Heart failure hospitalization reduction on semaglutide — 6 month update

pete_nash said:

Albumin binding above 99% is the whole reason weekly dosing works, and it is also why the trough matters more than the peak.

All true, with one condition: that curve is for people who reached the dose on schedule. Anyone who slowed the ladder for tolerability is on a different, flatter curve, and comparing yourself with the published mean will make you feel like a non-responder when you are not.

SurmountFan_IN said:

Agreed, though "tolerable" needs defining.

Saving this. It is the first explanation that did not require me to already understand it. Adding it to my notes with a link back to this thread.

pete_nash said:

Albumin binding above 99% is the whole reason weekly dosing works, and it is also why the trough matters more than the peak.

I will push back on the "any working dose is fine" framing. The maintenance evidence sits overwhelmingly at the top studied dose, and the extension data shows regain tracking dose reduction rather than tracking stopping. Holding low is reasonable; pretending it is evidentially equivalent is not.

ricardo_MIA said:

Prescribed on cardiovascular grounds rather than for weight, and almost everything written for patients assumes the opposite.

NNT calculation for cardiovascular risk clinical endpoints: NNT = 1/ARR (absolute risk reduction).

From SELECT trial: MACE at 39 months — 6.5% semaglutide vs 8.0% placebo. ARR = 1.5%. NNT = 67 over 3.3 years.

Compare to established therapies:

These NNTs are clinically meaningful and comparable to accepted cardiovascular interventions.

Moderator note: reminder that nothing in this thread is medical advice, and that clinical claims need a source. Tagging this one for the weekly digest.