NNT for MACE prevention — what worked for you?

Dr.LipidDallas said:

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

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.

Dr.KarenChen said:

I want to bring up the cardiovascular angle on cardiovascular risk.

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 63 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.

Dr.LipidDallas said:

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

This is my experience too, for whatever a second data point is worth.

Adding the clinical framing, because it changes how the question reads.

Senior perspective on cardiovascular risk: I'm 71 years old and started this journey skeptically. My geriatrician recommended it after years of failed interventions.

13 months later: down 39 lbs, more mobile, pain reduced, medications simplified. My quality of life has improved dramatically. I wish this existed 20 years ago.

To other older adults hesitating: the SELECT trial proved benefit in our age group. You deserve to feel good in your body regardless of age.