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Evidence-based GLP-1 & peptide discussion since 2023
ForumsPublic SquareMy wife thinks I am crazy for doing this lol — need advice

My wife thinks I am crazy for doing this lol — need advice

LipidDoc_ATL Thu, Oct 31, 2024 at 6:38 AM 54 replies 2,912 viewsPage 1 of 11
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LipidDoc_ATL
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Oct 31, 2024 at 6:38 AM#1

My own curve sits about four points below the published mean and I spent two months assuming that meant something was wrong with me or with my material.

So the question, as narrowly as I can put it: how to read a result like this without either dismissing it or over-reading it, since the summaries all read like press releases.

Not looking for reassurance. Looking for the part I have got wrong.

11 14rachel_ABQ, traveltech_sara, AttorneyGrant and 8 others
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Dr.KarenChen
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Oct 31, 2024 at 6:49 AM#2

This one has a reasonably settled answer, so here it is. Read four things before the headline number. The population, because trial populations are selected and supported in ways that real cohorts are not. The comparator, because "better than placebo" and "better than the current standard" are different claims and get reported identically. The primary endpoint as pre-registered, because a secondary endpoint promoted after the fact is a hypothesis rather than a finding. And the completion rate, because a large effect in the half of participants who finished is a different result from a large effect in everybody enrolled.

12 15JessicaM_2024, TomFromTexas, mike.trainer_LA and 9 others
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Dr.LipidDallas
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Oct 31, 2024 at 7:00 AM#3
Dr.KarenChen said:
Read four things before the headline number.
Dr.KarenChen said:
...regarding the trial evidence...

I think this is an underappreciated point. To expand on it with some data:

A recent meta-analysis of 18 RCTs (n=15,600) found that the trial evidence was associated with a robust effect size across diverse patient populations[1].

The NNT was 15, which is comparable to antihypertensives for stroke reduction. That's a strong clinical argument for this approach.

Last edited: Oct 31, 2024 at 9:00 AM
13 16cory_ATX, lori_vegas, Dr.PulmRoch and 10 others
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Dr.LeslieOBGYN
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Oct 31, 2024 at 7:11 AM#4
LipidDoc_ATL said:
My own curve sits about four points below the published mean and I spent two months assuming that meant something was wrong with me or with my…

Can confirm the pattern LipidDoc_ATL describes. Relative and absolute effects need reading together. A 20% relative reduction on a high baseline risk is a large absolute benefit; the same relative figure on a low baseline risk is a small one, and press summaries almost always quote the relative number because it is bigger.

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paige_pharma
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Oct 31, 2024 at 8:07 AM#5

Adding the clinical framing, because it changes how the question reads.

Forest plot interpretation for the the trial evidence meta-analysis: when reading the pooled estimate, pay attention to:

  1. Point estimate (HR/RR/OR) — center of the diamond
  2. Confidence interval width — precision of the estimate
  3. I² statistic — heterogeneity across studies
  4. Individual study weights — are results driven by one large trial?
  5. Prediction interval — range of plausible true effects in future settings

The the trial evidence meta-analysis shows a pooled RR of 0.86 (95% CI 0.70-0.91), I²=59%. This is a robust and consistent effect.

Last edited: Oct 31, 2024 at 9:07 AM
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