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The recent work of Kaiser et al,1 entitled ‘Lipoprotein(a) has no major impact on calcification activity in patients with mild to moderate aortic valve stenosis’, offers one more useful piece of evidence regarding the association of lipoprotein(a) (Lp(a)) with aortic valve (AoV) calcification. Although at first glance, the authors seem to present results contradictory to growing evidence that supports a strong causal relationship between Lp(a) and AoV calcification,2 a closer look seems to explain this deviation, in a way that reminds us of the ‘Abraham Wald’ paradigm, back in the 1940s.
When, during World War II, the mathematician Abraham Wald and his colleagues were asked which parts of the aircrafts should be reinforced to sustain the enemy’s fire, they gave a solution that was to become one of the most world-famous examples of what is called nowadays ‘survivorship’ bias. Against the obvious approach that the most-hit parts should be protected, Wald also considered as important the least-hit areas, claiming that planes receiving fire there might not have ‘survived’ to be accounted for.3 Their seminal work highlighted this form of ‘selection’ bias, which still remains relevant today in the research arena and one can argue that it …
Twitter @pan_pantelidis, @OikonomouVangel
Contributors Both authors contributed equally in searching the literature, revising the study under investigation, forming conclusions and drafting the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.
Provenance and peer review Commissioned; internally peer reviewed.
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