lucas_SP_BR said:

Dr.PulmRoch said: ...cardiovascular risk is just another fad...

lucas_SP_BR said:

...we don't know the long-term effects of cardiovascular risk...

This is a fair point, and I think intellectual honesty requires acknowledging it. GLP-1 agonists in their current form have ~8-10 years of human exposure data. That's not nothing, but it's not 30+ years either.

However: the risk-benefit calculation should also consider the KNOWN long-term effects of untreated obesity — diabetes, cardiovascular disease, cancer, joint destruction, reduced lifespan by 5-10 years.

Uncertainty about GLP-1 long-term safety vs certainty about obesity consequences. The calculus seems clear to me, but reasonable people can disagree.

lucas_SP_BR said:

Dr.PulmRoch said: ...cardiovascular risk is just another fad...

Saving this. It is the first explanation that did not require me to already understand it. Adding it to my notes with a link back to this thread.

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

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.

Dr.ObesityMed said:

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

Second this. The detail I would add is minor and it is already implied above.

Dr.ObesityMed said:

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

CRP reduction on cardiovascular risk — this is the lab result that excites me most:

Baseline hsCRP: 7.0 mg/L (high cardiovascular risk)
Month 6 hsCRP: 2.5 mg/L (moderate risk)
Month 12 hsCRP: 0.4 mg/L (low risk)

This level of inflammatory marker reduction is comparable to what you'd see with statin therapy. Combined with the weight loss, my 10-year ASCVD risk score dropped from 14% to 5%. My cardiologist is genuinely impressed.