Clinical · Comorbidities

[2026 update] Cardiovascular risk: reading the outcome trials as a set

Clinical › Comorbidities PCOS type 2 diabetes chronic kidney disease blood pressure obstructive sleep apnoea

sa.okonkwoTL22 Mar 2025#1

Posting this under the heading it deserves: Cardiovascular risk: reading the outcome trials as a set Everything below is what sits behind that.

I have spent a fortnight trying to pin Cardiovascular risk down and I want to set out where I have got to, because I suspect the honest answer is duller than the thread this will produce.

What I have: a consistent observation across a small number of cases, collected the same way each time. What I do not have: any controlled comparison, or any reason to think my cases are representative.

The specific question is whether the pattern survives once the obvious confounder is removed. I cannot remove it with what I have.

2 likes 17mo

a.weissTL27 Mar 2025#2

I had written a reply contradicting the opening post and deleted it. Here is what survived.

Cardiovascular risk came up in a thread eighteen months ago and was answered well. I cannot find it, which is itself the problem, so here is the reconstruction.

5 likes 17mo

k.roosTL210 Mar 2025#3

Checked the Cardiovascular risk claim against the primary source this morning. It survives, with a narrower scope than the version quoted here. Posting the narrower scope.

21 likes 17mo

l.dziedzicTL213 Mar 2025#4

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

0 likes 17mo

n.lehtinenTL216 Mar 2025#5

l.dziedzic, post #4: The practical value of this subcategory is helping somebody frame the question they take to an appointment, and that is worth being explicit about. Go to post

My position on Cardiovascular risk is current rather than settled. I have revised it once already and I expect to again, so treat it accordingly.

0 likes in reply to #4 16mo

i.bakkenTL219 Mar 2025#6

n.lehtinen, post #5: My position on Cardiovascular risk is current rather than settled. I have revised it once already and I expect to again, so treat it accordingly. Go to post

Coming back to post #2, because the follow-up matters more than the original answer.

The arithmetic on Cardiovascular risk is the easy part and it is where the errors are, which is an uncomfortable combination. Show your working and someone will catch it.

3 likes in reply to #5 16mo

KLindqvistTL4 Moderator22 Mar 2025 · edited#7

Picking up post #4: that is the part I would want checked first.

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

That is the version I would defend. It is not the version I started with.

15 likes 16mo

k.laurentTL224 Mar 2025#8

Following, with nothing to contribute beyond having asked the same thing elsewhere.

29 likes 16mo

s.karlsen_rphTL3Pharmacist27 Mar 2025#9

sa.okonkwo, post #1: Posting this under the heading it deserves: Cardiovascular risk: reading the outcome trials as a set Everything below is what sits behind that. I have spent a fortnight trying to pin Cardiovascular risk down and I want to set out where I have got to, because I suspect the honest answer is duller than the thread this will produce. What I… Go to post

Fair, and the limits you put on it are the part I will remember.

5 likes in reply to #1 16mo

h.vargaTL229 Mar 2025#10

Since Cardiovascular risk keeps coming up, it should probably be a maintained page rather than a recurring thread. I am happy to draft it if someone with more direct experience will review it.

14 likes 16mo

np_gilmoreTL3Nurse practitioner31 Mar 2025#11

Post #10 and I disagree about the size of the effect, not about the direction.

The version of Cardiovascular risk that I was taught turned out to be a teaching simplification. Useful, and not true in the way I had assumed it was.

8 likes 16mo

no.silvaTL23 Apr 2025 · edited#12

A condition that affects nutrition or absorption changes the calculus around a treatment that reduces intake, and that interaction is mostly unstudied.

2 likes 16mo

peak_purityTL35 Apr 2025#13

Collapsed as off-topic by two members at trust level 3 or above

I have been on both sides of the Cardiovascular risk argument in this category within eighteen months, which should tell you how strong the evidence for either side is.

s.dialloTL27 Apr 2025#14

Narrowing post #12, because the general version has more than one answer.

One caution on Cardiovascular risk: everything above assumes the underlying documentation is what it claims to be. That assumption is doing real work and is rarely stated.

27 likes 16mo

policy_readerTL2Regular9 Apr 2025#15

Post #14 put the caveat in the right place and I want to underline it.

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 claim is narrower than it sounds, and deliberately so.

