My reason for being on this is cardiovascular rather than cosmetic, which puts me in a small minority in most of these threads.
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.
If the honest answer is that nobody knows, that is a useful answer and I would rather have it.
CanadaChris said:My reason for being on this is cardiovascular rather than cosmetic, which puts me in a small minority in most of these threads.
SUSTAIN-6 was the first CVOT to show cardiovascular benefit with semaglutide, relevant to cardiovascular risk. In 3,297 T2DM patients with high CV risk: MACE HR 0.74 (95% CI 0.58-0.95, p=0.02)[1].
Notable: the retinopathy signal in SUSTAIN-6 (HR 1.76) was subsequently attributed to rapid A1C reduction in patients with pre-existing retinopathy — not a direct drug effect. This has been confirmed in longer-term follow-up studies.
[1] Marso SP, et al. N Engl J Med. 2016;375(19):1834-1844.
LipidDoc_ATL said:SUSTAIN-6 was the first CVOT to show cardiovascular benefit with semaglutide, relevant to cardiovascular risk.
I'm 67 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.
17 months later: down 54 lbs, off metoprolol, A1C from 8.8% to 5.5%. My cardiologist is thrilled. cardiovascular risk is absolutely relevant for older adults — don't let anyone tell you otherwise.
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View ResultsCanadaChris said:My reason for being on this is cardiovascular rather than cosmetic, which puts me in a small minority in most of these threads.
Adding a me-too, because a thread of one person's experience is not much use. Posting only so the count is not one.
Clinical perspective, offered as context rather than as advice.
Senior perspective on cardiovascular risk: I'm 62 years old and started this journey skeptically. My internist recommended it after years of failed interventions.
12 months later: down 45 lbs, more mobile, pain reduced, medications simplified. My quality of life has improved dramatically. I wish this existed 20 years ago.
To other older adults hesitating: the SELECT trial proved benefit in our age group. You deserve to feel good in your body regardless of age.