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To the Editor: Dr Tanasescu and colleagues¹ found that more intense exercise was associated with reduced risk of coronary heart disease (CHD). The authors acknowledge the possibility of potential confounding factors (the "healthy cohort" effect) and appropriately adjusted for these variables in their analyses. Nonetheless, the authors did not adjust for aspirin use, despite the known association between aspirin use and risk of CHD.² It is possible that self-selected aspirin use among health professionals could be associated with patterns of exercise, similar to the authors' observation of increasing use of vitamin E supplements with increasing level of physical activity. If information concerning aspirin intake were available it would be of interest to note whether accounting for its use influences the observed relationship between exercise and CHD.

Robert Burack, MD, MPH
Department of Medicine
Wayne State University
Detroit, Mich

1. Tanasescu M, Leitzmann MF, Rimm EB, Willett WC, Stampfer MJ, Hu FB. Exercise type and intensity in relation to coronary heart disease in men. JAMA. 2002;288:1994-2000. FREE FULL TEXT 2. Steering Committee of the Physicians' Health Study Research Group. Final report on the aspirin component of the ongoing Physicians' Health Study. N Engl J Med. 1989;321:129-135. ABSTRACT

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;289:419.

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