Oral Semaglutide and Change in Cardiovascular Risk Factors in High-Risk Type 2 Diabetes: A Post Hoc Secondary Analysis of the SOUL Randomized Clinical Trial

Mulvagh SL, Inzucchi SE, Marx N, Poulter NR, Deanfield JE, Pop-Busui R, Emerson SS, Mann JF, Engelmann MD, Hovingh GK, Mandavya K, Davicevic-Elez Z, Jeppesen OK, Lorenzatti A, Oguz A, Mankovsky B, Deerochanawong C, Gorgojo-Martinez JJ, Ji L, Bain SC, Mcguire DK, Buse JB, Vidotti MH, Leite SO, Aggarwal N, Bajaj H, Schlosser R, Noronha L, Pedersen S, Tellier G, Weisnagel J, Beca S, Alasaad H, Punthakee Z, Mancini JG, Tytus R, Ransom TP, Husain M, Tsoukas M, Liu J, Yuan G, Ye X, Dong X, Bian F, Angelo Cadena Bonfanti A, Hernandez Erazo ID, Hernández Ruiz EA, Gómez Mesa JE, Canecki-Varzic S, Loncar JV, Simegi-Djekic V, Kurir TT, Tusek S, Rahelic D, Marusic S, Kruljac I, Vitkovic DF, Oznerova M, Vrkoc J, Dole alová B, Jankovec Z, Olsovsky J, Zemanova J, Kyselova P, Mahelová A, Olsen AMZ, Mikkelsen D, Egstrup K, Pedersen-Bjergaard U, Potier L, Borot S, Gaborit B, Monier A, Pradignac A, Verges B, Larroumet A, Thuan JF, Lüdemann J, Esser M, Kahrmann G, Kempe HP, Koch T, Axthelm C, Paschen B, Rose L, Schaum T, Schulze J, Staudenmeyer A, Wenzl-Bauer V, Ma RC, Thomas N, Mohan V, Reddy VS, Rao PV, Sahay R, Singh J, Prakash A, Tandon N, Marwah T, Chaudhury T, Ghosh S, Kanungo AK, Mittal N, Jacob JJ, Chadha M, Bhagwat NM, Jain SM, Thulaseedharan NK, Girithara G, Desai A, Sharma SK, Murthy S, Sethi BK, Kadam Y, Kesavadev J, Daxini B, Chawla R, Gopalakrishnan UA, Baruah MP, Reddy SP, Suryanarayana KM, Singh KP, Saboo B, Aharon-Hananel G, Hochberg I, Sofer Y, Tirosh A, Shimon I, Vishlitzky V, Bashkin A, Tsur A, Shechter M, Andreozzi F, Setola E, Consoli A, Lupoli R, Genovese S, Maranghi M, Lauro D, Citarrella R, Fadini GP, Murdolo G, Carlo AD, Giorgino F, Buscemi S, Hanaoka K, Osonoi T, Ohashi H, Ezaki H, Yuki H, Kiyosue A, Hata Y, Sugawara M, Domae H, Iwata H, Nishida Y, Igarashi M, Fujino S, Oiwa A, Oh F, Sueyoshi A, Murakami T, Tanaka M, Idogaki A, Onaka H, Mizote I, Doi M, Ebisui O, Tanabe M, Natsuaki M, Jinnouchi H, Nakamura S, Mohamed WMIW, Yahaya N, Ratnasingam J, Ong TK, Mohamad M, Merican NSYA, Ghani RA, Adam NL, Fam TL, Tan FH, Morales Villegas EC, Gonzalez-Galvez G, Peralta DE, Medina Pech CE, García Ulloa AC, Laviada Molina HA, Banda Elizondo RG, Garza Ruiz JA, García Cantú EA, van Bemmel T, de Valk HW, Kooy A, Lieverse L, Landewe-Cleuren SA, Hoogenberg K, van Raalte D, Jebbink M, Oldenburg-Ligtenberg C, Abbink-Zandbergen E, Mihai B, Crisan C, Filip