Semaglutide Effects on Heart Disease and Stroke in Patients With Overweight or Obesity

The researchers are doing the study to see if semaglutide may reduce the risk of having cardiovascular events in patients with overweight or obesity and with prior cardiovascular disease. The participant will either get semaglutide (active medicine) or placebo ("dummy" medicine). Which treatment the participants get is decided by chance. The participant's chance of getting semaglutide or placebo is the same. The participant will get the study medicine in a pen. The participants will need to use the pen to inject the study medicine in a skinfold once a week. The study will last for about 2.5 to 5 years. Participants will have up to 25 clinic visits with the study doctor.


Eligibility Criteria:
Inclusion Criteria:

* Informed consent obtained before any trial-related activities. Trial-related activities are any procedures that are carried out as part of the trial, including activities to determine suitability for the trial
* Male or female, age greater than or equal to 45 years at the time of signing informed consent
* Body mass index (BMI) greater than or equal to 27 kg/m\^2
* Have established cardiovascular (CV) disease as evidenced by at least one of the following: prior myocardial infarction; prior stroke (ischemic or haemorrhagic stroke); or symptomatic peripheral arterial disease (PAD), as evidenced by intermittent claudication with ankle-brachial index (ABI) less than 0.85 (at rest), or peripheral arterial revascularization procedure, or amputation due to atherosclerotic disease

Exclusion Criteria:

Cardiovascular-related:

* Any of the following: myocardial infarction, stroke, hospitalisation for unstable angina pectoris or transient ischaemic attack within the past 60 days prior to the day of screening
* Planned coronary, carotid or peripheral artery revascularisation known on the day of screening
* Presently classified as being in New York Heart Association (NYHA) Class IV heart failure

Glycaemia-related:

* HbA1c greater than or equal to 48 mmol/mol (6.5 %) as measured by the central laboratory at screening
* History of type 1 or type 2 diabetes (history of gestational diabetes is allowed)
* Treatment with glucose-lowering agents within 90 days before screening
* Treatment with any glucagon-like-peptide-1 receptor agonist (GLP-1 RA) within 90 days before screening

General safety:

* History or presence of chronic pancreatitis
* Presence of acute pancreatitis within the past 180 days prior to the day of screening
* Personal or first degree relative(s) history of multiple endocrine neoplasia type 2 or medullary thyroid carcinoma
* End stage renal disease or chronic or intermittent haemodialysis or peritoneal dialysis
* Presence or history of malignant neoplasms within the past 5 years prior to the day of screening. Basal and squamous cell skin cancer and any carcinoma in-situ are allowed
* Severe psychiatric disorder which in the investigator's opinion could compromise compliance with the protocol
* Known or suspected hypersensitivity to trial products or related products
* Previous participation in this trial. Participation is defined as randomisation
* Receipt of any investigational medicinal product within 30 days before screening
* Female who is pregnant, breast-feeding or intends to become pregnant or is of child-bearing potential and not using a highly effective contraceptive method
* Any disorder, unwillingness or inability, which in the investigator's opinion, might jeopardise the participant's safety or compliance with the protocol