Prescribed on cardiovascular grounds rather than for weight, and almost everything written for patients assumes the opposite.
The question I want answered is how much of the SELECT benefit is plausibly independent of the weight loss, and whether that distinction changes anything practical.
I have searched first, so if this is covered somewhere point me at it and I will read it.
steve_okc said:Prescribed on cardiovascular grounds rather than for weight, and almost everything written for patients assumes the opposite.
6 month update on cardiovascular risk: down 42 lbs, off blood pressure meds, A1C normalized. Genuinely life-changing.
Dr.LipidDallas said:6 month update on cardiovascular risk: down 42 lbs, off blood pressure meds, A1C normalized.
I want to bring up the cardiovascular angle on cardiovascular risk.
The SELECT trial demonstrated a 20% reduction in MACE with semaglutide 2.4mg[1]. This is practice-changing because the CV benefit appears to be independent of the degree of weight loss — suggesting direct vascular and anti-inflammatory mechanisms.
For cardiovascular risk, this means we need to think beyond the primary outcome and consider the cardiovascular implications. The all-cause mortality reduction (HR 0.81) is the most clinically meaningful signal.
[1] Lincoff AM, et al. N Engl J Med. 2023;389(24):2221-2232.
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View Resultssteve_okc said:Prescribed on cardiovascular grounds rather than for weight, and almost everything written for patients assumes the opposite.
This matches mine closely enough to be worth saying so out loud.
Adding the clinical framing, because it changes how the question reads.
I'm 58 years old and want to share my perspective on cardiovascular risk as an older member of this community.
My doctor was initially hesitant because of my age, but the SELECT trial included patients up to 72 and showed consistent benefit across age groups. We started at the lowest dose with closer monitoring.
16 months later: down 43 lbs, off atorvastatin, A1C from 8.6% to 5.2%. My cardiologist is thrilled. cardiovascular risk is absolutely relevant for older adults — don't let anyone tell you otherwise.