From the other side of the consultation, briefly.

Senior perspective on cardiovascular risk: I'm 64 years old and started this journey skeptically. My internist recommended it after years of failed interventions.

12 months later: down 42 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 marcus_mpls — and this may be the naive question:

How would you tell the difference between that and the alternative explanation?

james_edin said:

Senior perspective on cardiovascular risk: I'm 64 years old and started this journey skeptically.

SUSTAIN-6 was the first CVOT to show cardiovascular benefit with semaglutide, relevant to cardiovascular risk. In 3,297 T2DM patients with high CV risk: MACE HR 0.74 (95% CI 0.58-0.95, p=0.02)[1].

Notable: the retinopathy signal in SUSTAIN-6 (HR 1.76) was subsequently attributed to rapid A1C reduction in patients with pre-existing retinopathy — not a direct drug effect. This has been confirmed in longer-term follow-up studies.

james_edin said:

Senior perspective on cardiovascular risk: I'm 64 years old and started this journey skeptically.

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

Baseline hsCRP: 12.0 mg/L (high cardiovascular risk)
Month 6 hsCRP: 1.5 mg/L (moderate risk)
Month 12 hsCRP: 0.7 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 19% to 4%. My cardiologist is genuinely impressed.

Moderator note: leaving this open. It is being argued well and the disagreement is the useful part. No action needed from anybody.