Abstract In Reply.— We thank Vasan for his comments. Since he mentions the meta-analysis of primary prevention trials by Muldoon and colleagues,1 our reply2 to Muldoon et al is applicable to Vasan as well. We would like to offer the following additional comments.We believe that it would be useful to have standardized information similar to that recommended for the primary prevention trials (on dropout status, adherence to treatment regimen, history and presence of psychiatric symptoms, history and current use of alcohol and antidepressants, autopsy data including blood alcohol concentrations, and narrative concerning the circumstances of death) for individuals who died due to suicides, accidents, and homicides in secondary prevention trials of cholesterol lowering such as the Coronary Drug Project. The more information one has concerning the circumstances and nature of these deaths, the greater the ability to judge whether the cholesterol-lowering regimen might be considered causal in each References 1. Muldoon MF, Manuck SB, Matthews KA. Lowering cholesterol concentrations and mortality: a quantitative review of primary prevention trials . BMJ. 1990;301:309-314.Crossref 2. Wysowski DK, Gross TP. Does cholesterol lowering increase non-illness-related mortality? Arch Intern Med. 1991;151:1453-1454.Crossref 3. Kessler AR, Kessler B, Yehuda S. Changes in the cholesterol level, cholesterol to phospholipid mole ratio, and membrane lipid microviscosity in rat brain induced by age and a plant oil mixture . Biochem Pharmacol. 1985;34:1120-1121.Crossref 4. Wysowski DK, Gross TP. Death due to accidents and violence in two recent trials of cholesterol-lowering drugs . Arch Intern Med. 1990;150:2169-2172.Crossref 5. National Committee for Injury Prevention. Injury prevention: meeting the challenge . Am J Prev Med. 1989;5( (suppl) ):1-18. 6. Lipid Research Clinics Program. The Lipid Research Clinics Coronary Primary Prevention Trial results, I: reduction in incidence of coronary heart disease . JAMA. 1984;251:351-364.Crossref 7. Frick MH, Elo O, Haapa K, et al. Helsinki Heart Study: primary-prevention trial with gemfibrozil in middle-aged men with dyslipidemia . N Engl J Med. 1987;317:1237-1245.Crossref 8. Kramer MS, Leventhal JM, Hutchinson TA, et al. An algorithm for the operational assessment of adverse drug reactions, I: background, description, and instructions for use . JAMA. 1979;242:623-632.Crossref
Archives of Internal Medicine – American Medical Association
Published: Feb 1, 1992
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