SOUL trial preliminary data — semaglutide in T2DM cardiovascular outcomes

TrialTracker_MD said:

Steady state is the thing most people miss.

Saving this. It is the first explanation that did not require me to already understand it. Taking it to my next appointment.

From the other side of the consultation, briefly.

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, -2.4 lbs/week average
Fasting glucose (finger stick): stable at 85 mg/dL
Blood pressure (home): 119/75 average
Resting heart rate: 65 bpm (down from 81)
Waist circumference: down 15 inches total

The resting heart rate improvement correlates with cardiovascular fitness gains. Everything is moving in the right direction.

andrew_nyc said:

Albumin binding above 99% is the whole reason weekly dosing works, and it is also why the trough matters more than the peak.

I read this differently from andrew_nyc, on substance rather than tone. The trial means are being read too generously in this thread. STEP populations were selected, supported, and titrated by protocol, and the real-world curves are consistently a few points worse. That difference is not noise, it is what happens when you remove the study infrastructure.

Dr.CardioMD said:

SELECT is the trial that changed the framing of this class, because it was an outcome trial rather than a weight trial: about a 20% relative reduction…

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.

Moderator note: a couple of off-topic posts removed. Carry on.