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ForumsCardiovascular OutcomesHeart failure hospitalization reduction on semaglutide — need advice Page 3

Heart failure hospitalization reduction on semaglutide — need advice

cory_ATX Thu, Jan 9, 2025 at 8:52 AM 12 replies 1,708 viewsPage 3 of 3
tony_orlando
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Jan 10, 2025 at 1:44 AM#11
julia.endo said:
The mechanism that matters here is not stomach emptying, it is central.

That reframing is the part I needed. Sending this to two other people who asked me the same thing last week.

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Dr.GastroMayo
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Jan 10, 2025 at 9:19 AM#12

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

Anti-inflammatory mechanisms of GLP-1 agonists and cardiovascular risk: beyond weight loss, GLP-1R activation directly suppresses NF-κB signaling, reduces NLRP3 inflammasome activation, and decreases monocyte/macrophage adhesion to endothelium[1].

Clinical correlates: hsCRP reduction of 30-60% (consistently seen across trials), reduced carotid intima-media thickness, and decreased coronary plaque inflammation on PET imaging.

These anti-inflammatory effects likely contribute to the cardiovascular benefit seen in SELECT — and may explain benefits beyond what weight loss alone would predict.

References:
[1] Hogan AE, et al. Diabetologia. 2014;57(4):781-784.
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Dr.ReproEndo
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Jan 10, 2025 at 4:54 PM#13
BariatricNurseD said:
The dose-response is real but shallow at the top.

I read this differently from BariatricNurseD, on substance rather than tone. The trial means are being read too generously in this thread. STEP populations were selected, supported, and titrated by protocol, and the real-world curves are consistently a few points worse. That difference is not noise, it is what happens when you remove the study infrastructure.

Last edited: Jan 10, 2025 at 5:54 PM
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josh_phd_bmore
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Jan 11, 2025 at 12:29 AM#14
cory_ATX 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…

Dizziness and cardiovascular risk: I was lightheaded for the first 3 weeks. Root cause was a combination of reduced caloric intake and mild dehydration.

Fix: minimum 80-100oz water daily, don't skip meals even if you're not hungry (eat small protein-rich snacks), and stand up slowly from sitting/lying positions. Also check your blood pressure — GLP-1-induced weight loss can make BP meds too strong, requiring dose reduction.

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Admin
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Jan 11, 2025 at 8:04 AM#15

Moderator note: reminder that nothing in this thread is medical advice, and that clinical claims need a source. No action needed from anybody.

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