I, Busegeanu MM, Roman G, Mot AC, Nicoara A, Anghel V, Pletea NN, Suciu M, Strajer D, Cernea S, Zilov A, Kobalava Z, Ruyatkina LA, Suplotova LA, Sergeeva-Kondrachenko MY, Yanovskaya ME, Kargina L, Ignatyeva A, Astamirova K, Zalevskaya A, Zagrebelnaya O, Frolova EV, Peskov AB, Mishchenko O, Otroshchenko O, Gaysina L, Shabelnikova OY, Saprina TV, Lysenko TA, Kunitsyna M, Zyangirova ST, Lalic N, Lalic K, Zivkovic TB, Kikovic S, Djukic A, Pesic M, Dimic D, Stokic E, Mitrovic M, Polovina S, Djordjevic M, Sosovec D, Pella D, Donicova V, Prasekova SH, Koleny D, Culak J, Cerna K, Hundza V, Gmitrov J, Lacka J, Plasil R, Bacus HB, Bhorat QE, Joshi P, Lakha DR, Makan V, Ntusi N, Padayachee T, Seeber ME, Pillay D, Joshi M, Mayet L, Lee J, Kim SG, Min KW, Kang ES, Lee WJ, Choi SH, Lee CB, López Suárez A, Ordóñez MÁG, Quintana AG, Ramos PM, Cigarrán S, Barrios C, González AS, Jodar E, Lista JD, Portillo CM, Carrasco CM, Tinahones F, Huang CN, Chen ST, Buranasupkajorn P, Sriwijitkamol A, Buranapin S, Suwanagool A, Tantiwong P, Boonyavarakul A, Benjachareonwong S, Leelawattana R, Vathesatogkit P, Sonmez YA, Tabak O, Kocak M, Sariakcali B, Bayram F, Guclu M, Gurkan E, Kebapci N, Comlekci A, Acibucu F, Ahbab S, Bilen H, Urbanovych A, Kuskalo P, Bondarets I, Petrosyan O, Pashkovska N, Oleksyk O, Kaydashev I, Maliar K, Myshanych G, Black D, Johnston P, Dang C, Dhatariya K, English P, Field B, Grimmer P, Gunstone A, Ray S, Tatovic D, Kernohan A, Lindsay R, Mcknight JA, Park A, Patel D, Philip S, Randeva H, Sathyapalan T, Turner W, Wyatt N, Allison DC, Awasty V, Ayele E, Bajaj C, Budoff MJ, Busch R, Casaubon L, Chaidarun SS, Chochinov RH, Chu JW, Daboul NY, Dang AH, Everhart BG, Arambasick J, Fink RI, Fitz-Patrick D, Fogarty CM, Gilbert MP, Johnson DM, Krishnasamy SS, Lane WS, Nakhle SN, Levenson D, O'Donnell P, Weiss D, Risser JA, Wierum C, Sivalingam K, Gupta D, Philis-Tsimikas A, Pratley RE, Mirza L, Snyder B, Rasouli N, Porter J, Ledesma GN, Powell T, Tandron IJ, Lingvay I, Reed JC, Patel MB, Lovre D, Chaicha-Brom T, Jantzi C, Brautigam D, Bao S, Mbogua CN, Zemel LR, Hasan S, Rosenstock J, Tran H, Poremba J, Baker C, Prier K, Chilka S, Agaiby JM, Condit J, Eagerton DC, Huffman D, Cornett GM, Traylor H, Brinson C, Bays HE, Jerkins T, Nicol PR, Siddiqui IA, Hewitt M, Odugbesan AO, Lillestol MJ, Thrasher JR, Gandy WH, Pant N, Nagelberg S, Cannon K, Anderson MW, Bhargava A, Doshi A, Jardula MF, Montero M, Purighalla RS, Warren ML, Harris K, Jackson RA, Khaira AS, Gonzalez-Orozco L, Gagianas PJ, Pantalone K, Murray AV (2026)

