176 e-Letters

published between 2013 and 2016

  • 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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  • Reply to comment "Dose-response relationship between caffeine and risk of atrial fibrillation"
    Daniel Caldeira

    We thank Yan Qu and colleagues for their interest in our publication.1 In our systematic review we concluded that caffeine exposure was not associated with increased AF risk. We also have performed a qualitative evaluation of dose-response, which uses the relative proportions of caffeine exposure within each study and the risk of atrial fibrillation (AF). Pooling the relative risk (RR) of low caffeine intake from each st...

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  • Dose-response relationship between caffeine and risk of atrial fibrillation
    Yan Qu

    Dear Editor, We read with great interest the recent meta-analysis showing that low-dose caffeine may have a protective effect on risk of atrial fibrillation, while no favorable effect was found for high dose of caffeine, and a sketch of a J-shape curve was speculated on the association of caffeine with risk of atrial fibrillation.1 Therefore, to clarify the dose-response relationship on caffeine and risk of atrial fibrilla...

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  • Use SMART risk score to correct under- and overtreatment.
    Siep Thomas

    Dorresteijn et al, (Heart 2013;99:866-872), presented a new tool, the SMART risk score, for predicting 10 year risk of recurrence in patients with established cardiovascular disease. This enables clinicians for the first time to differentiate treatment within the hitherto broadly assumed recurrence rate of at least 20% leading to guidelines that, so far, advise maximal drug treatment for elevated risk factors for all patie...

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