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If low or low-normal, switch to high-dose b12 supplementation separate from multivitamin (1000 to 2000 mcg daily oral or regular injections)

The SELECT cardiovascular outcomes trial (Lincoff et al., 2023, New England Journal of Medicine) enrolled 17,604 adults with obesity and established cardiovascular disease no diabetes, and demonstrated a 20% reduction in major adverse cardiovascular events (MACE) with 2.4mg semaglutide versus placebo

Where in the thigh can Ozempic (semaglutide) be injected?

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Pumps were filled with either semaglutide at 0.833 mg/mL (to allow for 7 g/day infusion) or saline vehicle and primed at 37 C for at least 40 h

Most patients benefit from increasing to higher maintenance doses