For adults with obesity and established cardiovascular disease, long-term (up to ~4 years) GLP-1 receptor agonist therapy is net-beneficial and acceptably safe: its cardiovascular and all-cause mortality benefits outweigh its documented harms, provided lean-mass loss is monitored and the lack of evidence beyond ~4 years is acknowledged.

Evidence (1)

SELECT: semaglutide and cardiovascular outcomes in obesity without diabetes

In 17,604 adults with obesity and established CVD (no diabetes), over a mean ~40 months semaglutide reduced the composite of CV death, non-fatal MI or non-fatal stroke by 20% versus placebo — the largest and longest randomized dataset bearing on long-term GLP-1 safety.

https://pmc.ncbi.nlm.nih.gov/articles/PMC11544414/

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Arguments for (1)

For adults with obesity and established cardiovascular disease, long-term (up to ~4 years) GLP-1 receptor agonist therapy is net-beneficial and acceptably safe: its cardiovascular and all-cause mortaltested-undermined

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