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June 4, 1997

Factors Contributing to Declines in Cardiac Mortality-Reply

Author Affiliations

Harvard School of Public Health Boston, Mass

JAMA. 1997;277(21):1678. doi:10.1001/jama.1997.03540450034020

In Reply.  —Dr Rumm and colleagues are incorrect in their assertion that our model was designed to favor treatment over prevention. In fact, we modeled known changes in risk factors and in outcomes of treatment to determine whether these changes could explain the known decline in mortality. As with any model, it is possible that any of our estimates could be incorrect, but we provided detailed information for peer review and believe it is inappropriate to claim we were somehow biased in favor of treatment over prevention. As we acknowledge in the Comment section, trends in aspirin use, estrogen replacement therapy, and exercise regimens may be important factors that we omitted from our analysis. Although causes other than risk factors or medical interventions may have played a major role as suggested by Rumm and colleagues, this remains speculative in the absence of data to support such a statement with respect to CHD