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To the Editor: Dr Mokdad and colleagues¹ reported that the leading cause of mortality in the United States is tobacco use, followed by poor diet/inactivity and alcohol use. I believe that the authors should also address the beneficial effects on mortality, if any, of these modifiable factors. Some may be beneficial in small quantities and may thus have a U-shaped relationship to mortality. One example is the well-documented beneficial effect of low levels of alcohol consumption on the health of populations with a high risk of cardiovascular disease.^2-4

George Anstadt, MD
ganstadt@aol.com
Occupational Health and Rehabilitation Inc
Rochester, NY

1. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004;291:1238-1245. FREE FULL TEXT 2. de Lorgeril M, Salen P, Martin JL, Boucher F, Paillard F, de Leiris J. Wine drinking and risks of cardiovascular complications after recent acute myocardial infarction. Circulation. 2002;106:1465-1469. FREE FULL TEXT 3. Denke MA. Metabolic syndrome. Curr Atheroscler Rep. 2002;4:444-447. PUBMED 4. CORK Bibliography: Alcohol, Beneficial Effects. Available at: http://www.projectcork.org/bibliographies/data/Bibliography_Beneficial_Effect_Alcohol.html. Accessibility verified June 2, 2004.

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

JAMA. 2004;291:2941.

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