To the Editor: In the study of risk factors for cardiovascular disease in women by Dr Ridker and colleagues,1 274 (59%) of the 464 outcome events were coronary revascularizations. However, there was no presentation of data related to all-cause mortality.
When lipid-related risk is being studied, overall mortality becomes an important outcome because there is evidence that statins do not reduce mortality in women with heart disease.2 Moreover, in a large population study including men and women, patients who were older than 50 years and who were in the lowest quartiles for cholesterol had significantly increased mortality that, in women, equaled the risk of smoking.3 The article cited by the authors on the Air Force/Texas Coronary Atherosclerosis Prevention Study4 of lovastatin is indeed indicative of an event-based benefit, but the study concluded with numerically more deaths in patients who took the drug than in those who took the placebo.5
Vos E, Rose CP. Risk Factors for Cardiovascular Disease in Women. JAMA. 2005;294(22):2843–2844. doi:10.1001/jama.294.22.2843-a
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