eLetters

13 e-Letters

published between 2018 and 2021

  • This was so helpful

    This was so helpful and easy! Do you have any aricelts on rehab?

  • 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...

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  • 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...

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