Publication Type: Journal article

Publication year: 2026

Journal

Book Volume: 11

Pages Range: 427-437

Journal Issue: 5

DOI: 10.1001/jamacardio.2026.0245

Abstract

Importance: Individuals with type 2 diabetes (T2D) are at high risk of atherosclerotic cardiovascular disease (ASCVD). In the SOUL randomized clinical trial, once-daily oral semaglutide reduced risk of major adverse cardiovascular (CV) events by 14% vs placebo in people with T2D and ASCVD and/or chronic kidney disease (CKD) receiving standard of care (SoC); however, whether oral semaglutide modifies recognized CV risk factors in the long term is unclear. Objective: To investigate whether treatment with oral semaglutide was associated with changes in ASCVD risk factors vs placebo. Design, Setting, and Participants: This secondary analysis comprises post hoc intention-to-treat analyses of the SOUL (A Heart Disease Study of Semaglutide in Patients With Type 2 Diabetes) double-blind multicenter randomized clinical trial (randomization 1:1 to oral semaglutide or placebo) among adults with T2D and ASCVD and/or CKD receiving SoC. Participants underwent randomization from June 2019 to March 2021, with a mean (SD) of 47.5 (10.9) months of follow-up, and data were analyzed from February to December 2025. Intervention(s): Participants were treated with either once-daily oral semaglutide (maximum dose, 14 mg) or placebo, in addition to standard care. Main Outcomes and Measures: The primary outcome was the association of oral semaglutide vs placebo with glycated hemoglobin (HbA1c), body weight, and blood pressure (BP) using estimated treatment differences (ETDs) and with high-sensitivity C-reactive protein (hsCRP) and lipid plasma levels using estimated treatment ratios (ETRs). Results: Of 9650 randomized participants (mean [SD] age, 66.1 (7.6) years; 2790 female participants [28.9%]), 9495 participants (98.4%) completed the trial. Early (13 weeks) improvements in HbA1c (-0.87 percentage points), body weight (-2.54%), systolic BP (SBP, -3.84 mm Hg), pulse pressure (-3.81 mm Hg), hsCRP (-18.08%), total cholesterol (TC, -7.00%), non-high-density lipoprotein cholesterol (non-HDL-C, -8.02%), HDL-C (-4.49%), and triglycerides (-8.15%) were observed with oral semaglutide vs placebo and sustained over the trial duration. Body weight reductions were gradual across both groups. At week 156, in favor of oral semaglutide were ETDs for HbA1c (-0.47 percentage points; 95% CI, -0.52 to -0.42), body weight (-3.26 percentage points; 95% CI, -3.55 to -2.98), SBP (-1.83 mm Hg; 95% CI, -2.47 to -1.18), and pulse pressure (-2.17 mm Hg; 95% CI, -2.72 to -1.61) and ETRs for hsCRP (0.77; 95% CI, 0.74-0.81), TC (0.99; 95% CI, 0.98-1.00), non-HDL-C (0.98; 95% CI, 0.97-0.99), HDL-C (1.01; 95% CI, 1.01-1.02), and triglycerides (0.94; 95% CI, 0.93-0.96). No significant treatment differences were observed for low-density lipoprotein cholesterol or diastolic BP. Conclusions and Relevance: In this post hoc secondary analysis of the SOUL randomized clinical trial, oral semaglutide was associated with early and sustained improvements vs placebo in multiple ASCVD risk factors in high-risk participants with T2D and ASCVD and/or CKD, incremental to SoC.

