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Total Cholesterol and Death from Coronary Heart Disease in Older Persons
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
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•Type with double-spacing
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Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
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TO THE EDITOR:
There are several problems with Corti and colleagues' attempt to correlate death from coronary heart disease and cholesterol levels in older persons [1]. First, calculations from crude mortality rates, requiring adjustments to achieve results that are the opposite of the raw data, can hardly be called observational evidence (as is done twice in the Discussion section). Second, statistical significance occurs only when the 44 deaths that occurred in the first year were excluded from the analysis. The authors collected these data in accordance with their own experimental design. The authors then argue that persons in the last year of life may have had several terminal illnesses. This argument applies to persons who died in the other 4 years of the study.
Third, the final paragraph contains misstatements of fact. Shepherd and colleagues (the West of Scotland study) [2] did not find a significant decrease in the rate of death from coronary heart disease in their pravastatin group. Neither did Sacks and associates in the CARE (Cholesterol and Recurrent Events) study [3]. The Scandinavian Simvastatin Survival Study (4S) did report a significant decrease in coronary heart disease mortality [4], but criticism of that report has been published [5]. To quote the 4S study as saying that it showed the efficacy of cholesterol-lowering treatment in the “secondary prevention of death from coronary heart disease among men and women” fails to point out that equal numbers of deaths occurred in women receiving simvastatin and those receiving placebo.
Corti and colleagues recognize the weaknesses of a single cholesterol measure and of information obtained from death certificates. The latter include a line for comorbid conditions: Did the authors determine whether such conditions were listed for the 44 deaths excluded from the analysis and for the other 208 deaths?
When the authors adjust for serum iron and albumin levels and then exclude the 44 deaths that occurred in the first year, are they not adjusting twice for comorbid conditions? Is this acceptable?
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
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