NNT for MACE prevention — July 2024

Dr.ObesityMed said:

Senior perspective on cardiovascular risk: I'm 68 years old and started this journey skeptically.

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.

nick_newbie said:

SUSTAIN-6 was the first CVOT to show cardiovascular benefit with semaglutide, relevant to cardiovascular risk.

This answered a question I did not know how to ask. Adding it to my notes with a link back to this thread.

Dr.ObesityMed said:

Senior perspective on cardiovascular risk: I'm 68 years old and started this journey skeptically.

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.

gary_naperville said:

My reason for being on this is cardiovascular rather than cosmetic, which puts me in a small minority in most of these threads.

6 month update on cardiovascular risk: down 54 lbs, off blood pressure meds, A1C normalized. Genuinely life-changing.

Moderator note: leaving this open. It is being argued well and the disagreement is the useful part. Thread quality here is what the rules are for. Keep it up.