Involved external institutions

University Hospital Hradec Králové / Fakultní Nemocnice Hradec Králové Czech Republic (CZ) Bispebjerg Hospital Denmark (DK) Slagelse Sygehus Denmark (DK) University Hospital Svendborg Hospital Denmark (DK) Nordsjællands Hospital Denmark (DK) Hôpital Bichat-Claude-Bernard (CHU, APHP) France (FR) Centre hospitalier régional et universitaire de Besançon (CHRU Besancon) France (FR) Prince of Wales Hospital / 威爾斯親王醫院 China (CN) Christian Medical College & Hospital India (IN) Madras Diabetes Research Foundation India (IN) Hamilton Medical Research Group (HMRG) United States (USA) (US) Healthcare Global Enterprises (HCG) / ಹೆಲ್ತ್ಕೇರ್ ಗ್ಲೋಬಲ್ ಎಂಟರ್ಪ್ರೈಸಸ್ ಲಿಮಿಟೆಡ್ India (IN) Apollo Hospitals India (IN) North Delhi Diabetes Centre India (IN) Chellaram Diabetes Institute (CDI) India (IN) Les Hôpitaux de Chartres France (FR) Helmholtz Zentrum München - Deutsches Forschungszentrum für Gesundheit und Umwelt (HMGU) / Helmholtz Munich Germany (DE) Hôpitaux universitaires de Strasbourg (HUS) / University Hospital Strasbourg France (FR) Centre Hospitalier Universitaire de Bordeaux / CHU Bordeaux France (FR) Nova Scotia Health Canada (CA) Toronto General Hospital (TGH) Canada (CA) McGill University Health Centre (MUHC) / Centre universitaire de santé McGill Canada (CA) The 5th People’s Hospital of Shanghai, Fudan University China (CN) Affiliated Hospital of Jiangsu University / 江蘇大學附設醫院 China (CN) Forschungszentrum Ruhr Germany (DE) Lady Hardinge Medical College India (IN) All India Institute of Medical Sciences India (IN) Jinan Central Hospital Group China (CN) Government Medical College, Kozhikode (Calicut medical College) / கோழிக்கோடு மருத்துவக் கல்லூரி India (IN) KG Hospital India (IN) Goa Medical College and Hospital (GMC) / गोवा मेडिकल कॉलेज और अस्पताल India (IN) Lifecare Hospital and Research Centre India (IN) CARE Hospitals Outpatient Centre India (IN) Inamdar Multispeciality Hospital India (IN) Jothydev's Diabetes Research Centre India (IN) FHM Fortis Hospital Mohali India (IN) Ospedale San Raffaele (früher: Centro San Raffaele del Monte Tabor Foundation) Italy (IT) Università degli Studi Gabriele D'Annunzio Italy (IT) Università degli Studi di Napoli Federico II Italy (IT) Centro Cardiologico Monzino (IRCCS) Italy (IT) Policlinico Umberto I Italy (IT) San Diego Family Care United States (USA) (US) First Valley Medical Group (FVMG) United States (USA) (US) Scripps Whittier Diabetes Institute United States (USA) (US) AdventHealth United States (USA) (US) Lynn Health Science Institute United States (USA) (US) Southgate Medical Group LLP United States (USA) (US) Rocky Mountain Regional VA Medical Center United States (USA) (US) Healthscan Clinical Trials, LLC. United States (USA) (US) Rocky Mountain Diabetes Center United States (USA) (US) Clinical Investigation Specialists (CIS Research) United States (USA) (US) Midstate Endocrine Associates United States (USA) (US) Lillestol Research LLC United States (USA) (US) Simcare Medical Research, LLC. United States (USA) (US) Northern Pines Health Center, PC United States (USA) (US) Physicians East United States (USA) (US) DCOL Center for Clinical Research United States (USA) (US) Dominion Medical Associates Inc. (DMA) United States (USA) (US) Zhytomyr Regional Clinical Hospital named after. O.F. Gerbachevsky / Житомирська обласна клінічна лікарня ім. О.Ф.