JessicaH_TX said:The gap between trial results and real-world results is consistent and it is not fraud.
This is where I part company with the consensus forming above. I would add the less popular caveat: these trial populations under-represented several groups, older adults and the highest BMI categories among them. The results probably generalise, and "probably" should be stated as an assumption rather than dropped.
marcus_mpls 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…
Forest plot interpretation for the the trial evidence meta-analysis: when reading the pooled estimate, pay attention to:
- Point estimate (HR/RR/OR) — center of the diamond
- Confidence interval width — precision of the estimate
- I² statistic — heterogeneity across studies
- Individual study weights — are results driven by one large trial?
- Prediction interval — range of plausible true effects in future settings
The the trial evidence meta-analysis shows a pooled RR of 0.81 (95% CI 0.69-0.86), I²=54%. This is a robust and consistent effect.
Dr.CardioMD said:I would add the less popular caveat: these trial populations under-represented several groups, older adults and the highest BMI categories among them.
Propensity score matching studies and the trial evidence: when RCTs aren't available for a specific question, propensity score-matched observational studies can provide useful evidence.
A recent PSM study of 12,000 GLP-1 users vs matched controls showed reduced MI incidence (HR 0.78) over 3 years of follow-up[1].
These results complement the RCT data and suggest the benefits translate to real-world populations.
[1] Registry-based cohort study, pre-print 2024.
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View ResultsA narrower follow-up, since the general answer is now clear:
How would you tell the difference between that and the alternative explanation?
Reporting back.
Update — my curve sits below the published mean and the explanation is that the trial arm had support I do not have. That was reassuring rather than otherwise.