 adults with heart disease and overweight, Wegovy cut heart attack, stroke and cardiovascular death from 8.0% to 6.5% (hazard ratio 0.80). Zepbound has no heart indication yet; its outcomes trial reports in 2027. Compounded versions were never tested.

Julian CaraulaniFounder, PriceTracker GLP-1Last checked October 2026

9 min read · published October 2026

Key takeaways

1Six GLP-1 brands are FDA approved to reduce the risk of major adverse cardiovascular events (heart attack, stroke or cardiovascular death): Wegovy, Ozempic, Rybelsus, Mounjaro, Trulicity and Victoza.
2Wegovy is the only one approved for that without type 2 diabetes: adults with established heart disease and obesity or overweight. In SELECT, events fell from 8.0% on placebo to 6.5% on Wegovy.
3Zepbound has no heart indication. Its 15,374-person outcomes trial in obesity (SURMOUNT-MMO) lists October 2027 for results. Mounjaro's diabetes trial matched Trulicity on heart events but did not beat it.
4In heart failure with preserved ejection fraction, semaglutide improved symptoms (STEP-HFpEF) and tirzepatide lowered heart failure events (SUMMIT). Neither is a labeled heart failure indication.
5Compounded semaglutide and tirzepatide were not the products in any of these trials and carry no indication. Medicare Part D can cover a GLP-1 prescribed for heart risk reduction.

Six GLP-1 brands are FDA approved to lower the risk of a heart attack, stroke or cardiovascular death: Wegovy, Ozempic, Rybelsus, Mounjaro, Trulicity and Victoza. Wegovy is the only one approved for that in people without diabetes, after the SELECT trial cut those events from 8.0% on placebo to 6.5% (hazard ratio 0.80).¹² The other five carry the heart indication for adults with type 2 diabetes.³⁴⁵⁷⁸ Zepbound, the tirzepatide brand for weight, has no heart indication yet; its outcomes trial in obesity lists October 2027 for results.⁹¹²

Doctors call the outcome these trials count "MACE", short for major adverse cardiovascular events: cardiovascular death, a non-fatal heart attack or a non-fatal stroke.¹ A hazard ratio of 0.80 means about 20% fewer first events over the trial, relative to placebo. The table below is every brand, what its label says and the trial behind it.

Which GLP-1s have an FDA heart indication?

Brand (molecule)	Who the heart indication covers	Outcomes trial	Result for MACE
Wegovy injection and tablets (semaglutide)	Adults with established heart disease and obesity or overweight, no diabetes needed¹	SELECT, 17,604 people, vs placebo¹	6.5% vs 8.0%, hazard ratio 0.80²
Ozempic injection (semaglutide)	Adults with type 2 diabetes and established heart disease; a separate kidney indication includes cardiovascular death³	SUSTAIN 6, 3,297 people, vs placebo³	Hazard ratio 0.74³
Rybelsus and Ozempic tablets (oral semaglutide)	Adults with type 2 diabetes at high risk of these events⁴	Trial 7, 9,650 people, vs placebo⁴	Hazard ratio 0.86⁴
Mounjaro (tirzepatide)	Adults with type 2 diabetes at high risk of these events⁵	SURPASS-CVOT, 13,299 people, vs Trulicity⁵	Hazard ratio 0.92 vs Trulicity: as good, not proven better⁵
Trulicity (dulaglutide)	Adults with type 2 diabetes and heart disease or multiple risk factors⁷	REWIND, 9,901 people, vs placebo⁷	12.0% vs 13.4%, hazard ratio 0.88⁷
Victoza (liraglutide)	Adults with type 2 diabetes and established heart disease⁸	LEADER, vs placebo⁸	13.0% vs 14.9%, hazard ratio 0.87⁸
Zepbound (tirzepatide)	None: approved for weight and obstructive sleep apnea only⁹	SURMOUNT-MMO, 15,374 people, results listed October 2027¹²	Not yet reported¹²

Two things the table makes plain. First, the indication follows the brand and the population that was studied, not the molecule: semaglutide sold as Wegovy has a heart claim for people without diabetes, while the same molecule sold as Ozempic has one only with diabetes.¹³ Second, tirzepatide's heart evidence today is in diabetes, measured against another GLP-1 rather than placebo.⁵