5 likes 16mo

f.rasmussenTL211 Apr 2025#16

Building on post #14 rather than restating it.

Cardiovascular risk is a good example of a question where the honest answer is boring and the interesting answers are unsupported. I would go with boring.

0 likes 16mo

m.dalgaardTL3Regular13 Apr 2025#17

h.varga, post #10: Since Cardiovascular risk keeps coming up, it should probably be a maintained page rather than a recurring thread. I am happy to draft it if someone with more direct experience will review it. Go to post

Gastrointestinal conditions interact with a mechanism that slows gastric emptying in ways that are plausible and largely unstudied.

0 likes in reply to #10 15mo

m.vukovicTL215 Apr 2025#18

KLindqvist, post #7: Picking up post #4: that is the part I would want checked first. Interactions between comorbidities: diabetes and kidney disease together change the risk calculation for hypoglycemia and for medication clearance. They are not independent variables. That is the version I would defend. It is not the version I started with. Go to post

This is the sort of exchange that makes the archive worth searching.

20 likes in reply to #7 15mo

revision_historyTL3Wiki editor17 Apr 2025 · edited#19

Bariatric surgery history: altered anatomy after surgery affects absorption. That matters for oral medications and for reconstituted solutions. Discussing specific medications and doses with a clinician familiar with bariatric surgery is prudent.

2 likes 15mo

e.mbekiTL219 Apr 2025#20

Picking up post #17: that is the part I would want checked first.

Posting my Cardiovascular risk numbers with the method attached so they can be discounted properly. Uncontrolled, unblinded, and collected by someone who wanted a particular answer.

0 likes 15mo

stopper_traceTL2Member21 Apr 2025#21

Careful with the language on Cardiovascular risk. "Not detected" and "not present" are different findings and the first is a statement about the method.

5 likes 15mo

n.hartmannTL223 Apr 2025#22

i.bakken, post #6: Coming back to post #2, because the follow-up matters more than the original answer. The arithmetic on Cardiovascular risk is the easy part and it is where the errors are, which is an uncomfortable combination. Show your working and someone will catch it. Go to post

Where the honest answer is "nobody knows", giving it plainly is more useful than a confident synthesis of mechanism and anecdote.

That is one dataset and I would not build a rule on it.

14 likes in reply to #6 15mo

NHuddlestonTL1Member25 Apr 2025 · edited#23

s.diallo, post #14: Narrowing post #12, because the general version has more than one answer. One caution on Cardiovascular risk: everything above assumes the underlying documentation is what it claims to be. That assumption is doing real work and is rarely stated. Go to post

Narrowing post #22, because the general version has more than one answer.

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.

0 likes in reply to #14 15mo

m.guerreroTL227 Apr 2025#24

Everything in post #20 holds. The case it does not cover is the one I have.

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.

0 likes 15mo

WendelboeTL2Member29 Apr 2025#25

I would keep Cardiovascular risk and the decision it usually gets used for separate in this thread. They are related and they are not the same question, and merging them is why the last one went badly.

2 likes 15mo

f.yildizTL21 May 2025#26

n.lehtinen, post #5: My position on Cardiovascular risk is current rather than settled. I have revised it once already and I expect to again, so treat it accordingly. Go to post

Cardiovascular risk looks different depending on whether you are reading the primary literature or the summaries of it, and the difference is not in our favour.

9 likes in reply to #5 15mo

g.pemberton_ukTL3Regional · UK3 May 2025#27

Marking my place. If it changes for me I will come back and say so.

28 likes 15mo

ai.vukovicTL25 May 2025#28

Answering the question post #24 raises rather than the one it answers.

Where two conditions pull in opposite directions, that is a clinical judgement rather than a lookup, and it is the kind of question a forum answers worst.

I would be interested in a counterexample if anyone has one.

0 likes 15mo

osmolal_tableTL1Member6 May 2025#29

Post #26 is the version of this I will quote in future. One addition.

Adding a small correction to the Cardiovascular risk summary above rather than a disagreement with it. The substance holds; one of the figures is out by a factor that matters.

13 likes 15mo

so.mbekiTL28 May 2025#30

Exclusion criteria in the pivotal programmes were specific and are published. Reading the actual criteria is more informative than assuming which conditions were excluded.

27 likes 15mo

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