[2026 update] Cardiovascular risk: reading the outcome trials as a set posts 61–90

Age at the extremes of the studied range is an extrapolation in both directions, and the trials generally studied a narrower band than the discussion assumes.

The disagreement above is smaller than it looks once the terms are fixed.

Picking up post #75: that is the part I would want checked first.

Filing a mild objection to the consensus on Cardiovascular risk. Mild because I might be wrong; an objection because nobody has addressed the case that does not fit.

I had written a reply contradicting post #75 and deleted it. Here is what survived.

What I would check first on Cardiovascular risk is whether the thing being measured moved or whether the way of measuring it moved. Those look identical in a graph.

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.

Asking about a population rather than about yourself is a legitimate framing and generally gets a better answer, because the general case is answerable.

The conclusion is tentative; the arithmetic underneath it is not.

Interactions between comorbidities: diabetes and kidney disease together change the risk calculation for hypoglycemia and for medication clearance. They are not independent variables.

The step people skip is the one I have spelled out.

Post #80 answers the question as asked. The question underneath it is different.

Mechanistic reasoning about a population that was excluded from the trials has an unimpressive track record. It is a good way to generate a question for a clinician.

Somebody will have a better source than mine, and I hope they post it.

Cardiovascular risk is well covered in the tag pages, and the older discussions are better than the recent ones because they were argued out properly. Worth twenty minutes before adding to this one.

Nothing to add on the substance. Thank you for taking the question at face value.

Worth separating two things that post #82 runs together.

What I would want before treating Cardiovascular risk as settled: the method, the sample, and whether anyone tried to find the opposite result. Two of the three are usually missing.

Post #84 is right about the mechanism and I think understates the practical bit.

Nothing here is medical advice and clinicians posting in this subcategory say so on their own account rather than because a rule requires it.

Reading it again, the caveat matters more than the finding.

Coming back to post #82, because the follow-up matters more than the original answer.

Where a condition is well controlled and where it is not are different questions and the published data rarely distinguishes them.

It is worth checking rather than assuming, which costs nothing.

I would put moderate confidence on the mainstream reading of Cardiovascular risk and no more. That is not scepticism for its own sake; it is where the sourcing actually stops.

On Cardiovascular risk: the maintained page in the documentation commons covers the general case with citations and a review date, which is more reliable than any reply here including this one.

The practical value of this subcategory is helping somebody frame the question they take to an appointment, and that is worth being explicit about.

I had written a reply contradicting post #86 and deleted it. Here is what survived.

The version of Cardiovascular risk that circulates here is a simplification of a simplification. It is not wrong, but it has lost the conditions under which it holds, and those conditions are where the interesting cases live.