My reason for being on this is cardiovascular rather than cosmetic, which puts me in a small minority in most of these threads.
The narrow version of the question is how much of the SELECT benefit is plausibly independent of the weight loss, and whether that distinction changes anything practical.
Practical detail welcome, however dull — the duller the better.
Dr.LeslieOBGYN said:My reason for being on this is cardiovascular rather than cosmetic, which puts me in a small minority in most of these threads.
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.
Dr.GutHealth said:I want to bring up the cardiovascular angle on cardiovascular risk.
NNT calculation for cardiovascular risk clinical endpoints: NNT = 1/ARR (absolute risk reduction).
From SELECT trial: MACE at 39 months — 6.5% semaglutide vs 8.0% placebo. ARR = 1.5%. NNT = 67 over 3.3 years.
Compare to established therapies:
| Intervention | NNT | Timeframe |
|---|---|---|
| Semaglutide (MACE) | 67 | 3.3 years |
| Statins primary prevention (MI) | ~100 | 5 years |
| Aspirin secondary prevention | ~77 | 2 years |
These NNTs are clinically meaningful and comparable to accepted cardiovascular interventions.
PeptideDetective — Independent Peptide Analytics
Community-driven peptide testing and vendor rating platform. Transparent results. Unbiased analysis. Trusted by thousands.
View ResultsDr.LeslieOBGYN said:My reason for being on this is cardiovascular rather than cosmetic, which puts me in a small minority in most of these threads.
Same experience, arrived at from the opposite direction. Posting only so the count is not one.
Adding the clinical framing, because it changes how the question reads.
Continuous metabolic monitoring dashboard for cardiovascular risk — I track everything in a spreadsheet and here's the month-over-month trend for my key markers:
Weight: consistent downtrend, -1.7 lbs/week average
Fasting glucose (finger stick): stable at 86 mg/dL
Blood pressure (home): 117/72 average
Resting heart rate: 66 bpm (down from 82)
Waist circumference: down 16 inches total
The resting heart rate improvement correlates with cardiovascular fitness gains. Everything is moving in the right direction.