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Evidence-based GLP-1 & peptide discussion since 2023
ForumsCardiovascular OutcomesSELECT trial: 20% MACE reduction — looking for input Page 6

SELECT trial: 20% MACE reduction — looking for input

TinaHashiRN Sun, Jan 4, 2026 at 9:06 AM 29 replies 1,384 viewsPage 6 of 6
NeuroNate
Senior Member
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Dec 2023
Chicago, IL
Jan 7, 2026 at 12:31 AM#26
chris_chi24 said:
Anti-inflammatory mechanisms of GLP-1 agonists and cardiovascular risk: beyond weight loss, GLP-1R activation directly suppresses NF-κB signaling,…

There is a second half to this that has not been said yet. Read four things before the headline number. The population, because trial populations are selected and supported in ways that real cohorts are not. The comparator, because "better than placebo" and "better than the current standard" are different claims and get reported identically. The primary endpoint as pre-registered, because a secondary endpoint promoted after the fact is a hypothesis rather than a finding. And the completion rate, because a large effect in the half of participants who finished is a different result from a large effect in everybody enrolled.

Last edited: Jan 7, 2026 at 6:31 AM
32 7jason_paloalto, Dr.LeslieOBGYN, MikeNYC_runner and 29 others
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Dr.PathRoch
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Jun 2024
Rochester, MN
Jan 7, 2026 at 6:49 AM#27
chris_chi24 said:
Anti-inflammatory mechanisms of GLP-1 agonists and cardiovascular risk: beyond weight loss, GLP-1R activation directly suppresses NF-κB signaling,…

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.

References:
[1] Lincoff AM, et al. N Engl J Med. 2023;389(24):2221-2232.
31 6InsuranceTom, WendyG_ATL, SaraMom3 and 28 others
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Dr.SleepRoch
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Apr 2024
Rochester, MN
Jan 7, 2026 at 1:07 PM#28

A narrower follow-up, since the general answer is now clear:

What did you change at the same time, and can you separate the two now?

30 5Dr.NephBHM_UK, kim_atl_prep, sarah_TO and 27 others
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jennifer_SEA
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Seattle, WA
Jan 7, 2026 at 7:25 PM#29
Dr.PathRoch said:
I want to bring up the cardiovascular angle on cardiovascular risk.

I'm 67 years old and want to share my perspective on cardiovascular risk as an older member of this community.

My doctor was initially hesitant because of my age, but the SELECT trial included patients up to 72 and showed consistent benefit across age groups. We started at the lowest dose with closer monitoring.

12 months later: down 59 lbs, off lisinopril, A1C from 7.8% to 5.2%. My cardiologist is thrilled. cardiovascular risk is absolutely relevant for older adults — don't let anyone tell you otherwise.

29 4jim_asheville, matt_MKE, Dr.ReproEndo and 26 others
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TinaHashiRN
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Sep 2024
Raleigh, NC
Jan 8, 2026 at 1:44 AM#30

Reporting back.

Follow-up: I read the paper rather than the summary and the qualifier I was missing was in the second paragraph of the results.

7 7MikeNYC_runner and 4 others
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