Has anyone dealt with blood pressure went from scary to perfect - anyone else?? — Page 5 — Cardiovascular Outcomes

Dr.BariatricHTX

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Feb 2024

Houston, TX

Nov 20, 2024 at 11:16 PM#21

Clinical perspective, offered as context rather than as advice.

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:

Intervention	NNT	Timeframe
Semaglutide (MACE)	67	3.3 years
Statins primary prevention (MI)	~100	5 years
Aspirin secondary prevention	~77	2 years

These NNTs are clinically meaningful and comparable to accepted cardiovascular interventions.

37 10CarlaRPh_TPA, steph_laguna, fiona_glasgow and 34 others

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kate.chem

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Dec 2023

California

Nov 28, 2024 at 6:06 AM#22

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

Same pattern here, and in the same order. Nothing to add that would improve it.

Last edited: Nov 28, 2024 at 9:06 AM

38 11VanRx_Mike, steve_okc, dave_SLC and 35 others

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Dr.PulmRoch

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Jun 2024

Rochester, MN

Dec 5, 2024 at 1:00 PM#23

Dr.BariatricHTX 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 84 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.

Last edited: Dec 5, 2024 at 2:00 PM

39 12AttorneyGrant, DebRD_ATL, KristenIndy and 36 others

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dave_SLC

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Aug 2024

Salt Lake City, UT

Dec 12, 2024 at 7:58 PM#24

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

Dr.BariatricHTX said:
...we don't know the long-term effects of cardiovascular risk...

This is a fair point, and I think intellectual honesty requires acknowledging it. GLP-1 agonists in their current form have ~8-10 years of human exposure data. That's not nothing, but it's not 30+ years either.

However: the risk-benefit calculation should also consider the KNOWN long-term effects of untreated obesity — diabetes, cardiovascular disease, cancer, joint destruction, reduced lifespan by 5-10 years.

Uncertainty about GLP-1 long-term safety vs certainty about obesity consequences. The calculus seems clear to me, but reasonable people can disagree.

Last edited: Dec 12, 2024 at 11:58 PM

40 13FranDenver, Dr.BariatricHTX, LindaRN_retired and 37 others

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