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.LipidDallas said:Prescribed on cardiovascular grounds rather than for weight, and almost everything written for patients assumes the opposite.
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.KarenChen said:I want to bring up the cardiovascular angle on cardiovascular risk.
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 63 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.
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View ResultsDr.LipidDallas said:Prescribed on cardiovascular grounds rather than for weight, and almost everything written for patients assumes the opposite.
This is my experience too, for whatever a second data point is worth.
Adding the clinical framing, because it changes how the question reads.
Senior perspective on cardiovascular risk: I'm 71 years old and started this journey skeptically. My geriatrician recommended it after years of failed interventions.
13 months later: down 39 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.