STARTing a new path in cardiovascular prevention: Lessons from SELECT and real-world evidence on Semaglutide in obesity-driven risk

Obesity has more than doubled in prevalence over the past four decades, now affecting over a billion individuals worldwide and more than 70 % of adults in the United States. It significantly reduces both life expectancy and quality of life, with two-thirds of its excess mortality linked to cardiovascular disease (CVD) [1]. Despite its strong associations with atherosclerosis, heart failure, thromboembolic disease, and arrhythmias, obesity remains an underrecognized disease and is often managed less aggressively than other cardiovascular risk factors. Beyond weight gain, obesity drives CVD and metabolic disorders through chronic inflammation, insulin resistance, and dyslipidemia. Given its far-reaching consequences, urgent action is needed [1]. The optimal management of obesity should be comprehensive, recognizing it as a disease per se rather than merely a risk factor. The focus should extend beyond weight loss to reducing morbidity and mortality.