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

Letter

Drug combinations and all cause mortality in heart disease

Use of statins is not supported by study

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

EDITOR—The key problem with the article by Hippisley-Cox and Coupland, who reported benefit from having been prescribed a statin, is outlined by a line in the discussion, according to which confounding by indication could have occurred if patients with a better prognosis were more likely to be prescribed different combinations of treatments.1

High, rather than low, cholesterol concentrations are linked with greater statin use, and this selects the high cholesterol group, in which early death from heart failure is less2 and general mortality in elderly patients is lower.3 4

It is therefore unfortunate that Hippisley-Cox and Coupland say that treatment including statins improves survival rather than emphasising the simple point of selection bias—that is, of not being in the "low cholesterol" group of elderly people, where increased mortality may well be concentrated and cholesterol lowering treatment was not indicated.

This cohort study could lead to "could have" medicine, whereas . . . [Full text of this article]

Eddie Vos, maintains health-heart.org

Sutton (QC), Canada J0E 2K0 vos@health-heart.org


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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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