RSS Feeds
Cardiovascular Outcomes and Renal Disease
- Johannes F.E. Mann, MD;
- Hertzel C. Gerstein, MD; and
- Salim Yusuf, MD
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 Unpublished letters cannot be returned.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.
IN RESPONSE:
McCullough and colleagues correctly point out that patients with even mild renal insufficiency exhibit an excess of car-diovascular risk factors. Controlling for such risk factors indicated that renal insufficiency is an additional, independent risk factor. This is also evident from Table 1 of our article. Therapeutic nihilism was obviously not a problem of the HOPE study because antiplatelet, blood pressure-lowering, and cholesterol-lowering agents were, if anything, more frequently administered in patients with renal insuf-ficiency than those without.
However, we emphasize that the results of the HOPE study contradict the common practice to withhold angiotensin-converting enzyme inhibitors, including ramipril, in patients with renal insuffi-ciency. We have no evidence that patients with renal insufficiency in the HOPE study received fewer thrombolytics; invasive procedures, including revascularization (a secondary outcome of the HOPE study); or β-blockers. It is entirely possible that risk factors we did not evaluate may explain some of the increased risk associated with even mild renal insufficiency. However, current experimental and clinical evidence indicates that some aspects of renal failure may promote atherosclerosis and may be treatable. Further research into these factors is necessary, and our article was published to stimulate such investigations.
Johannes F.E. Mann, MD
Hertzel C. Gerstein, MD
Salim Yusuf, MD
The HOPE Office; McMaster University; Hamilton, Ontario L8L 2X2, Canada
- Copyright ©2004 by the American College of Physicians
