eLetters

177 e-Letters

published between 2020 and 2023

  • Homocysteine and coronary heart disease - Authors' reply
    Una B Fallon
    Dear Editor

    We wish to thank Professor Wald and colleagues for highlighting an error in our paper.1 We misreported the standard deviation for total plasma homocysteine concentration (tHcy) in table 2 so that this was, as Wald infers, too small. This error occurred because our analyses were based on the log transformed data. The true value of the back-transformed standard deviation is between 3.4 and 4.8...

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  • Clinical and functional relevance of PFO relates to size
    Mark Turner
    Dear Editor,

    We were interested to read the review about the exciting topic of patent foramen ovale (PFO).[1]

    The authors raise the interesting conundrum that has prevented PFO being considered an important abnormality - How can a problem affecting one-quarter of all individuals be associated with disease? Indeed with regard to decompression illness (DCI) the authors state that whilst many divers have a PFO,...

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  • Guidelines should consider troponin assay performance
    M W France
    Dear Editor,

    We have concerns about the role of troponin measurements in the recently published guidelines on the management of acute coronary syndromes not associated with ST elevation on the ECG.[1] We feel that following the guideline in its present form will blunt the usefulness of troponin measurements as a decision support tool.

    The recommended decision limits seem to reflect an insufficiently critical appraisal...

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  • Clinical and functional relevance of PFO relates to size - Authors' response
    Adrian Banning

    Dear Editor,

    I am grateful to Dr Turner and Dr Bryson for their interest in our Editorial.

    I think they are right, all PFOs are "not equal". As stated in the editorial, there is only conclusive data that large patent foramen ovale capable of passage of more than 20 micro bubbles without provocative manouvers are implicated in crytogenic stroke. It seems reasonable to infer that the situation with d...

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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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  • 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: 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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  • 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: 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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