PharmHunterJen 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…

Senior perspective on cardiovascular risk: I'm 66 years old and started this journey skeptically. My cardiologist recommended it after years of failed interventions.

14 months later: down 54 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.

Following on from NurseKim_ATL — and this may be the naive question:

Was that from a primary source or from a summary of one?

josh_phd_bmore said:

Senior perspective on cardiovascular risk: I'm 66 years old and started this journey skeptically.

josh_phd_bmore said:

...we don't know the long-term effects of cardiovascular risk...

This is a fair point, and I think intellectual honesty requires acknowledging it. GLP-1 agonists in their current form have ~8-10 years of human exposure data. That's not nothing, but it's not 30+ years either.

However: the risk-benefit calculation should also consider the KNOWN long-term effects of untreated obesity — diabetes, cardiovascular disease, cancer, joint destruction, reduced lifespan by 5-10 years.

Uncertainty about GLP-1 long-term safety vs certainty about obesity consequences. The calculus seems clear to me, but reasonable people can disagree.

josh_phd_bmore said:

Senior perspective on cardiovascular risk: I'm 66 years old and started this journey skeptically.

Vitamin deficiency cascade with cardiovascular risk: after 6+ months of reduced food intake, I developed a subtle but important pattern: low B12 → elevated homocysteine → increased cardiovascular risk marker.

The connection: B12 is a cofactor for homocysteine metabolism. Without adequate B12, homocysteine accumulates. This is ironic — taking a CV-protective medication while developing a CV risk factor from reduced nutrition.

Solution: comprehensive vitamin supplementation and regular lab monitoring. Don't let the medication's benefits be undermined by nutritional deficiencies.

JenPlateau said:

josh_phd_bmore said: ...we don't know the long-term effects of cardiovascular risk...

JenPlateau 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.