Has anyone dealt with select trial: 20% mace reduction?

TrialNerd_Beth said:

Relative and absolute effects need reading together.

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.

labquiet_amy said:

Agreed, and subgroup analyses deserve particular suspicion.

This is exactly what I could not find anywhere else. Printing the relevant bit and taking it with me.

TrialNerd_Beth said:

Relative and absolute effects need reading together.

Pushing back on TrialNerd_Beth here. I would add the less popular caveat: these trial populations under-represented several groups, older adults and the highest BMI categories among them. The results probably generalise, and "probably" should be stated as an assumption rather than dropped.

Dr.SurgeonPGH said:

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

Vitamin deficiency cascade with cardiovascular risk: after 6+ months of reduced food intake, I developed a subtle but important pattern: low B12 → elevated homocysteine → increased cardiovascular risk marker.

The connection: B12 is a cofactor for homocysteine metabolism. Without adequate B12, homocysteine accumulates. This is ironic — taking a CV-protective medication while developing a CV risk factor from reduced nutrition.

Solution: comprehensive vitamin supplementation and regular lab monitoring. Don't let the medication's benefits be undermined by nutritional deficiencies.

Moderator note: reminder that nothing in this thread is medical advice, and that clinical claims need a source. Report rather than reply if it drifts again.