[2026 update] Cardiovascular risk: reading the outcome trials as a set posts 31–60
This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.
Type 2 diabetes: the population with the largest evidence base for these compounds. The SURPASS and SUSTAIN programmes established glycaemic benefit. The renal and cardiovascular benefit evidence is separate from the glycaemic benefit evidence.
This is the sort of thing the wiki should carry and currently does not.
Something worth flagging about Cardiovascular risk: the strongest-sounding claims in this thread are the ones with no source attached, which is the usual pattern and not a coincidence.
The arithmetic in post #32 is right; the assumption feeding it is the part to check.
I have three months of notes on Cardiovascular risk and the honest summary is that the trend is real and the week-to-week numbers are noise. I nearly drew the opposite conclusion from the first fortnight.
Post #35 describes the usual case. This is about the unusual one.
Adding what did not work for me on Cardiovascular risk, since the failures never get written up and they are half the useful information.
Adding the measurement that post #35 says would settle it.
Cardiovascular risk has a well-known answer and a correct answer, and the interesting work is establishing that they are the same. Nobody has done that here yet.
Nothing here is medical advice and clinicians posting in this subcategory say so on their own account rather than because a rule requires it.
Post #39 is right about the mechanism and I think understates the practical bit.
Where the Cardiovascular risk discussion usually stalls is that nobody wants to say "I do not know" and everyone is willing to say "it varies". Those are the same sentence with different clothes on.
Post #38 describes the usual case. This is about the unusual one.
Multiple comorbidities: a person with diabetes, kidney disease, and cardiovascular disease is outside the studied populations in most trials. Extrapolating to that person requires reasoning from the individual component trials and mechanisms.
Acknowledging rather than arguing. The reasoning holds as far as I can follow it.
On Cardiovascular risk I would separate what is worth knowing from what is worth acting on. The first list is long and the second is short, and conflating them is how threads get heated.
Picking up post #44: that is the part I would want checked first.
A note on how Cardiovascular risk gets discussed rather than on Cardiovascular risk itself: the confident posts get the replies and the careful ones get ignored, and the careful ones have been right more often.
Asking about a population rather than about yourself is a legitimate framing and generally gets a better answer, because the general case is answerable.
Cardiovascular disease: several compounds have cardiovascular outcome trials. SELECT was in people without diabetes; SUSTAIN 6 was in high-risk diabetes. Absolute benefit is largest in high-risk people.
I would rather be precise about what I do not know than vague about what I do.
I had written a reply contradicting post #46 and deleted it. Here is what survived.
Interactions between comorbidities: diabetes and kidney disease together change the risk calculation for hypoglycemia and for medication clearance. They are not independent variables.
Filing this under things that are true until someone shows me otherwise.
One more thing on Cardiovascular risk that took me far too long to see: the two figures people quote are not measuring the same quantity. Once you notice that, the apparent contradiction disappears.
No disagreement from me. Posting only so the question does not look ignored.
I read post #49 twice before replying, because I had assumed the opposite.
Worth separating Cardiovascular risk as a question about the compound from Cardiovascular risk as a question about the documentation. They get answered by different people and only one of them is answerable here.
Post #53 answers the question as asked. The question underneath it is different.
Where I have landed on Cardiovascular risk, having got it wrong once in public: the direction is clear, the magnitude is not, and anyone quoting a precise magnitude has borrowed it from somewhere that did not measure it.
Type 2 diabetes: the population with the largest evidence base for these compounds. The SURPASS and SUSTAIN programmes established glycaemic benefit. The renal and cardiovascular benefit evidence is separate from the glycaemic benefit evidence.
I am reporting what happened, not recommending it.
Coming back to post #53, because the follow-up matters more than the original answer.
Before the thread moves on from Cardiovascular risk — what is the sample size behind the claim? I am not being difficult; I have seen the same figure quoted from an n of four and from an n of four hundred.
Where a condition is well controlled and where it is not are different questions and the published data rarely distinguishes them.
Post #57 put the caveat in the right place and I want to underline it.
I disagree with the framing of Cardiovascular risk above, and I think it is a substantive disagreement rather than a terminological one. Setting out why, so it can be checked.
The reasoning depends on an assumption that is doing a lot of work and is never stated. If the assumption holds, the conclusion follows. I do not think it holds generally.
Building on post #57 rather than restating it.
Source for the Cardiovascular risk figure, since it was asked for. It is in the discussion rather than the abstract, which is why the version circulating is stronger than the paper is.
Reading the surrounding paragraph is worth the two minutes. The authors are more careful than their summarisers.