The SELECT trial: Wegovy in people without diabetes

SELECT is the trial most people mean when they ask about GLP-1 heart benefits. It enrolled people "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."² On the label, established disease means a prior heart attack, a prior stroke or peripheral arterial disease, and anyone with type 1 or type 2 diabetes was excluded.¹ Everyone got Wegovy 2.4 mg or placebo weekly on top of their usual heart care, and the median follow-up was 41.8 months.¹

Main result: a first heart attack, stroke or cardiovascular death in 569 of 8,803 people on semaglutide (6.5%) against 701 of 8,801 on placebo (8.0%), hazard ratio 0.80.²
Who stopped: side effects led 16.6% of the semaglutide group to stop the drug for good, against 8.2% on placebo.²
Who paid for it: Novo Nordisk, the maker of Wegovy.²

The label's own table splits the result by component, and the parts did not move equally. Fatal or non-fatal heart attacks: 2.8% on Wegovy vs 3.8% on placebo, hazard ratio 0.72. Cardiovascular death alone: 2.5% vs 3.0%, hazard ratio 0.85, with a confidence interval running from 0.71 to 1.01, so on its own it is not a proven reduction.¹ Wegovy tablets carry the same heart indication as the injection.¹

Ozempic, Rybelsus, Trulicity and Victoza: the diabetes trials

Before SELECT, every GLP-1 heart claim came from people with type 2 diabetes, and those trials are why Ozempic, Rybelsus, Trulicity and Victoza carry one.

Ozempic, SUSTAIN 6. 3,297 people with type 2 diabetes and atherosclerotic heart disease, followed at least 2 years; hazard ratio for a first event 0.74.³ Ozempic also has a kidney indication in type 2 diabetes with chronic kidney disease that counts cardiovascular death.³
Rybelsus, oral semaglutide. 9,650 people with type 2 diabetes and heart disease or chronic kidney disease took a 14 mg tablet daily or placebo; hazard ratio 0.86.⁴
Victoza, LEADER. A first event in 13.0% on liraglutide vs 14.9% on placebo, hazard ratio 0.87, and 0.85 for death from any cause.⁸
Trulicity, REWIND. 9,901 people with type 2 diabetes and heart disease or multiple risk factors, median follow-up 5.4 years; a first event in 12.0% vs 13.4%, hazard ratio 0.88.⁷ Its label is the broadest of the diabetes group because it includes people with risk factors and no established disease.⁷

Mounjaro and Zepbound: where tirzepatide stands

Lilly tested Mounjaro against Trulicity, not against placebo. In SURPASS-CVOT, a first heart attack, stroke or cardiovascular death happened in 12.2% on tirzepatide and 13.1% on dulaglutide, hazard ratio 0.92; that met the bar for "noninferiority" but not superiority (P = 0.09).⁶ The label puts it the same way: "Superiority to dulaglutide was not established."⁵ Because Trulicity itself lowers these events, matching it was enough for Mounjaro to gain a heart indication in type 2 diabetes.⁵⁷ The trial reported more gastrointestinal side effects on tirzepatide.⁶

Zepbound is a different label. It is approved for weight reduction and for moderate to severe obstructive sleep apnea, with no heart indication.⁹ The trial that could change that is SURMOUNT-MMO: 15,374 adults with obesity, a primary outcome of death from any cause, heart attack, stroke, coronary revascularization or heart failure events, no longer recruiting, with primary completion listed for October 2027.¹² Until it reports, nobody can say from a trial whether Zepbound protects the heart in people without diabetes.

Heart failure: what STEP-HFpEF and SUMMIT found

Both makers also ran trials in heart failure with preserved ejection fraction (HFpEF), the stiff-heart kind common in people with obesity. Heart failure is not among the indications on either brand's label.¹⁹

Trial	Who	What changed	Funder
STEP-HFpEF, semaglutide 2.4 mg, 52 weeks	529 people with HFpEF and a BMI of 30 or more¹⁰	Symptom score up 16.6 points vs 8.7 on placebo; weight down 13.3% vs 2.6%; 6-minute walk up 21.5 m vs 1.2 m¹⁰	Novo Nordisk¹⁰
SUMMIT, tirzepatide up to 15 mg, median 104 weeks	731 people with HFpEF and a BMI of 30 or more¹¹	Cardiovascular death or worsening heart failure 9.9% vs 15.3% (hazard ratio 0.62); worsening heart failure 8.0% vs 14.2%¹¹	Eli Lilly¹¹

One detail in SUMMIT is easy to miss: cardiovascular deaths were few, 8 on tirzepatide and 5 on placebo, so the trial cannot tell whether death itself changed; the drop came from heart failure events.¹¹

Compounded semaglutide and tirzepatide

None of these trials used a compounded product, and compounded semaglutide or tirzepatide carries no FDA indication of any kind, heart or otherwise. SELECT tested Wegovy; SURPASS-CVOT and SUMMIT tested Lilly's tirzepatide.¹⁵¹¹ A compounded dose may contain the same molecule, but the heart results above belong to the approved brands. If heart protection is the reason you want a GLP-1, that is a question for the prescriber about which product fits your history. For more on how compounded versions are made, see 503A vs 503B pharmacies.

