fiona_VT said:

Prescribed on cardiovascular grounds rather than for weight, and almost everything written for patients assumes the opposite.

CRP reduction on cardiovascular risk — this is the lab result that excites me most:

Baseline hsCRP: 7.0 mg/L (high cardiovascular risk)
Month 6 hsCRP: 3.5 mg/L (moderate risk)
Month 12 hsCRP: 0.6 mg/L (low risk)

This level of inflammatory marker reduction is comparable to what you'd see with statin therapy. Combined with the weight loss, my 10-year ASCVD risk score dropped from 14% to 6%. My cardiologist is genuinely impressed.

COA_Karl said:

CRP reduction on cardiovascular risk — this is the lab result that excites me most: Baseline hsCRP: 7.0 mg/L (high cardiovascular risk) Month 6 hsCRP:…

COA_Karl 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.

fiona_VT said:

Prescribed on cardiovascular grounds rather than for weight, and almost everything written for patients assumes the opposite.

Can confirm. Same sequence, different timescale. The detail I would add is minor and it is already implied above.

From the other side of the consultation, briefly.

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.