eLetters

22 e-Letters

  • Increased mortality associated with low cholesterol does not reflect reverse causality, but causes it.

    DiNicolantonio and McCarty suggest that the inverse association between low cholesterol and mortality in elderly people reflects reverse causality; meaning that the low cholesterol is caused by the disorder being treated.1 One of their arguments is that those whose cholesterol decreases with increasing age die more frequently from cancer and other diseases, compared to those with low cholesterol prior to treatment. However, many studies have shown that low cholesterol may predispose to cancer2 as well as infectious diseases.3 In a previous paper2 we identified nine cohort studies including more than 140,000 individuals, in which cancer was inversely associated with cholesterol measured 10–30 years earlier, and where the association persisted after exclusion of cancer cases appearing during the first 4 years.
    The authors claim that statin treatment does not increase the risk of cancer based on a meta-analysis of 27 randomised trials published by the Cholesterol Treatment Trialists’ (CTT) Collaborators. But very few statin trials have continued for more than five years, and most carcinogenic chemicals need more time to create cancer. In spite of that cancer appeared significantly more often in three statin trials (2). In two other trials, non-melanoma skin cancer appeared more often and with statistical significance if the figures from the two trials were calculated together (2). Since then the number of non-melanoma skin cancers has not been reported in any trial. Fu...

    Show More
  • Multidisciplinary infective endocarditis care teams should address substance use disorders and harm reduction services

    We read with great interest Kaura and colleagues’ evaluation of a multidisciplinary care team for hospital inpatients with infective endocarditis (IE) (1). The study provides further evidence for the effectiveness of a team-based approach to IE care – a model endorsed by both European (2) and American (3) guidelines. Despite limitations inherent in a before-and-after study design, it is clear that the IE team provides patients rapid access to cardiology, microbiology, and surgical care with coordination between services.

    Notably absent from this multidisciplinary approach, however, is care for substance use disorders. We wish to draw readers’ attention to the 10% of study participants for whom injection drug use (IDU) was identified as a predisposing factor in their IE. We believe a coordinated IE team offers enormous potential to provide addictions care and harm reduction services for patients with IE who inject drugs.

    Compared with people who do not inject drugs, people who inject drugs are far more likely to have recurrences and repeat hospitalizations for IE, and face increased mortality risk after a first episode of IE (4,5). Rates of hospitalization for IDU-associated IE also appear to be increasing (4,6–8).

    Evidence-based interventions can be provided in-hospital to reduce both rates of injecting and harms associated with ongoing injection. These interventions include initiating opioid agonist therapies (e.g. methadone or buprenorphine) for opi...

    Show More
  • India is struggling under a staggering burden of chronic disease
    David E. Brown

    The citizenry of India are especially sensitive to excessive linoleic acid intake as noted by S. L. Malhotra in a research paper published back in 1967. Excerpt: "Much evidence indicates that consumption of even small quantities of unsaturated fatty acids decreases the liability to ischaemic heart disease (Bronte-Stewart et al., 1956; Kinsell et al., 1952). This hypothesis, too, does not find support in our data. The South...

    Show More
  • Re: Evidence from RCTs did not support introduction of dietary fat guidelines in 1977 & 1983
    Vivien S. Lund

    Dietary advice that reducing fat and saturated fat consumption will reduce the risk of coronary heart disease was introduced in the UK in 1983. The authors of this systematic review and meta-analysis conclude that evidence from randomised controlled trials, available at the time, did not support that advice.

    It is important to highlight that the review looks at the results of just six relatively short-term ra...

    Show More
  • Randomised controlled trials and diet-heart recommendations
    Christine M Williams

    Re: Harcombe et al. Evidence from randomised controlled trials did not support the introduction of dietary fat guidelines in 1977 and 1983:

    The claim made by the authors of this paper that guidelines on dietary fat introduced in the 1970s and 1980s were not based on good scientific evidence is misguided and potentially dangerous. Whilst it is important to ensure an ongoing interrogation of the evidence linking d...

    Show More
  • Re:Letter to the Editor: Evidence from randomised controlled trials not support the introduction of dietary fat guidelines in 1977 and 1983: a systematic review and meta-analysis
    Zoe Harcombe

    We would like to thank you for your interesting and helpful comments.

    We are currently finalising the follow-up paper, which is to consider all RCT evidence for current dietary guidelines before and since their introduction, to see if they have been supported in hindsight. We will review the risk of bias assessment tool, as suggested.

    We do accept the role that cohort studies can play but wanted to focu...

    Show More
  • Letter to the Editor: Evidence from randomised controlled trials not support the introduction of dietary fat guidelines in 1977 and 1983: a systematic review and meta-analysis
    Lukas Schwingshackl

    With great interest we read the meta-analysis of Harcombe and co- workers titled "Evidence from randomized controlled trials did not support the introduction of dietary fat guidelines in 1977 and 1983: a systematic review and meta-analysis" published in volume 2 of the Open Heart Journal [1]. In their article, the authors systematically reviewed randomized controlled trials investigating the associations between dietary fa...

    Show More
  • Fascinating: So it was basically a political decision
    David J Unwin

    At last I know how these damaging and pernicious guidelines came about. They introduced a dark age of medicine and dogma that continues to effect my practice.

    How I struggle to get patients to accept eggs and butter as part of a healthy diet . It's my belief that sugar and other carbohydrates are the real problem.

    I have seen great results for 70 patients in my practice with the metabolic syndrome usi...

    Show More
  • More contradictions to the dietary guidelines
    Uffe Ravnskov

    Hopefully the meta-analysis by Harcombe et al. (1) may inspire the authorities to correct their dietary recommendations, because other studies have shown that the intake of saturated fatty acids (SFA) does not increase the risk of cardiovascular disease.

    Not only did the authors of the dietary guideline from 1977 and 1983 ignore the dietary trials; they also ignored several unsupportive cohort studies. Before 1...

    Show More
  • Though commonly missed, however exceedingly important
    Rajeev Gupta

    Dear Sir:

    The data is accumulating to show the adverse outcomes in critically sick patients with persistently elevated troponins. An elegant study by Amman et al (1) in 58 critically ill patients without acute coronary syndromes concluded "Positive troponin levels were associated with higher mortality (22.4% vs. 5.2%, p < 0.018) and a lower LVEF (p = 0.0006). Troponin-positive patients had significantly high...

    Show More

Pages