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July 14, 2004

Risk-Treatment Paradox in Use of Statins—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;292(2):169. doi:10.1001/jama.292.2.169-b

In Reply: We agree with Drs Weiss and Varadhan that it is important to determine competing causes of death before initiating therapy in elderly patients, since any benefits of a therapy would be nullified if death from noncardiovascular causes were imminent. We found that the likelihood of statin use progressively declined by 6% for every 1% increase in the baseline risk of future cardiac events. This paradox was neither a function of age nor a statistical artifact of those at the extremes of disease severity; the results were similar among those with long vs limited life expectancies. Consequently, we disagree that competing risks alone are likely to explain our findings. While we acknowledge the challenge physicians face when balancing benefit-yield tradeoffs against competing risks from noncardiovascular causes, such challenges must be overcome if potential survival gains of lifesaving therapies are to be maximized in the population.