Does insurance or Medicare cover a GLP-1 for the heart?

A heart indication changes the coverage question, because it is not a weight loss use. KFF explains that Medicare is barred by law from covering drugs used "specifically for weight loss," but that "People on Medicare can get GLP-1s covered by Part D plans only if they are used for a medically accepted FDA-approved indication other than obesity, like type 2 diabetes, cardiovascular disease risk reduction, or sleep apnea."¹³ So Wegovy prescribed to someone with established heart disease is a Part D question, not a weight loss exclusion. Our Medicare guide walks through it, and getting a GLP-1 covered covers commercial plans, where the heart diagnosis belongs on the prior authorization.

What it costs without coverage

The cheapest branded Wegovy on our board today is $208 a month, and Novo's own self-pay prices by dose are in the ladder below. Compounded semaglutide starts at $69, with the caveat above: it is not the product SELECT tested.

Wegovy · the manufacturer’s own ladder · sellers checked October 2026

What each dose costs

Ease in0.25 / 0.5 mgThe starting doses, priced at $199/mo for a new patient's first two fills through December 31, 2026. After that they cost the standard $349.$199/mo
Build1 / 1.7 mgThe middle of the ladder. The manufacturer's self-pay price is flat across every pen dose from 0.25 to 2.4 mg.$349/mo
Maintain2.4 mgThe top of the standard pen range. The self-pay price is the same as every tier below it.$349/mo
High dose7.2 mg (HD)The high-dose strength, $50/mo above the standard pen price.$399/mo

Against that, the cheapest verified seller of Wegovy today is Sesame Care at $208/mo all in, checked October 2026. See every Wegovy price.

Dose steps and manufacturer prices from the manufacturer, as published. Your dose and your schedule are set by your prescriber.

For the brand side, see what Wegovy costs and the Wegovy savings offer. To compare the two molecules on weight, read tirzepatide vs semaglutide.

