Arterial stiffness reduction on GLP-1 — need advice

tony_orlando 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…

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.

Following on from james_edin — and this may be the naive question:

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

DoseLogDan said:

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

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 40 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.

DoseLogDan said:

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

Metabolic syndrome resolution on cardiovascular risk: I went from meeting 3 of 5 diagnostic criteria to meeting ZERO after 11 months of treatment.

The 5 criteria (and my journey):

1. Waist circumference: 50" → 36" ✅ Resolved
2. Triglycerides: 222 → 97 ✅ Resolved
3. HDL: 34 → 54 ✅ Resolved
4. Blood pressure: 142/92 → 120/74 ✅ Resolved
5. Fasting glucose: 117 → 86 ✅ Resolved

Metabolic syndrome reversal is, in my view, the most medically significant outcome of GLP-1 therapy.

TrialNerd_Beth said:

Lp(a) and cardiovascular risk: a nuance that matters.

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

Baseline hsCRP: 11.0 mg/L (high cardiovascular risk)
Month 6 hsCRP: 3.5 mg/L (moderate risk)
Month 12 hsCRP: 0.8 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 18% to 6%. My cardiologist is genuinely impressed.