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Vitamins and Hormone Therapy for Coronary Atherosclerosis
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To the Editor: Dr Waters and colleagues1 found that neither hormone replacement therapy nor antioxidant vitamins had any effect on angiographic or clinical outcomes among postmenopausal women with known coronary artery disease. The authors also found a nonsignificant trend toward worse outcomes in women who received either intervention. I have 2 concerns, however, about their methodology.
First, for women who died or experienced nonfatal myocardial infarction (MI), the worst possible score they might have received in their respective treatment group was imputed. Although this approach may seem reasonable on the basis of the severely adverse clinical outcome, such assignment is numerically justified only if angiographic findings have a direct relationship with the clinical outcome. The assignment of worst-case angiographic scores unjustifiably exaggerates the adverse putative impact of the vitamins. Despite this quantitative exaggeration, the differences in angiographic score remained nonsignificant.
Second, the 2 types of treatment, hormone replacement therapy vs . . . [Full Text of this Article]
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