Sources13

Wegovy (semaglutide) injection and tablets prescribing information (DailyMed): indications and section 14.1, the SELECT cardiovascular outcomes trial (Study 1) read October 2026“to reduce the risk of major adverse cardiovascular (CV) events (CV death, non-fatal myocardial infarction, or non-fatal stroke) in adults with established CV disease and either obesity or overweight. ... WEGOVY tablets are indicated in combination with a reduced calorie diet and increased physical activity: ... Patients with a history of type 1 or type 2 diabetes were excluded. ... In this trial, 17,604 patients were randomized to WEGOVY injection or placebo. ... The median follow-up duration was 41.8 months. ... WEGOVY injection significantly reduced the risk for first occurrence of MACE. The estimated hazard ratio (95% CI) was 0.80 (0.72, 0.90) ... 262 (3%) 223 (2.5%) 0.85 (0.71; 1.01) ... 334 (3.8%) 243 (2.8%) 0.72 (0.61; 0.85)” ↩
Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes (SELECT). N Engl J Med 2023;389(24):2221-2232 (PubMed abstract; funded by Novo Nordisk) read October 2026“we 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. ... A primary cardiovascular end-point event occurred in 569 of the 8803 patients (6.5%) in the semaglutide group and in 701 of the 8801 patients (8.0%) in the placebo group (hazard ratio, 0.80; 95% confidence interval, 0.72 to 0.90; P<0.001). Adverse events leading to permanent discontinuation of the trial product occurred in 1461 patients (16.6%) in the semaglutide group and 718 patients (8.2%) in the placebo group” ↩
Ozempic (semaglutide) injection prescribing information (DailyMed): indications and section 14.2, the SUSTAIN 6 cardiovascular outcomes trial read October 2026“to reduce the risk of major adverse cardiovascular events in adults with type 2 diabetes mellitus and established cardiovascular disease. ... to reduce the risk of sustained eGFR decline, end-stage kidney disease and cardiovascular death in adults with type 2 diabetes mellitus and chronic kidney disease. ... In this trial, 3,297 patients with inadequately controlled type 2 diabetes and atherosclerotic cardiovascular disease were randomized to OZEMPIC (0.5 mg or 1 mg) once weekly or placebo for a minimum observation time of 2 years. ... OZEMPIC significantly reduced the occurrence of MACE. The estimated hazard ratio for time to first MACE was 0.74 (95% CI: 0.58, 0.95).” ↩
Rybelsus and Ozempic (oral semaglutide) tablets prescribing information (DailyMed): indications and section 14.4, Trial 7 (NCT03914326) read October 2026“to reduce the risk of major adverse cardiovascular events (cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke) in adults with type 2 diabetes mellitus who are at high risk for these events. ... In this trial, 9,650 patients with type 2 diabetes mellitus and established cardiovascular (CV) disease and/or chronic kidney disease (CKD) ... were randomized to either once daily semaglutide tablets 14 mg or placebo, in addition to standard of care. ... Semaglutide tablets significantly reduced the occurrence of MACE. The estimated hazard ratio for time to first MACE was 0.86 (95% CI: 0.77, 0.96)” ↩
Mounjaro (tirzepatide) prescribing information (DailyMed): indications and section 14.6, the SURPASS-CVOT trial against dulaglutide read October 2026“to reduce the risk of major adverse cardiovascular (CV) events (CV death, non-fatal myocardial infarction, or non-fatal stroke) in adults with type 2 diabetes mellitus who are at high risk for these events. ... In this trial, 13,299 patients with inadequately controlled type 2 diabetes mellitus and established CV disease were randomized to once weekly subcutaneous MOUNJARO (up to 15 mg) versus once weekly subcutaneous dulaglutide (1.5 mg) ... MOUNJARO was non-inferior to dulaglutide for reducing the occurrence of MACE-3. The estimated hazard ratio for time to first MACE was 0.92 (95.3% CI: 0.83, 1.01) for MOUNJARO compared to dulaglutide. Superiority to dulaglutide was not established.” ↩
Nicholls SJ, Pavo I, Bhatt DL, et al. Cardiovascular Outcomes with Tirzepatide versus Dulaglutide in Type 2 Diabetes (SURPASS-CVOT). N Engl J Med 2025;393(24):2409-2420 (PubMed abstract; funded by Eli Lilly) read October 2026“A primary end-point event occurred in 801 patients (12.2%) in the tirzepatide group and 862 (13.1%) in the dulaglutide group (hazard ratio, 0.92; 95.3% confidence interval, 0.83 to 1.01; P = 0.003 for noninferiority; P = 0.09 for superiority). The incidence of adverse events appeared to be similar in the two groups, although more gastrointestinal adverse events were observed in the tirzepatide group.” ↩
Trulicity (dulaglutide) prescribing information (DailyMed): indications and the REWIND cardiovascular outcomes trial read October 2026“To reduce the risk of major adverse cardiovascular events in adults with type 2 diabetes mellitus who have established cardiovascular disease or multiple cardiovascular risk factors. ... In this trial, 9901 adult patients with type 2 diabetes mellitus and established cardiovascular (CV) disease or multiple cardiovascular risk factors were randomized to TRULICITY 1.5 mg or placebo both added to standard of care. The median follow-up duration was 5.4 years. ... 594 (12.0%) 663 (13.4%) 0.88 (0.79, 0.99)” ↩
Victoza (liraglutide) prescribing information (DailyMed): indications and the LEADER cardiovascular outcomes trial read October 2026“to reduce the risk of major adverse cardiovascular events in adults with type 2 diabetes mellitus and established cardiovascular disease. ... VICTOZA significantly reduced the occurrence of MACE. The estimated hazard ratio (95% CI) for time to first MACE was 0.87 (0.78, 0.97). ... 608 (13.0%) 694 (14.9%) 0.87 (0.78; 0.97) ... The estimated hazard ratio of time to all-cause death for VICTOZA compared to placebo was 0.85 (0.74, 0.97).” ↩
Zepbound (tirzepatide) prescribing information (DailyMed): indications read October 2026“to reduce excess body weight and maintain weight reduction long term in adults with obesity or adults with overweight in the presence of at least one weight-related comorbid condition. ... to treat moderate to severe obstructive sleep apnea (OSA) in adults with obesity.” ↩
Kosiborod MN, Abildstrøm SZ, Borlaug BA, et al. Semaglutide in Patients with Heart Failure with Preserved Ejection Fraction and Obesity (STEP-HFpEF). N Engl J Med 2023;389(12):1069-1084 (PubMed abstract; funded by Novo Nordisk) read October 2026“We randomly assigned 529 patients who had heart failure with preserved ejection fraction and a body-mass index ... of 30 or higher to receive once-weekly semaglutide (2.4 mg) or placebo for 52 weeks. ... The mean change in the KCCQ-CSS was 16.6 points with semaglutide and 8.7 points with placebo ... the mean percentage change in body weight was -13.3% with semaglutide and -2.6% with placebo ... The mean change in the 6-minute walk distance was 21.5 m with semaglutide and 1.2 m with placebo” ↩
Packer M, Zile MR, Kramer CM, et al. Tirzepatide for Heart Failure with Preserved Ejection Fraction and Obesity (SUMMIT). N Engl J Med 2025;392(5):427-437 (PubMed abstract; funded by Eli Lilly) read October 2026“we randomly assigned, in a 1:1 ratio, 731 patients with heart failure, an ejection fraction of at least 50%, and a body-mass index ... of at least 30 ... the median duration of follow-up was 104 weeks. Adjudicated death from cardiovascular causes or a worsening heart-failure event occurred in 36 patients (9.9%) in the tirzepatide group and in 56 patients (15.3%) in the placebo group (hazard ratio, 0.62; 95% confidence interval [CI], 0.41 to 0.95; P = 0.026). Worsening heart-failure events occurred in 29 patients (8.0%) in the tirzepatide group and in 52 patients (14.2%) in the placebo group (hazard ratio, 0.54; 95% CI, 0.34 to 0.85), and adjudicated death from cardiovascular causes occurred in 8 patients (2.2%) and 5 patients (1.4%), respectively (hazard ratio, 1.58; 95% CI, 0.52 to 4.83).” ↩
ClinicalTrials.gov NCT05556512, A Study of Tirzepatide (LY3298176) on the Reduction on Morbidity and Mortality in Adults With Obesity (SURMOUNT-MMO, Eli Lilly): status, enrollment and primary outcome read October 2026“"overallStatus":"ACTIVE_NOT_RECRUITING","primaryCompletionDateStruct":{"date":"2027-10"} ... "count":15374,"type":"ACTUAL" ... Time to First Occurrence of Any Component Event of Composite (All-Cause Death, Nonfatal Myocardial Infarction (MI), Nonfatal Stroke, Coronary Revascularization, or Heart Failure Events)” ↩
KFF, What to Know About the BALANCE Model for GLP-1s in Medicare and Medicaid (Part D coverage of GLP-1s for uses other than obesity) read October 2026“from the outset, Medicare has been prohibited by law from covering medications when used specifically for weight loss. People on Medicare can get GLP-1s covered by Part D plans only if they are used for a medically accepted FDA-approved indication other than obesity, like type 2 diabetes, cardiovascular disease risk reduction, or sleep apnea.” ↩

