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April 22, 1992

Long-term Mortality After Primary Prevention for Cardiovascular Disease

Author Affiliations

Boston (Mass) City Hospital

JAMA. 1992;267(16):2184. doi:10.1001/jama.1992.03480160041019

To the Editor.  —I would like to comment on two aspects of the increased mortality found in the Strandberg et al study.1First, this study found only a theoretical reduction in anticipated cardiac end points after 5 years using the Keys' equation. From the data given, the total cholesterol levels decreased 5.6% in the study group and increased 1.4% in the control group. This 7% difference went into the calculated improvement anticipated in cardiac end points. The Keys' equation, however, incorporates only total cholesterol in its calculation, not high-density lipoprotein cholesterol (HDL-C). In the Strandberg et al study,1 however, two agents (probucol and β-blockers) were used, which specifically change the cholesterol composition adversely by lowering the HDL-C levels. Unfortunately, HDL-C measurements were not made at the beginning of the study. However, if we assume that the initial HDL-C levels for the to-be-treated subjects were the same as