My reason for being on this is cardiovascular rather than cosmetic, which puts me in a small minority in most of these threads.
What would genuinely help is knowing 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.
CarlaRPh_TPA said:My reason for being on this is cardiovascular rather than cosmetic, which puts me in a small minority in most of these threads.
Cardiac biomarkers and cardiovascular risk: my cardiologist ordered advanced cardiac labs given my family history. Results were encouraging:
- NT-proBNP: 73 pg/mL (normal, cardiac function preserved)
- Lp(a): 43 nmol/L (genetic, unchanged — expected)
- ApoB: dropped from 158 to 98 mg/dL (excellent response)
- Coronary calcium score: 0 (unchanged from baseline — reassuring)
The ApoB reduction is particularly meaningful — it's considered the best single predictor of cardiovascular risk. GLP-1 therapy seems to improve this consistently.
DebRD_ATL said:Cardiac biomarkers and cardiovascular risk: my cardiologist ordered advanced cardiac labs given my family history.
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.
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View ResultsCarlaRPh_TPA 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.
From the other side of the consultation, briefly.
Mendelian randomization evidence supporting GLP-1 pathway modulation for cardiovascular risk: genetic variants in the GLP1R gene region associated with lower BMI also show associations with reduced cardiovascular risk, confirming a causal pathway[1].
This "natural experiment" (people born with genetically higher GLP-1 signaling being leaner and healthier) provides orthogonal evidence supporting the pharmacological approach. When genetic epidemiology, clinical trials, and mechanistic studies all converge, confidence in the therapeutic approach is high.
[1] Zheng SL, et al. Lancet Diabetes Endocrinol. 2023;11(12):869-879.