Гербачевського Ukraine (UA) Odessa Regional Clinical Hospital Ukraine (UA) University of Cape Town (UCT) South Africa (ZA) Centre for Diabetes and Endocrinology (CDE) South Africa (ZA) Catholic University of Korea Korea, Republic of (KR) Korea University Medical Center (KUMC) Korea, Republic of (KR) Eulji University / 을지대학교 Korea, Republic of (KR) Severance Hospital / 세브란스 병원 Korea, Republic of (KR) Asan Medical Center / 서울아산병원 Korea, Republic of (KR) Your Diabetes Endocrine Nutrition Group, Inc. United States (USA) (US) Seoul National University Bundang Hospital (SNUBH) / 분당 서울대병원 Korea, Republic of (KR) Hanyang University Guri Hospital / 한양대학교구리병원 Korea, Republic of (KR) Hospital Virgen del Camino Spain (ES) Antequera Hospital / Hospital de Antequera Spain (ES) Hospital Universitario de Gran Canaria Doctor Negrín Spain (ES) Complejo Hospitalario Universitario de Santiago de Compostela Spain (ES) Hospital Público da Mariña Spain (ES) Hospital del Mar Spain (ES) Coruña University Hospital / Complexo Hospitalario Universitario A Coruña (CHUAC) Spain (ES) Quirónsalud Valencia Hospital Spain (ES) Hospital Universitario Reina Sofía de Córdoba Edificio IMIBIC Spain (ES) Hospitales Universitarios Virgen Macarena y Virgen del Rocío Spain (ES) Marqués de Valdecilla University Hospital / Hospital Universitario de Marqués de Valdecilla (HUMV) Spain (ES) Hospital Universitario Virgen de la Victoria Spain (ES) Chung Shan Medical University / 中山醫學大學 Taiwan (TW) American Health Network of Indiana LLC (AHN) United States (USA) (US) Chang Gung Medical Foundation / 長庚醫療財團法人 / Chang Gung Memorial Hospital (CGMH) Taiwan (TW) King Chulalongkorn Memorial Hospital / โรงพยาบาลจุฬาลงกรณ์ Thailand (TH) Siriraj Hospital Thailand (TH) University Diabetes & Endocrine Consultants United States (USA) (US) Central Texas Clinical Research United States (USA) (US) Louisville Metabolic and Atherosclerosis Research Center (L-MARC) United States (USA) (US) Twinsburg Family Health and Surgery Center United States (USA) (US) PharmQuest Life Sciences United States (USA) (US) Endocrine Metabolic Associates - Jefferson Health United States (USA) (US) Velocity Clinical Research United States (USA) (US) Tatratrial s.r.o. Slovakia (SK) University Hospital Bratislava / Univerzitná nemocnica Bratislava / Nemocnica Ružinov Slovakia (SK) Centre hospitalier universitaire (CHU) de Dijon Bourgogne France (FR) Novo Nordisk India Private Limited India (IN) Novo Nordisk A/S Denmark (DK) TOTALL Diabetes Hormone Institute India (IN) Policlinico Tor Vergata Italy (IT) Azienda Universitaria Ospedaliera Consorziale - Policlinico Bari Italy (IT) Tokorozawa Heart Center / 所沢ハートセンター Japan (JP) New Tokyo Hospital / 新東京病院 Japan (JP) Tokyo-Eki Center-building Clinic / 東京駅センタービルクリニック Japan (JP) Minamino Cardiovascular Hospital / みなみ野循環器病院 Japan (JP) Tokyo Nishi Tokushukai Hospital / 東京西徳洲会病院 Japan (JP) Policlinico Universitario Paolo Giaccone Italy (IT) Juntendo University Hospital / 順天堂大学医学部附属順天堂医院 Japan (JP) The University of Tokyo Hospital (UTH) / 東京大学医学部附属病院 Japan (JP) Fukui Prefectural Hospital / 福井県立病院 Japan (JP) Shinshu University Hospital / 信州大学医学部附属病院 Japan (JP) Uji-Tokushukai Medical Center / 宇治徳洲会病院 Japan (JP) Kyoto University Hospital / 京都大学医学部附属病院 Japan (JP) Saiseikai Suita Hospital Japan (JP) Nozaki Tokushukai Hospital / 野崎徳洲会病院 Japan (JP) Japanese Red Cross Takatsuki Hospital / 高槻赤十字病院 Japan (JP) Osaka University Hospital / 大阪大学医学部附属病院 Japan (JP) Kagawa Prefectural Central Hospital Japan (JP) Ehime Prefectural Central Hospital Japan (JP) Azienda Ospedale Università Padova / University Hospital of Padova Italy (IT) Ospedale S. Maria della Misericordia / Azienda Ospedaliera di Perugia Italy (IT) Saga University Hospital / 佐賀大学医学部附属病院 Japan (JP) Jinnouchi Hospital / 陣内病院 Japan (JP) WELL Health