Spironolactone and risk of upper gastrointestinal events: Association is unproved

doi:10.1136/bmj.333.7566.501

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Muhammad F Dawwas, clinical research fellow (dawwas@rcseng.ac.uk)

Clinical Effectiveness Unit, Royal College of Surgeons of England, London WC2A 3PE

EDITOR—The study reported by Verhamme et al has several noteworthy limitations.1 Firstly, the mortality benefit conferred by spironolactone therapy in heart failure has been shown only among patients with severe disease2 and hence, as the authors acknowledged, such patients are far more likely to be prescribed this therapy than patients with, for example, relatively asymptomatic echocardiographic evidence of impaired left ventricular function. Given …