The SELECT trial enrolled 17,604 adults with pre-existing cardiovascular disease and measured cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke as the primary composite endpoint. Semaglutide 2.4 mg weekly produced a hazard ratio of 0.80 (95% CI 0.72 to 0.90) against placebo. That is the clinical ledger.

The capital ledger runs ahead of it. Novo Nordisk's regional distribution footprint across Singapore, Thailand, and Indonesia expanded through 2025 on a thesis that semaglutide-class drugs represent a "metabolic aging" platform. That thesis has no corresponding Phase 3 registration. NMPA's Center for Drug Evaluation approved semaglutide for weight management in China in 2024 against anthropometric and glycemic endpoints; MOH Singapore's formulary listing followed the cardiovascular indication. No APAC regulator at marketing-authorization level has received a semaglutide application naming GrimAge or DunedinPACE as a primary endpoint. Novo Nordisk's Phase 3 pipeline, as registered on ClinicalTrials.gov through Q2 2026, contains no trial with a biological age primary endpoint.