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ForumsCardiovascular OutcomesHas anyone dealt with blood pressure went from scary to perfect - anyone else??

Has anyone dealt with blood pressure went from scary to perfect - anyone else??

sophie_paris Thu, Oct 31, 2024 at 3:24 AM 39 replies 2,318 viewsPage 1 of 8
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sophie_paris
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Oct 31, 2024 at 3:24 AM#1

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

The question I want answered is how much of the SELECT benefit is plausibly independent of the weight loss, and whether that distinction changes anything practical.

I would rather have one careful answer than five confident ones.

41 11SallyK_inj, CryptoCarl, MariaRD and 38 others
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Dr.RenalNash
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Oct 31, 2024 at 4:26 AM#2
sophie_paris said:
My reason for being on this is cardiovascular rather than cosmetic, which puts me in a small minority in most of these threads.

Mendelian randomization evidence supporting GLP-1 pathway modulation for cardiovascular risk: genetic variants in the GLP1R gene region associated with lower BMI also show associations with reduced cardiovascular risk, confirming a causal pathway[1].

This "natural experiment" (people born with genetically higher GLP-1 signaling being leaner and healthier) provides orthogonal evidence supporting the pharmacological approach. When genetic epidemiology, clinical trials, and mechanistic studies all converge, confidence in the therapeutic approach is high.

References:
[1] Zheng SL, et al. Lancet Diabetes Endocrinol. 2023;11(12):869-879.
Last edited: Oct 31, 2024 at 9:26 AM
40 10pam_stl, wei_SG, cory_ATX and 37 others
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maria_elpaso
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El Paso, TX
Oct 31, 2024 at 5:28 AM#3
Dr.RenalNash said:
Mendelian randomization evidence supporting GLP-1 pathway modulation for cardiovascular risk: genetic variants in the GLP1R gene region associated…

I want to bring up the cardiovascular angle on cardiovascular risk.

The SELECT trial demonstrated a 20% reduction in MACE with semaglutide 2.4mg[1]. This is practice-changing because the CV benefit appears to be independent of the degree of weight loss — suggesting direct vascular and anti-inflammatory mechanisms.

For cardiovascular risk, this means we need to think beyond the primary outcome and consider the cardiovascular implications. The all-cause mortality reduction (HR 0.81) is the most clinically meaningful signal.

References:
[1] Lincoff AM, et al. N Engl J Med. 2023;389(24):2221-2232.
39 9TrialNerd_Beth, HPLC_Greg, LibrarianMeg and 36 others
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ricardo_MIA
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Sep 2024
Miami, FL
Oct 31, 2024 at 6:30 AM#4
sophie_paris said:
My reason for being on this is cardiovascular rather than cosmetic, which puts me in a small minority in most of these threads.

Mine went the same way, slower.

38 8KetoKyle, CanadaChris, ZaraB_AL and 35 others
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Dr.ReproEndo
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Oct 31, 2024 at 12:25 PM#5

From the other side of the consultation, briefly.

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.

37 7carl_compliance, DanielChem_CHI, marco_milano and 34 others
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