Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
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.
Ko DT, Alter DA. Risk-Treatment Paradox in Use of Statins—Reply. JAMA. 2004;292(2):169. doi:10.1001/jama.292.2.169-b