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J Am Coll Cardiol, 2006; 48:1471, doi:10.1016/j.jacc.2006.07.012 (Published online 11 September 2006).
© 2006 by the American College of Cardiology Foundation
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CORRESPONDENCE: LETTER TO THE EDITOR

Reply

John J.V. McMurray, MD, FACC*, Robert M. Califf, MD, FACC and Marc A. Pfeffer, MD, PhD, FACC

* Western Infirmary, Cardiology, Dumbarton Road, Glasgow G11 6NT, Scotland, United Kingdom (Email: j.mcmurray{at}bio.gla.ac.uk).

Unfortunately, Drs. Bangalore and Messerli did not cite our concluding sentence about myocardial infarction in full, omitting the final statement that our observation was "a possibility that needs to be prospectively tested" (1). A p value of 0.187 (for the comparison of combination treatment with captopril and valsartan versus captopril monotherapy) might, with the appropriate caution we applied in the Abstract Conclusions and elsewhere, reasonably be described as a trend. In addition, in supportive analyses using other classifications of events (e.g., investigator reported versus adjudicated) and other statistical techniques, the p value for combination versus monotherapy was nominally statistically significant.

Overall, strokes were numerically fewer in the combination treatment group than in the captopril-only group, with a p value of 0.079, which, according to Drs. Bangalore and Messerli’s own criteria, might be described as a trend. It is not clear why one would try to segment the Kaplan-Meier curves into 6-month time periods.

We clearly stated that our observations had been made in a post hoc analysis, were not conclusive, and required prospective testing. Fortunately, such a trial has been conducted and will be reported in the near future (2).


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  1. McMurray J, Solomon S, Pieper K, et al. The effect of valsartan, captopril, or both on atherosclerotic events after acute myocardial infarction: an analysis of the Valsartan in Acute Myocardial Infarction Trial (VALIANT) J Am Coll Cardiol 2006;47:726-733.[Abstract/Free Full Text]
  2. Teo K, Yusuf S, Sleight P, et al. ONTARGET/TRANSCEND investigators Rationale, design, and baseline characteristics of 2 large, simple, randomized trials evaluating telmisartan, ramipril, and their combination in high-risk patients: the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial/Telmisartan Randomized Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease (ONTARGET/TRANSCEND) trials Am Heart J 2004;148:52-61.[CrossRef][ISI][Medline]




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