Author Affiliation: Columbia University Medical Center, New York, New York (firstname.lastname@example.org).
To the Editor: Dr Canto and colleagues1 found that hospital mortality increased as the number of cardiovascular risk factors declined. This inverse relationship is perplexing and the potential explanations discussed by the authors appear not completely satisfactory.
The authors just considered the number of risk factors, whereas the severity of each factor was not evaluated. Blood pressure, plasma glucose, and lipids are continuous, not discreet, variables that exert a dose-dependent effect on cardiovascular risk.2 It would be of interest to see the results of the analysis conducted considering these parameters, which also would help to clarify the still controversial association of the metabolic syndrome and mortality after myocardial infarction (MI).3
Santulli G. Coronary Heart Disease Risk Factors and Mortality. JAMA. 2012;307(11):1137-1138. doi:10.1001/jama.2012.323