Prescribed on cardiovascular grounds rather than for weight, and almost everything written for patients assumes the opposite.
Relative versus absolute is the distinction that gets lost: a 20% relative reduction on a high baseline risk is a large absolute benefit, and the same relative figure on a low baseline risk is a small one.
The question I want answered is how much of the SELECT benefit is plausibly independent of the weight loss, and whether that distinction changes anything practical.
Tell me what I have not thought of.
This one has a reasonably settled answer, so here it is. The dose-response is real but shallow at the top. Across STEP 1 and STEP 4 the gap between 1.7mg and 2.4mg is a couple of percentage points of body weight on average, and the average is carrying a wide spread — plenty of people at 1.7mg sit above the 2.4mg mean. If a dose is working and tolerable, "working" is the relevant variable, not "maximal".
FDA_TrackerJim said:The dose-response is real but shallow at the top.
Agreed, though "tolerable" needs defining. A dose you tolerate by eating almost nothing is not tolerated, it is being paid for somewhere else — usually in lean mass, sometimes in adherence three months later.
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Browse GL Biochemdave_SLC said:Prescribed on cardiovascular grounds rather than for weight, and almost everything written for patients assumes the opposite.
That holds for the injectable. The oral formulation has different absorption behaviour and the dose numbers are not interchangeable, which is worth saying out loud because people quote them as if they were.
Adding the clinical framing, because it changes how the question reads.
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 39 lbs, off metoprolol, A1C from 7.8% to 5.4%. My cardiologist is thrilled. cardiovascular risk is absolutely relevant for older adults — don't let anyone tell you otherwise.