BMJ  2005;331:159 (16 July), doi:10.1136/bmj.331.7509.159

Letter

Drug combinations and all cause mortality in heart disease

No new insights were gained

The first 150 words of the full text of this article appear below.

EDITOR—Hippisley-Cox and Coupland conclude that the addition of angiotensin converting enzyme (ACE) inhibitors to combinations of drugs conferred no additional benefit in their study of patients in primary care with ischaemic heart disease.1 However, such a conclusion should be reached with caution.

The drugs were given to the patients with the highest risk of death. A higher percentage of patients who died were treated with ACE inhibitors, and the greatest improvement in risk of death after adjustment for risk factors was seen in the patients treated with these drugs.

ACE inhibitors might thus have been given to the patients with the most severe disease in each comorbidity group—for example, to diabetic patients with kidney disease and to patients with the most severe heart failure. Therefore the study can give no indication of the crucial question whether the outcome would have been equally good for the group of 463 . . . [Full text of this article]

Staffan Bjorck, medical adviser

Department of Healthcare Evaluation, Regionens Hus, SE 54180 Skövde, Sweden staffan.bjorck@vgregion.se


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Relevant Article

Effect of combinations of drugs on all cause mortality in patients with ischaemic heart disease: nested case-control analysis
Julia Hippisley-Cox and Carol Coupland
BMJ 2005 330: 1059-1063. [Abstract] [Full Text] [PDF]

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