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 am after 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.
carlos_SATX said:My reason for being on this is cardiovascular rather than cosmetic, which puts me in a small minority in most of these threads.
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, -2.4 lbs/week average
Fasting glucose (finger stick): stable at 85 mg/dL
Blood pressure (home): 119/75 average
Resting heart rate: 65 bpm (down from 81)
Waist circumference: down 15 inches total
The resting heart rate improvement correlates with cardiovascular fitness gains. Everything is moving in the right direction.
LarryQC_SD said:Continuous metabolic monitoring dashboard for cardiovascular risk — I track everything in a spreadsheet and here's the month-over-month trend for my…
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.
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View Resultscarlos_SATX said:My reason for being on this is cardiovascular rather than cosmetic, which puts me in a small minority in most of these threads.
Second this.
From the other side of the consultation, briefly.
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.