SELECT trial: 20% MACE reduction — need advice

Dr.ObesityLA said:

Read four things before the headline number.

Genuinely useful, thank you. I had the facts and not the framework.

Clinical perspective, offered as context rather than as advice.

Continuous metabolic monitoring dashboard for cardiovascular risk — I track everything in a spreadsheet and here's the month-over-month trend for my key markers:

Weight: consistent downtrend, -1.5 lbs/week average
Fasting glucose (finger stick): stable at 84 mg/dL
Blood pressure (home): 115/74 average
Resting heart rate: 64 bpm (down from 80)
Waist circumference: down 14 inches total

The resting heart rate improvement correlates with cardiovascular fitness gains. Everything is moving in the right direction.

pat_auckland said:

Relative and absolute effects need reading together.

Pushing back on pat_auckland here. I would add the less popular caveat: these trial populations under-represented several groups, older adults and the highest BMI categories among them. The results probably generalise, and "probably" should be stated as an assumption rather than dropped.

nick_newbie 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…

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.

Moderator note: the sourcing question belongs in the vendor section and has been split out.