147 e-Letters

published between 2010 and 2013

  • Baseline artery diameter confounds flow-mediated dilation only if a percentage change is selected as the size-scaling index
    Greg Atkinson

    Dear Editor, Maruhashi et al.[1] meticulously measured the flow-mediated changes in brachial artery diameter with a large sample of participants. The changes in diameter were quantified using the conventional percentage-based index (FMD%). As usual, baseline artery diameter (Dbase) was found to be substantially and negatively correlated with FMD%. So it seems that even the most robust protocols and precise measurements o...

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  • Hypertension in the Elderly
    Alexandros Briasoulis

    We read with interest the correspondence of Luis Carlos Saiz regarding our meta-analysis on the effects of antihypertensive treatment in patients over 65 years of age. The author asserts the INternational VErapamil SR-Trandolapril STudy (INVEST) trial [1] should not have been included in the meta-analysis as it did not recruit a predominantly elderly population.

    INVEST enrolled a total of 22,576 patients from 8...

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  • The possible impact of lack of ethnic and geographical diversity on the association of MTHFR mutations, homocysteine levels and heart disease outcomes
    Naveen L. Pereira

    Methylenetetrahydrofolate reductase (MTHFR) plays an important role in conversion of homocysteine to methionine by catalyzing the production of 5-methyl tetrahydrofolate hence effectively decreasing plasma homocysteine levels. The MTHFR 677C>T nonsynonymous single nucleotide polymorphism (SNP) leads to a substitution of Valine for Alanine and results in the formation of a thermolabile variant of the enzyme with decr...

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  • Re:Re:Use SMART risk score to correct under- and overtreatment.
    Johannes A. Dorresteijn

    As was pointed out by dr. Thomas and dr. Pleumeekers in personal communication, we have to admit that the case of a 70-year old patient with a 15% 10-year risk is not unthinkable. For example, a patient with the following characteristics has a predicted 15% 10-year risk for recurrent cardiovascular events: male 70 years, no smoker, systolic blood pressure 130 mmHg, diabetes mellitus no, CAD yes, CVD no, AAA no, PAD no,...

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  • Re:QRISK2 validation by ethnic group
    Therese Tillin

    Author's response

    We thank Professor Hippisley-Cox and colleagues for their comments on our paper. We agree that our study has limitations, but consider that we have stated these clearly within the manuscript. We believe that, notwithstanding these limitations, we bring new information regarding the performance of these widely used cardiovascular risk scores in three British ethnic groups. Importantly, these...

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  • QRISK2 validation by ethnic group
    Julia Hippisley-Cox

    Tillin et al recently reported a cohort study[1] comparing the performance of QRISK2 and Framingham in the Southall and Brent cohort in London. We have a number of comments on the study and the interpretation of results.

    1. Number of events : The main problem with the paper, is that numbers are very small and given the resulting wide confidence intervals the authors have overstated their findings. There is no...

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  • Potential weakness of the metanalysis
    Luis Carlos Saiz

    Dear Editor,

    I have read with interest your metanalysis on effects of antihypertensive treatment in patients over 65 years of age, and I would like to point to an issue quite relevant on my view. I have checked some of the trials included because I doubted if it was possible to the authors to separate participants with more than 65 years from younger, excluding the latter from the analysis. For instance, in the...

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  • Re:Have I missed something here?
    Aref A. Bin Abdulhak

    Peri-ablation dabigatran in atrial fibrillation: not only about thromboembolism.

    We have read with interest the letter by Ward (1) about our recent publication (2). The author raised an important point: why should dabigatran be interrupted during a procedure known to be associated with risk of thromboembolic events? Ward also noted that our meta-analysis did not include any study with uninterrupted dabigatran....

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  • Have I missed something here?
    David E Ward

    Am I missing something here? It is generally accepted that the omission of a single dose of dabigatran, which has a short elimination half-life, may place a patient at risk of thromboembolism. So why should atrial fibrillation ablation be any different especially when one is potentially stimulating thrombus formation in the left atrium during and possibly after the procedure? Why not continue the drug through the proced...

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  • Re:Use SMART risk score to correct under- and overtreatment.
    Johannes A.N. Dorresteijn

    Complex drug regimens and overtreatment in elderly persons are important medical issues. Less stringent treatment for example of blood pressure, may be allowed or is even advisable in the elderly, especially in the presence of coexisting morbidities, adverse side effects of medication or impaired mobility. Still, the SMART risk score will not help determine which patients can safely withdraw treatment for several reasons...

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