Prescribed on cardiovascular grounds rather than for weight, and almost everything written for patients assumes the opposite.
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.
I would rather have one careful answer than five confident ones.
Dr.EM_Chicago said:Prescribed on cardiovascular grounds rather than for weight, and almost everything written for patients assumes the opposite.
Dizziness and cardiovascular risk: I was lightheaded for the first 3 weeks. Root cause was a combination of reduced caloric intake and mild dehydration.
Fix: minimum 80-100oz water daily, don't skip meals even if you're not hungry (eat small protein-rich snacks), and stand up slowly from sitting/lying positions. Also check your blood pressure — GLP-1-induced weight loss can make BP meds too strong, requiring dose reduction.
CarlaRPh_TPA said:Dizziness and cardiovascular risk: I was lightheaded for the first 3 weeks.
Senior perspective on cardiovascular risk: I'm 64 years old and started this journey skeptically. My cardiologist recommended it after years of failed interventions.
14 months later: down 37 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.
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View ResultsDr.EM_Chicago 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.
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.