NNT for MACE prevention — July 2024

gary_naperville said:

My reason for being on this is cardiovascular rather than cosmetic, which puts me in a small minority in most of these threads.

I'm 62 years old and want to share my perspective on cardiovascular risk as an older member of this community.

My doctor was initially hesitant because of my age, but the SELECT trial included patients up to 72 and showed consistent benefit across age groups. We started at the lowest dose with closer monitoring.

9 months later: down 46 lbs, off atorvastatin, A1C from 7.2% to 5.3%. My cardiologist is thrilled. cardiovascular risk is absolutely relevant for older adults — don't let anyone tell you otherwise.

FDA_TrackerJim said:

I'm 62 years old and want to share my perspective on cardiovascular risk as an older member of this community.

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.

gary_naperville said:

My reason for being on this is cardiovascular rather than cosmetic, which puts me in a small minority in most of these threads.

Same experience, arrived at from the opposite direction.

Clinical perspective, offered as context rather than as advice.

gary_naperville said:

...we're creating a generation dependent on cardiovascular risk...

I understand the concern, but consider this analogy: are we "creating a generation dependent on" blood pressure medication? Cholesterol medication? Thyroid medication?

Obesity is a chronic disease with biological drivers. Treating it with medication is no different from treating any other chronic condition. The "dependency" framing implies weakness or moral failure — neither of which is accurate.

If ongoing medication is what keeps someone healthy, that's successful treatment, not dependency.