In a multicenter, double-blind, randomized trial, 17,604 patients 45 years of age or older with preexisting cardiovascular disease and a BMI >= 27 but without diabetes received once-weekly subcutaneous semaglutide (2.4 mg) or placebo. The primary composite cardiovascular endpoint was death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. Over a mean follow-up of 39.8 months, semaglutide reduced primary endpoint risk by 20% (HR 0.80; 95% CI 0.72-0.90; P<0.001).