carl_compliance 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.

JessicaH_TX said:

I want to bring up the cardiovascular angle on cardiovascular risk.

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.

carl_compliance 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.

Clinical perspective, offered as context rather than as advice.

6 month update on cardiovascular risk: down 41 lbs, off blood pressure meds, A1C normalized. Genuinely life-changing.