Reply to FDA removed black box warning for HRT

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Reply to "FDA removed black box warning for HRT"

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[quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous]For those who want data and official medical positions, here's some research on HRT and type 2 diabetes. Summarizing, it shows that across multiple large randomized trials and meta-analyses, HRT with estrogen (with or without progestin) reduces the risk of developing type 2 diabetes on the order of 20–30% and improves insulin resistance and glucose control:

Margolis KL et al., Diabetologia 2004 — 15,641 postmenopausal women randomized and placebo controlled: https://link.springer.com/article/10.1007/s00125-004-1448-x

Mauvais-Jarvis et al. 2017 – Endocrine Reviews
https://academic.oup.com/edrv/article/38/3/173/3063786

Note that HRT does not have an FDA-approved prevention indication.

The North American Menopause Society in their 2022 position statement said that they do NOT recommend starting HRT primarily to prevent diabetes, but that a diabetes-preventive effect is a real, evidence-based benefit in appropriate women (younger, early postmenopause): https://pubmed.ncbi.nlm.nih.gov/35797481/
[/quote]

Sure. But since we are being so detailed about the absolute of HRT it is also important to be detailed about the absolute benefits: “The cumulative incidence of treated diabetes was 3.5% in the hormone therapy group and 4.2%”

So there was 0.7% fewer diabetes cases in the HRT group. Hardly a stunning number on an individual level. These findings are probably most important to conclude that a woman with diabetes or at risk of it can take HRT without a negative impact on diabetes. [/quote]

This PP doesn't understand statistics. She doesn't know the difference between absolute difference and relative risk, so her post is seriously misleading.

Here's an example: Using seatbelts lowers your risk of death in a serious car crash by 50%. If you don't use a seatbelt and you get in a serious crash, your risk of dying is 43%. If you use a seatbelt, the risk drops to 21%. So by using a seatbelt, you cut your risk in half! Pretty good, right?

But the chances of anyone dying in a serious car crash isn't especially high. So the *absolute* difference between seat belt users and non-users -- 0.0005% -- looks absolutely tiny. That tiny-seeming number = cutting your chance of death in half.

So when PP says, 0.7% (absolute difference) is "hardly a stunning number on an individual level," she's completely misunderstanding what the appropriate "individual" number is. The "individual" number is the decrease in the relative risk an individual might have. That number is 21%, and that is the effect of HRT.

Whether you think a 21% reduction is a compelling number or not is up to you. [/quote]

Great now do the breast cancer and stroke risk. [/quote]

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