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Coenzyme A Reductase Inhibitors and Stroke
- Heiner C. Bucher, MD, MPH;
- Lauren E. Griffith, MS; and
- Gordon H. Guyatt, MD, MSc
- Medizinische Universitats-Poliklinik; CH-4031 Basel, Switzerland McMaster University; Hamilton, Ontario L8N 3Z5, Canada
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IN RESPONSE:
Dr. Crouse wonders why we did not include seven additional trials of HMGcoA reductase inhibitors in our analysis. These trials did not report the number of strokes that occurred, so the requisite information for our analysis was not available. Dr. Crouse hypothesizes that the strong effect observed occurred because more of the HMGcoA studies are secondary prevention trials. Two meta-analyses analyzing the effects of HMGcoA inhibitors that have been published since our overview [1, 2] have found similar odds ratios with large, overlapping confidence intervals for the primary and secondary prevention trials involving HMGcoA reductase inhibitors. These data argue against Dr. Crouse's hypothesis. Dr. Crouse is correct that not all trials included in our analysis explicitly stated whether they excluded patients with previous strokes. However, it is highly unlikely that including such patients would affect the conclusions of our study.
Drs. Ornstein and Zacharski provide an interesting hypothesis about additional possible mechanisms for the beneficial effects of HMGcoA reductase inhibitors. We share their opinion that additional clinical studies are needed to confirm these mechanisms and to further elucidate their clinical relevance.
Heiner C. Bucher, MD, MPH
Medizinische Universitats-Poliklinik; CH-4031 Basel, Switzerland
Lauren E. Griffith, MS
Gordon H. Guyatt, MD, MSc
McMaster University; Hamilton, Ontario L8N 3Z5, Canada
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.
- Copyright ©2004 by the American College of Physicians
