Semaglutide cardiovascular benefit: SELECT trial deep dive

claudia_zurich said:

Steady state is the thing most people miss.

Thank you for spelling out the reasoning rather than just the conclusion. Taking it to my next appointment.

Clinical perspective, offered as context rather than as advice.

Cardiac biomarkers and cardiovascular risk: my cardiologist ordered advanced cardiac labs given my family history. Results were encouraging:

• NT-proBNP: 73 pg/mL (normal, cardiac function preserved)
• Lp(a): 33 nmol/L (genetic, unchanged — expected)
• ApoB: dropped from 148 to 98 mg/dL (excellent response)
• Coronary calcium score: 0 (unchanged from baseline — reassuring)

The ApoB reduction is particularly meaningful — it's considered the best single predictor of cardiovascular risk. GLP-1 therapy seems to improve this consistently.

NurseKim_ATL said:

Albumin binding above 99% is the whole reason weekly dosing works, and it is also why the trough matters more than the peak.

I will push back on the "any working dose is fine" framing. The maintenance evidence sits overwhelmingly at the top studied dose, and the extension data shows regain tracking dose reduction rather than tracking stopping. Holding low is reasonable; pretending it is evidentially equivalent is not.

Dr.CardioMD 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…

Dr.CardioMD said:

...cardiovascular risk is just another fad...

I understand the skepticism — we've all seen "miracle" weight loss solutions come and go. But consider what makes GLP-1 agonists different:

• Phase 3 RCTs with thousands of participants (not 20-person pilot studies)
• Published in NEJM, JAMA, Lancet (not press releases)
• Replicated across multiple independent research groups
• Proven cardiovascular and renal benefits beyond weight loss
• Biological mechanism fully characterized at the receptor level

This isn't a fad — it's a new drug class supported by the highest level of clinical evidence. The comparison to past fads is understandable but inappropriate.

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