• Public health

To the Editor: We have read with interest the article written by Bramlage et al,1 and we want to congratulate the authors and manifest our agreement with the findings of lower mortality in patients receiving optimal medical therapy (OMT) with statins, aspirin, clopidogrel, beta-blockers and renin angiotensin system blockers/angiotensin-receptor blockers. However, we think it appropriate to mention that patients who have received OMT probably needed to have medical conditions that could support this type of approach, such as blood pressure levels that tolerate hypotensive drugs, having an adequate ventricular function to receive negative inotropic agents or the coagulation system working properly to receive anticoagulant/antiplatelet drugs, among other conditions that allow the use of these and other classes of medications.2 Hence, patients who can receive the OMT are already better, and thus will have better outcomes. Regarding the use of statin, which is a medication commonly used,3 we would like to know the position of the authors on the following question: what are the reasons in this study for its limited use, especially in a suboptimal group?