My reason for being on this is cardiovascular rather than cosmetic, which puts me in a small minority in most of these threads.
What I actually want to know 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.
NeuroNate 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.CardioMD said:I want to bring up the cardiovascular angle on cardiovascular risk.
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, -2.1 lbs/week average
Fasting glucose (finger stick): stable at 82 mg/dL
Blood pressure (home): 116/72 average
Resting heart rate: 62 bpm (down from 78)
Waist circumference: down 12 inches total
The resting heart rate improvement correlates with cardiovascular fitness gains. Everything is moving in the right direction.
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Browse GL BiochemNeuroNate said:My reason for being on this is cardiovascular rather than cosmetic, which puts me in a small minority in most of these threads.
Mine went the same way, slower. The detail I would add is minor and it is already implied above.
From the other side of the consultation, briefly.
I'm 62 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.
14 months later: down 61 lbs, off atorvastatin, A1C from 8.2% to 5.4%. My cardiologist is thrilled. cardiovascular risk is absolutely relevant for older adults — don't let anyone tell you otherwise.