Diagnostic Centre Canada (CA) CHU de Québec-Université Laval Canada (CA) LMC Healthcare Canada (CA) McMaster University Canada (CA) Vancouver General Hospital Canada (CA) El Instituto Médico DAMIC Argentina (AR) Clinical Hospital Merkur Croatia (HR) Istanbul Medeniyet University / İstanbul Medeniyet Üniversitesi Turkey (TR) National Academy of Medical Sciences of Ukraine (NAMS) / NAMS Ukraine Ukraine (UA) Rangsit University / มหาวิทยาลัยรังสิต Thailand (TH) University Hospital Dubrava Croatia (HR) Hospital Universitario Fundación Alcorcón (HUFA) Spain (ES) Peking University People's Hospital (PKUPH) / 北京大学人民医院 China (CN) Solmed Clinic / Poliklinika Solmed Croatia (HR) Swansea University United Kingdom (GB) University of Texas Southwestern Medical Center (UT Southwestern) United States (USA) (US) Pula General Hospital / Opća bolnica Pula Croatia (HR) University of North Carolina at Chapel Hill United States (USA) (US) INTENDIA klinika s.r.o. Czech Republic (CZ) St. Anne's University Hospital / Sv. Anny v Brně Czech Republic (CZ) Instituto de Pesquisa Clínica de Campinas (IPECC) Brazil (BR) Cline Research Center Curitiba CRC Brazil (BR) Dalhousie University Canada (CA) Yale University United States (USA) (US) Universitätsklinikum Aachen (UKA) Germany (DE) Imperial College London / The Imperial College of Science, Technology and Medicine United Kingdom (GB) University College London (UCL) United Kingdom (GB) Oregon Health and Science University (OSHU) United States (USA) (US) University of Washington United States (USA) (US) KfH-Nierenzentrum / KfH Kidney Centre Germany (DE) Sunshine Coast Health Institute Australia (AU) Ramaiah Memorial Hospital India (IN) Fortis Healthcare Ltd. India (IN) Dr. Jivraj Mehta Institute of Technology (DJMIT) India (IN) Hadassah Medical Center / מרכז רפואי הדסה‎‎ Israel (IL) Rambam Health Care Campus Israel (IL) Chaim Sheba Medical Center at Tel HaShomer / המרכז הרפואי עש חיים שיבא – תל השומר‎‎ Israel (IL) Meir Medical Center / מרכז רפואי מאיר Israel (IL) Azienda Universitaria Ospedaliera Renato Dulbecco (AOU Renato Dulbecco) Italy (IT) Gandhi Medical College (GMC) India (IN) Ramdevrao Hospital India (IN) Osmania General Hospital India (IN) Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences (PGIMS Rohtak) India (IN) Assistance Publique Hopitaux de Marseille France (FR) Clínica de la Costa Colombia (CO) Hausärztlich-Kardiologisches MVZ „Am Felsenkeller“ GmbH Germany (DE) Universidad del Norte Colombia (CO) Dr. Kanungo's Diabetes Centre India (IN) Dayanand Medical College & Hospital India (IN) Clinical Hospital Center Osijek / Klinički bolnički centar Osijek (KBC Osijek) Croatia (HR) RED-Institut GmbH Germany (DE) Opća Bolnica Zadar / General Hospital Zadar Croatia (HR) Medicus Wesken Gesundheitszentrums Lingen Germany (DE) Christian Medical College & Hospital, Ludhiana (C.M.C. & Hospital) India (IN) P. D. Hinduja Hospital & Medical Research Center India (IN) Topiwala National Medical College & BYL Nair Charitable Hospital India (IN) Varazdin General Hospital / Opća Bolnica Varaždin Croatia (HR) University Hospital Split Croatia (HR) Special Hospital for Medical Rehabilitation Krapinske Toplice / Specijalna bolnica za medicinsku rehabilitacijsku medicinu Krapinske Toplice Croatia (HR) Naka Kinen Clinic Japan (JP) HEIWADAI Hospital / 平和台病院 Japan (JP) Hospital Universiti Sains Malaysia (HUSM) Malaysia (MY) Hospital Raja Perempuan Zainab II Malaysia (MY) University of Malaya Medical Centre (UMMC) Malaysia (MY) Sarawak Heart Centre Malaysia (MY) Fukuoka Tokushukai Hospital / 福岡徳洲会病院 Japan (JP) Franciscan