anders_CPH said:

Read four things before the headline number.

I read this differently from anders_CPH, on substance rather than tone. 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.

pete_RVA 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…

pete_RVA 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 statins for secondary prevention. That's a strong clinical argument for this approach.

KevinCompounds said:

I would add the less popular caveat: these trial populations under-represented several groups, older adults and the highest BMI categories among them.

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 0.77 (95% CI 0.70-0.87), I²=35%. This is a robust and consistent effect.

One thing that is still open after alex_tucson’s answer:

What did you change at the same time, and can you separate the two now?

OP back with an update, since a thread like this is useless without one.

Follow-up: I read the paper rather than the summary and the qualifier I was missing was in the second paragraph of the results.