A narrower follow-up, since the general answer is now clear:

How much of the between-person variation is pharmacokinetic and how much is just adherence measured badly?

GenomicsKate said:

Update since I posted: I held at 1.7mg for a further twelve weeks and lost another 4kg slowly, which settles it for me.

Cardiac biomarkers and cardiovascular risk: my cardiologist ordered advanced cardiac labs given my family history. Results were encouraging:

• NT-proBNP: 72 pg/mL (normal, cardiac function preserved)
• Lp(a): 32 nmol/L (genetic, unchanged — expected)
• ApoB: dropped from 152 to 97 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.

GenomicsKate said:

Update since I posted: I held at 1.7mg for a further twelve weeks and lost another 4kg slowly, which settles it for me.

Metabolic syndrome resolution on cardiovascular risk: I went from meeting 4 of 5 diagnostic criteria to meeting ZERO after 9 months of treatment.

The 5 criteria (and my journey):

1. Waist circumference: 48" → 36" ✅ Resolved
2. Triglycerides: 238 → 113 ✅ Resolved
3. HDL: 32 → 60 ✅ Resolved
4. Blood pressure: 148/92 → 121/75 ✅ Resolved
5. Fasting glucose: 118 → 84 ✅ Resolved

Metabolic syndrome reversal is, in my view, the most medically significant outcome of GLP-1 therapy.

GenomicsKate said:

Update since I posted: I held at 1.7mg for a further twelve weeks and lost another 4kg slowly, which settles it for me.

Thank you for spelling out the reasoning rather than just the conclusion. I will report back once I have actually tried it.

Adding the clinical framing, because it changes how the question reads.

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, -2.3 lbs/week average
Fasting glucose (finger stick): stable at 88 mg/dL
Blood pressure (home): 118/74 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.