Arterial stiffness reduction on GLP-1 — pulse wave velocity studies

Dr.MetabolicMD said:

I'm 58 years old and want to share my perspective on cardiovascular risk as an older member of this community.

This answered a question I did not know how to ask. I will report back once I have actually tried it.

From the other side of the consultation, briefly.

Lp(a) and cardiovascular risk: a nuance that matters. Unlike most lipid markers, Lp(a) is 90%+ genetically determined and doesn't really change with weight loss or GLP-1 therapy.

My Lp(a) has remained at 43 nmol/L across all time points. If yours is elevated (>50 nmol/L), you need additional risk mitigation strategies regardless of your GLP-1 response. Don't assume your medication is covering all cardiovascular risk factors.

Dr.AddMedPHL said:

Positive "side effect" of cardiovascular risk: my blood pressure dropped so much that I'm now off metoprolol entirely!

Dr.AddMedPHL 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.

Dr.RaviCardio 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…

6 month update on cardiovascular risk: down 53 lbs, off blood pressure meds, A1C normalized. Genuinely life-changing.

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