Dr.PulmRoch 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: 10.0 mg/L (high cardiovascular risk)
Month 6 hsCRP: 2.5 mg/L (moderate risk)
Month 12 hsCRP: 0.3 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 17% to 5%. My cardiologist is genuinely impressed.

PharmD_Rodriguez said:

DanielChem_CHI said: ...cardiovascular risk is just another fad...

This answered a question I did not know how to ask.

Dr.PulmRoch said:

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

Dr.PulmRoch 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.

tane_welly said:

Prescribed on cardiovascular grounds rather than for weight, and almost everything written for patients assumes the opposite.

NNT calculation for cardiovascular risk clinical endpoints: NNT = 1/ARR (absolute risk reduction).

From SELECT trial: MACE at 39 months — 6.5% semaglutide vs 8.0% placebo. ARR = 1.5%. NNT = 67 over 3.3 years.

Compare to established therapies:

These NNTs are clinically meaningful and comparable to accepted cardiovascular interventions.

Moderator note: leaving this open. It is being argued well and the disagreement is the useful part. Carry on.