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May 2, 2007

Mortality and Adherence to Pharmacotherapy After Acute Myocardial Infarction—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2007;297(17):1877-1878. doi:10.1001/jama.297.17.1878-a

In Reply: We agree with Dr Parakh and colleagues that depression is a very important factor when exploring the survival effects associated with drug adherence, given that depression affects patient behavior and outcome. An in-depth evaluation of depression and its interactions with both adherence and mortality was beyond the scope of our study.

Dr Kinjo and colleagues, as well as Parakh and colleagues, raise concerns over the use of CCBs as a “neutral study control” because certain CCBs may be associated with higher mortality when administered to patients following AMI. While studies have demonstrated higher mortality risk associated with the use of selected CCBs following AMI among specific population subgroups, evidence suggests that the relationship between CCB and post-MI mortality is on average neutral, especially among more stable patient populations.1 Our study required a stable patient population for the accurate ascertainment of adherence (eligibility criteria necessitated that all patients survive at least 1 year following AMI). In addition, the relationship between CCB adherence and survival observed in our study was neutral regardless of patient risk strata or CCB subclass (dihydropyridines vs nondihydropyridines).

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