Prescribed on cardiovascular grounds rather than for weight, and almost everything written for patients assumes the opposite.
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.
Tell me what I have not thought of.
tane_welly said:Prescribed on cardiovascular grounds rather than for weight, and almost everything written for patients assumes the opposite.
tane_welly said:...we don't know the long-term effects of cardiovascular risk...
This is a fair point, and I think intellectual honesty requires acknowledging it. GLP-1 agonists in their current form have ~8-10 years of human exposure data. That's not nothing, but it's not 30+ years either.
However: the risk-benefit calculation should also consider the KNOWN long-term effects of untreated obesity — diabetes, cardiovascular disease, cancer, joint destruction, reduced lifespan by 5-10 years.
Uncertainty about GLP-1 long-term safety vs certainty about obesity consequences. The calculus seems clear to me, but reasonable people can disagree.
Dr.ReproEndo said:tane_welly said: ...we don't know the long-term effects of cardiovascular risk...
Metabolic syndrome resolution on cardiovascular risk: I went from meeting 3 of 5 diagnostic criteria to meeting ZERO after 11 months of treatment.
The 5 criteria (and my journey):
- Waist circumference: 50" → 34" ✅ Resolved
- Triglycerides: 228 → 108 ✅ Resolved
- HDL: 34 → 60 ✅ Resolved
- Blood pressure: 148/90 → 121/75 ✅ Resolved
- Fasting glucose: 123 → 86 ✅ Resolved
Metabolic syndrome reversal is, in my view, the most medically significant outcome of GLP-1 therapy.
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View Resultstane_welly said:Prescribed on cardiovascular grounds rather than for weight, and almost everything written for patients assumes the opposite.
Same experience, arrived at from the opposite direction. The detail I would add is minor and it is already implied above.
Clinical perspective, offered as context rather than as advice.
tane_welly said:...cardiovascular risk is just another fad...
I understand the skepticism — we've all seen "miracle" weight loss solutions come and go. But consider what makes GLP-1 agonists different:
- Phase 3 RCTs with thousands of participants (not 20-person pilot studies)
- Published in NEJM, JAMA, Lancet (not press releases)
- Replicated across multiple independent research groups
- Proven cardiovascular and renal benefits beyond weight loss
- Biological mechanism fully characterized at the receptor level
This isn't a fad — it's a new drug class supported by the highest level of clinical evidence. The comparison to past fads is understandable but inappropriate.