NNT for MACE prevention — what worked for you?

CarlaRPh_TPA said:

I'm 55 years old and want to share my perspective on cardiovascular risk as an older member of this community.

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.

MikeKY_noInsulin said:

Lp(a) and cardiovascular risk: a nuance that matters.

Bookmarking. The distinction being drawn above is the one nobody else makes. Adding it to my notes with a link back to this thread.

CarlaRPh_TPA said:

I'm 55 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.

Dr.LipidDallas said:

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

Anti-inflammatory mechanisms of GLP-1 agonists and cardiovascular risk: beyond weight loss, GLP-1R activation directly suppresses NF-κB signaling, reduces NLRP3 inflammasome activation, and decreases monocyte/macrophage adhesion to endothelium[1].

Clinical correlates: hsCRP reduction of 30-60% (consistently seen across trials), reduced carotid intima-media thickness, and decreased coronary plaque inflammation on PET imaging.

These anti-inflammatory effects likely contribute to the cardiovascular benefit seen in SELECT — and may explain benefits beyond what weight loss alone would predict.

Moderator note: reminder that nothing in this thread is medical advice, and that clinical claims need a source. Report rather than reply if it drifts again.