Common questions

Do GLP-1 drugs protect the heart?

Some are proven to lower heart attack, stroke and cardiovascular death in the people they were tested in. Six brands carry that FDA indication: Wegovy, Ozempic, Rybelsus, Mounjaro, Trulicity and Victoza. Only Wegovy has it for people without diabetes, based on the SELECT trial.

How much did Wegovy lower heart risk in the SELECT trial?

In 17,604 adults aged 45 or older with heart disease, overweight or obesity and no diabetes, a first heart attack, stroke or cardiovascular death occurred in 6.5% on semaglutide 2.4 mg and 8.0% on placebo, a hazard ratio of 0.80, over a median follow-up of 41.8 months. Novo Nordisk funded the trial.

Is Ozempic approved to reduce heart attack risk?

Yes, for adults with type 2 diabetes and established cardiovascular disease, based on SUSTAIN 6 (hazard ratio 0.74). Ozempic also has a kidney indication in type 2 diabetes with chronic kidney disease that includes cardiovascular death. Without diabetes, the semaglutide brand with a heart indication is Wegovy.

Does Zepbound or Mounjaro have heart benefits?

Mounjaro is approved to reduce heart events in adults with type 2 diabetes at high risk, after it matched Trulicity in SURPASS-CVOT (hazard ratio 0.92, not proven better). Zepbound has no heart indication; its obesity outcomes trial, SURMOUNT-MMO, lists October 2027 for results. In HFpEF heart failure, tirzepatide lowered worsening heart failure events in SUMMIT.

Does compounded semaglutide have the same heart benefits?