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May 26, 1989

Randomized Clinical Trials in Heart Disease-Reply

JAMA. 1989;261(20):2953-2954. doi:10.1001/jama.1989.03420200042021

In Reply.—  We thank Drs Ketterer and Basinski and coworkers for their interest in our report.In our article we chose to review the data on interventions where either a large number of small or one or two very large trials had been conducted. Although Dr Ketterer cites several studies of the relationship between type A behavior and coronary heart disease (CHD), only one1 is a randomized, controlled trial. This moderate-sized study needs confirmation in larger, well-designed trials before one can conclude reliably that modification of type A behavior leads to a reduction in deaths due to CHD or recurrent infarction.Interpretation of trials of lowering cholesterol levels is far more complex than the apparent results on one or another end point. The results of the trials should be viewed in the context of epidemiologic, animal, and angiographic data and the inherent limitations of the trials themselves. The epidemiologic