Health Indianapolis United States (USA) (US) Tulane University United States (USA) (US) Holston Medical Group United States (USA) (US) Great Lakes Medical Research United States (USA) (US) Synergy Groups Medical United States (USA) (US) Suncoast Clinical Research (SCR) United States (USA) (US) Maharaj Nakorn Chiang Mai Hospital / โรงพยาบาลมหาราชนครเชียงใหม่ Thailand (TH) Southern New Hampshire Diabetes and Endocrinology (SNHH) United States (USA) (US) Methodist Physicians Clinic United States (USA) (US) Putrajaya Hospital Malaysia (MY) Maharaj Nakhon Ratchasima Hospital / โรงพยาบาลมหาราชนครราชสีมา Thailand (TH) Phramongkutklao Hospital / โรงพยาบาลพระมงกุฎเกล้า Thailand (TH) Police General Hospital Thailand (TH) Songklanagarind Hospital / โรงพยาบาลสงขลานครินทร์ Thailand (TH) Ramathibodi Hospital / โรงพยาบาลรามาธิบดี Thailand (TH) Gülhane Training and Research Hospital / Gülhane Eğitim ve Araştırma Hastanesi (GEAH) Turkey (TR) Kanuni Sultan Suleyman Training and Research Hospital Turkey (TR) Hospital Sultanah Bahiyah (HSB) Malaysia (MY) Karadeniz Technical University / Karadeniz Teknik Üniversitesi (KTU) Turkey (TR) Universiti Teknologi MARA (UiTM) / MARA University of Technology Malaysia (MY) Sivas Cumhuriyet University / Sivas Cumhuriyet Üniversitesi Turkey (TR) Hospital Tuanku Ja’afar Malaysia (MY) Erciyes University / Erciyes Üniversitesi Turkey (TR) Hospital Miri Malaysia (MY) Sarawak General Hospital / Hospital Umum Sarawak Malaysia (MY) Antalya Training and Research Hospital / TC Sağlık Bakanlığı Turkey (TR) Instituto Jalisciense de Investigación En Diabetes y Obesidad Mexico (MX) Mustafa Kemal Üniversitesi Turkey (TR) Investigación Médica Sonora S.C. Hermosillo (INMEDS) Mexico (MX) Eskişehir Osmangazi Üniversitesi Turkey (TR) Dokuz Eylül Üniversitesi (DEU) Turkey (TR) Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Mexico (MX) İstanbul Haseki Training and Research Hospital Turkey (TR) Atatürk University Turkey (TR) Unidad Médica para la Salud Integral (UMSI) Mexico (MX) Transcarpathian Regional Clinical Hospital named after Andriy Novak / Закарпатська Обласна Клінічна Лікарня імені Андрія Новака Ukraine (UA) 1st City Clinical Hospital of Poltava City Council / 1-А міська клінічна лікарня Полтавської міської ради Ukraine (UA) Gelre ziekenhuizen Apeldoorn Netherlands (NL) University Medical Centre Utrecht (UMC Utrecht) Netherlands (NL) Diakonie Klinikum GmbH Germany (DE) Royal Victoria Hospital United Kingdom (GB) North Manchester General Hospital United Kingdom (GB) Maxima Medisch Centrum MMC Veldhoven Netherlands (NL) Maastricht University Netherlands (NL) Nottingham University Hospitals United Kingdom (GB) Martini Ziekenhuis Netherlands (NL) Derriford Hospital United Kingdom (GB) Amsterdam University Medical Centers (Amsterdam UMC) / Amsterdam Universitair Medische Centra Netherlands (NL) East Surrey Hospital United Kingdom (GB) Reinier de Graaf Hospital Netherlands (NL) Staploe Medical Centre United Kingdom (GB) Meander Medisch Centrum Netherlands (NL) Radboud University Nijmegen Medical Centre / Radboudumc of voluit Radboud Universitair Medisch Centrum (UMC) Netherlands (NL) Spitalul Clinic de Pneumoftiziologie Iasi Romania (RO) Centrul Medical MEDIAB Romania (RO) Novus Medical Romania (RO) Harrogate District Hospital United Kingdom (GB) Southmead Hospital United Kingdom (GB) Policlinica ASTRA Romania (RO) Queen Elizabeth University Hospital United Kingdom (GB) Spitalul Clinic Județean de Urgență Craiova Romania (RO) Hanaoka Seishu Memorial Hospital / 花岡青州記念病院 Japan (JP) Spitalul Clinic Județean de Urgență "Sf. Apostol