My reason for being on this is cardiovascular rather than cosmetic, which puts me in a small minority in most of these threads.
So the question, as narrowly as I can put it: how much of the SELECT benefit is plausibly independent of the weight loss, and whether that distinction changes anything practical.
Not looking for reassurance. Looking for the part I have got wrong.
sarah_nash92 said:My reason for being on this is cardiovascular rather than cosmetic, which puts me in a small minority in most of these threads.
Lp(a) and cardiovascular risk: a nuance that matters. Unlike most lipid markers, Lp(a) is 90%+ genetically determined and doesn't really change with weight loss or GLP-1 therapy.
My Lp(a) has remained at 54 nmol/L across all time points. If yours is elevated (>50 nmol/L), you need additional risk mitigation strategies regardless of your GLP-1 response. Don't assume your medication is covering all cardiovascular risk factors.
Dr.ObesityMed said:Lp(a) and cardiovascular risk: a nuance that matters.
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.
PeptideDetective — Independent Peptide Analytics
Community-driven peptide testing and vendor rating platform. Transparent results. Unbiased analysis. Trusted by thousands.
View Resultssarah_nash92 said:My reason for being on this is cardiovascular rather than cosmetic, which puts me in a small minority in most of these threads.
This matches mine closely enough to be worth saying so out loud.
From the other side of the consultation, briefly.
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, -1.9 lbs/week average
Fasting glucose (finger stick): stable at 88 mg/dL
Blood pressure (home): 119/74 average
Resting heart rate: 68 bpm (down from 84)
Waist circumference: down 18 inches total
The resting heart rate improvement correlates with cardiovascular fitness gains. Everything is moving in the right direction.