Prescribed on cardiovascular grounds rather than for weight, and almost everything written for patients assumes the opposite.
Relative versus absolute is the distinction that gets lost: a 20% relative reduction on a high baseline risk is a large absolute benefit, and the same relative figure on a low baseline risk is a small one.
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.
Not looking for reassurance. Looking for the part I have got wrong.
oliver_london 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 57 lbs, off blood pressure meds, A1C normalized. Genuinely life-changing.
TrialNerd_Beth said:6 month update on cardiovascular risk: down 57 lbs, off blood pressure meds, A1C normalized.
Anti-inflammatory mechanisms of GLP-1 agonists and cardiovascular risk: beyond weight loss, GLP-1R activation directly suppresses NF-κB signaling, reduces NLRP3 inflammasome activation, and decreases monocyte/macrophage adhesion to endothelium[1].
Clinical correlates: hsCRP reduction of 30-60% (consistently seen across trials), reduced carotid intima-media thickness, and decreased coronary plaque inflammation on PET imaging.
These anti-inflammatory effects likely contribute to the cardiovascular benefit seen in SELECT — and may explain benefits beyond what weight loss alone would predict.
[1] Hogan AE, et al. Diabetologia. 2014;57(4):781-784.
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View Resultsoliver_london said:Prescribed on cardiovascular grounds rather than for weight, and almost everything written for patients assumes the opposite.
Can confirm. Same sequence, different timescale. Posting only so the count is not one.
Adding the clinical framing, because it changes how the question reads.
Cardiac biomarkers and cardiovascular risk: my cardiologist ordered advanced cardiac labs given my family history. Results were encouraging:
- NT-proBNP: 52 pg/mL (normal, cardiac function preserved)
- Lp(a): 42 nmol/L (genetic, unchanged — expected)
- ApoB: dropped from 147 to 92 mg/dL (excellent response)
- Coronary calcium score: 0 (unchanged from baseline — reassuring)
The ApoB reduction is particularly meaningful — it's considered the best single predictor of cardiovascular risk. GLP-1 therapy seems to improve this consistently.