SELECT cost-effectiveness — 6 month update

Dr.MetabolicMD said:

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

Metabolic syndrome resolution on cardiovascular risk: I went from meeting 4 of 5 diagnostic criteria to meeting ZERO after 12 months of treatment.

The 5 criteria (and my journey):

1. Waist circumference: 51" → 35" ✅ Resolved
2. Triglycerides: 277 → 102 ✅ Resolved
3. HDL: 35 → 59 ✅ Resolved
4. Blood pressure: 147/95 → 120/74 ✅ Resolved
5. Fasting glucose: 127 → 87 ✅ Resolved

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

bri_stats said:

Agreed, and coverage criteria are plan-specific rather than insurer-specific.

Saving this. It is the first explanation that did not require me to already understand it. I will report back once I have actually tried it.

Dr.MetabolicMD said:

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

Pushing back on Dr.MetabolicMD here. The affordability discussion here usually stops at individual tactics. At list price this class is out of reach for most of the people who would benefit, and no amount of appeal strategy changes that — it is a pricing problem wearing a paperwork costume.

PeptideChemSF said:

Prescribed on cardiovascular grounds rather than for weight, and almost everything written for patients assumes the opposite.

Anti-inflammatory mechanisms of GLP-1 agonists and cardiovascular risk: beyond weight loss, GLP-1R activation directly suppresses NF-κB signaling, reduces NLRP3 inflammasome activation, and decreases monocyte/macrophage adhesion to endothelium[1].

Clinical correlates: hsCRP reduction of 30-60% (consistently seen across trials), reduced carotid intima-media thickness, and decreased coronary plaque inflammation on PET imaging.

These anti-inflammatory effects likely contribute to the cardiovascular benefit seen in SELECT — and may explain benefits beyond what weight loss alone would predict.

Moderator note: the sourcing question belongs in the vendor section and has been split out. Thread quality here is what the rules are for. Keep it up.