STEP-HFpEF: semaglutide in heart failure with preserved EF — need advice

Dr.Martinez said:

The dose-response is real but shallow at the top.

Thank you for spelling out the reasoning rather than just the conclusion. Adding it to my notes with a link back to this thread.

Clinical perspective, offered as context rather than as advice.

I'm 55 years old and want to share my perspective on cardiovascular risk as an older member of this community.

My doctor was initially hesitant because of my age, but the SELECT trial included patients up to 72 and showed consistent benefit across age groups. We started at the lowest dose with closer monitoring.

13 months later: down 60 lbs, off metoprolol, A1C from 8.0% to 5.5%. My cardiologist is thrilled. cardiovascular risk is absolutely relevant for older adults — don't let anyone tell you otherwise.

Dr.ObesityLA said:

The mechanism that matters here is not stomach emptying, it is central.

I read this differently from Dr.ObesityLA, 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.

pam_stl 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…

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

Baseline hsCRP: 12.0 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 19% to 5%. My cardiologist is genuinely impressed.

Moderator note: a post naming a supplier has been edited. Discuss suppliers in the review sections, not here. No action needed from anybody.