Andrei" Galați Romania (RO) Diabet Med & Clinic Romania (RO) Spitalul Clinic Judetean de Urgenta Targu Mures Târgu Mureş Romania (RO) I.M. Sechenov First Moscow State Medical University Russian Federation (RU) Peoples' Friendship University of Russia (PFUR) / Российский университет дружбы народов (RUDN) Russian Federation (RU) The Glasgow Clinical Research Facility (GCRF) United Kingdom (GB) Western General Hospital United Kingdom (GB) Tyumen State University Russian Federation (RU) University of Cambridge United Kingdom (GB) Royal Free Hospital United Kingdom (GB) Aberdeen Royal Infirmary (ARI) United Kingdom (GB) University Hospitals Coventry and Warwickshire United Kingdom (GB) Hull Royal Infirmary United Kingdom (GB) The Burbage Surgery United Kingdom (GB) Auroramed Ltd Russian Federation (RU) Awasty Research Network United States (USA) (US) Ulyanovsk Regional Clinical Hospital / Ульяновская областная клиническая больница Russian Federation (RU) Diabetes and Thyroid Center of Fort Worth United States (USA) (US) The Lundquist Institute for Biomedical Innovation United States (USA) (US) Albany Medical College United States (USA) (US) Kazan (Volga region) Federal University / Казанский (Приволжский) федеральный университет Russian Federation (RU) Dartmouth-Hitchcock Medical Center (DHMC) United States (USA) (US) Advanced Medical Research United States (USA) (US) Facey Medical Foundation United States (USA) (US) Siberian State Medical University / Сибирский государственный медицинский университет Russian Federation (RU) Heritage Valley Health System United States (USA) (US) The Research Group of Lexington (TRG) United States (USA) (US) East-West Medical Research Institute United States (USA) (US) Spartanburg Medical Research United States (USA) (US) University of Vermont United States (USA) (US) Unity Health-White County Medical Center United States (USA) (US) Zvezdara University Clinical Centre / Kliničko Bolnički Centar Zvezdara Serbia (RS) Military Medical Academy (Serbia) / Војномедицинска академија / Vojnomedicinska akademija (VMA) Serbia (RS) University Clinical Center Kragujevac / Универзитетски клинички центар Крагујевац Serbia (RS) University of Nish Serbia (RS) Robley Rex VA Medical Center (Louisville VA Medical Center) United States (USA) (US) University Clinical Center of Vojvodina / Универзитетски клинички центар Војводине Serbia (RS) Palm Research Center United States (USA) (US) East Coast Medical Associates United States (USA) (US) Selma Medical Associates, Inc. United States (USA) (US) MediTask s.r.o Slovakia (SK) Soweto Clinical Trial Centre Johannesburg South Africa (ZA) Accellacare Clinical Research United States (USA) (US) Kernodle Clinic United States (USA) (US) IowaDiabetes United States (USA) (US) Desert Oasis Healthcare (DOHC) United States (USA) (US) Eastern Nephrology Associates (ENA) United States (USA) (US) Preferred Primary Care Physicians United States (USA) (US)

How to cite

APA:

Mulvagh, S.L., Inzucchi, S.E., Marx, N., Poulter, N.R., Deanfield, J.E., Pop-Busui, R.,... Murray, A.V. (2026). Oral Semaglutide and Change in Cardiovascular Risk Factors in High-Risk Type 2 Diabetes: A Post Hoc Secondary Analysis of the SOUL Randomized Clinical Trial. JAMA Cardiology, 11(5), 427-437. https://doi.org/10.1001/jamacardio.2026.0245

MLA:

Mulvagh, Sharon L., et al. "Oral Semaglutide and Change in Cardiovascular Risk Factors in High-Risk Type 2 Diabetes: A Post Hoc Secondary Analysis of the SOUL Randomized Clinical Trial." JAMA Cardiology 11.5 (2026): 427-437.

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