eLetters

174 e-Letters

published between 2001 and 2004

  • Re: Psychological characteristics and heart disease
    Andrew Haines
    Macleod and Davey Smith suggest that the association that we found between psychological characteristics, particularly obsessionality and the somatic symptoms of anxiety on the one hand and fatal IHD on the other [1] were due to confounding by socio-economic factors. They suggest that we should have shown estimates before and after adjustment for social class.

    We did discuss the adjustment for social class in the paper and p...

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  • Psychological characteristics and heart disease
    John Macleod

    Editor,

    Haines and colleagues present a further example from observational epidemiology of an association between a psychosocial factor and cardiovascular health (1). They suggest that this association is likely to be causal - a suggestion apparently accepted by the popular press in their reporting of this research (2).

    However, given the non-specificity of the association between a range of such factor...

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  • Re: Don't blame spironolactone yet: Look at prescriber and patient related factors first?
    C Berry

    Dear Editor,

    We thank Dr. MacFadyen for his thoughtful comments on our report. We were trying to draw to readers' attention, our observations that severe renal dysfunction and hyperkalaemia can occur when spironolactone is added to conventional therapy (and other, non-heart failure, drugs) in "real" patients with heart failure, a phenomenon not described in the carefully selected RALES population. Interesting...

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  • Don't blame spironolactone yet: Look at prescriber and patient related factors first?
    Robert J MacFadyen

    Dear Editor,

    Berry and McMurray (Heart 2001;85:e8) report three of four cases of serious adverse events in association with spironolactone linked to the non-specific symptom of diarrhoea. As cited, Professor McMurray many years ago reported the renal adverse effects of "diarrhoea" induced volume depletion in conjunction with ACE inhibition as a simple case study. I may have misinterpreted the recent report but I...

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  • Re: New performance indicator should take account of prehospital thrombolysis
    Robin Norris

    Dear Editor

    As John Rawles states, the benefit of prehospital thrombolysis could be much greater than the FTT estimate for hospital treated patients of 1.6 lives/1000 treated per hour of delay [1]. Indeed, the "golden hour" [2] may even be extended to the "golden two hours" as Rawles' own seminal work suggests [3]. The point we were trying to make in the SHARP report [4] was that 30/1000 is the most that can be ex...

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  • New performance indicator should take account of prehospital thrombolysis
    John Rawles
    Dear Editor

    Robin Norris and the SHARP Investigators are to be congratulated on another study that is full of interest [1]. The new performance indicator proposed is, indeed, very attractive. Quite correctly, the number of lives saved by hospital thrombolysis is calculated using the figure of 30/1000 derived from hospital trials. But there is one point on which I must take issue, and that is the additional life-saving fr...

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  • Age as a risk factor for hemorrhage in aspirin users
    John I Levitt

    April 3, 2001

    To the Editor:

    It seems that there is a potential flaw in the analysis by Sanmuganathan, et al (1), of the relative risk benefit ratio in the use of aspirin for the primary prevention of coronary artery disease. The coronary risks are calculated using tables in which age is a major determinant, but the risks of a bleeding complication are averaged over all ages. Since bleeding complicat...

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  • Re: Age as a risk factor for hemorrhage in aspirin users
    PS Sanmuganathan

    Dear Editor,

    Dr Levitt has raised a valuable point that the risk benefit relationship of aspirin may vary with age as well as CHD risk and it is worth re-evaluating the conclusions made in our paper [1].

    He has however misunderstood the way in which we calculated benefit from aspirin treatment. Because haemorrhagic strokes were not always reported separately they had to be included in cardiovascular e...

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  • Move immediate coronary care out of the hospital into the community - Authors' response
    Harvey White

    Dear Editor,

    I agree wholeheartedly with many of Dr Rawles' comments. There are five components of delay in the "pain-to-needle" time. My editorial focused on administration of thrombolytic therapy in the emergency department, and as such I did not discuss other important components of delay.

    Patient delays in summoning medical assistance have proven to be very difficult to influence. Delays in the arr...

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  • Move immediate coronary care out of the hospital into the community
    John Rawles
    Dear Editor,

    The major factor influencing the outcome of thrombolytic therapy for acute myocardial infarction is not door-to-needle time, as Harvey White claims, but pain-to-needle time. The largest component of the overall delay from onset to thrombolytic treatment is attributable to the patient's delay in calling for medical help. There is then an appreciable delay between calling for an ambulance or a doctor and arr...

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