CORRESPONDENCE: LETTER TO THE EDITOR
Reply
Jeffrey J. Goldberger, MD, FACC* and
Alan H. Kadish, MD, FACC
* Northwestern University, Feinberg School of Medicine, 251 East Huron, Feinberg Pavilion 8-542, Chicago, Illinois 60611 (Email: j-goldberger{at}northwestern.edu).
Drs. Coplan and Ramos reemphasize several important points from our study (1). First, because this was a retrospective analysis of a randomized clinical trial, the results must be properly tested in a prospective clinical trial before firm conclusions can be drawn regarding the effects of statins on survival in nonischemic cardiomyopathy. Regarding the mechanism for the observed survival benefit related to statin use in the DEFINITE (DEFIbrillators in Non-Ischemic cardiomyopathy Treatment Evaluation) substudy, Drs. Coplan and Ramos again correctly point out that the data do not support a pure antiarrhythmic effect, as discussed in our study.
With regard to our interpretation regarding the implausibility that statin use incidentally identified a low-risk population, it should be noted that the subgroup treated with statins was older and had a higher incidence of diabetes. As noted by the investigators and discussed in our study, low cholesterol has been reported to be associated with increased mortality, raising the possibility that absence of treatment with statins represents a selection bias for a high-risk group, perhaps due to poor nutrition. Although cholesterol or albumin levels were not obtained on all participants, there was no difference in body mass index between patients treated with statins and those not treated.
Interestingly, subsequent to publication of the DEFINITE substudy, Go et al. (2) reported reduction in mortality associated with statin use in a large cohort study in which cholesterol levels were only slightly lower in the group not treated with statins.
Finally, Drs. Coplan and Ramos correctly point out that future studies should consider the potential inverse relationship between heart failure mortality and cholesterol level. However, we believe it is implausible that the excess mortality in this DEFINITE substudy was related to low cholesterol in the group not treated with statins.
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References
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1. Goldberger JJ, Subacius H, Schaechter A, et al. Effects of statin therapy on arrhythmic events and survival in patients with nonischemic dilated cardiomyopathy J Am Coll Cardiol 2006;48:1228-1233.[Abstract/Free Full Text]2. Go AS, Lee WY, Yang J, et al. Statin therapy and risks for death and hospitalization in chronic heart failure JAMA 2006;296:2105-2111.[Abstract/Free Full Text]
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