SELECT cost-effectiveness — looking for input

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 5.3%. My cardiologist is thrilled. cardiovascular risk is absolutely relevant for older adults — don't let anyone tell you otherwise.

Dr.EM_Chicago said:

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

Same pattern here, and in the same order.

Dr.EM_Chicago said:

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

Dizziness and cardiovascular risk: I was lightheaded for the first 2 weeks. Root cause was a combination of reduced caloric intake and mild dehydration.

Fix: minimum 80-100oz water daily, don't skip meals even if you're not hungry (eat small protein-rich snacks), and stand up slowly from sitting/lying positions. Also check your blood pressure — GLP-1-induced weight loss can make BP meds too strong, requiring dose reduction.

Dr.EM_Chicago said:

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

Lp(a) and cardiovascular risk: a nuance that matters. Unlike most lipid markers, Lp(a) is 90%+ genetically determined and doesn't really change with weight loss or GLP-1 therapy.

My Lp(a) has remained at 73 nmol/L across all time points. If yours is elevated (>50 nmol/L), you need additional risk mitigation strategies regardless of your GLP-1 response. Don't assume your medication is covering all cardiovascular risk factors.

Following on from Dr.EM_Chicago — and this may be the naive question:

What did you change at the same time, and can you separate the two now?