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To the Editor: Dr Khot and colleagues¹ found that 80% to 90% of patients with coronary heart disease (CHD) have at least 1 of the 4 conventional risk factors, (ie, cigarette smoking, diabetes, hyperlipidemia, and hypertension). The authors thus suggested that these 4 risk factors should be emphasized to address the epidemic of coronary heart disease (CHD). Similarly, Dr Greenland and colleagues² found that at least 87% of individuals with either fatal or nonfatal CHD had exposure to at least 1 of these 4 risk factors. Neither group of authors, however, discussed the high prevalence of these risk factors among individuals who did not develop CHD. Those who develop CHD are, in fact, similar to the general population in terms of these risk factors, as the data of Greenland et al indicate.

Similarly, an important limitation of the study by Khot et al is that they did not obtain comparative . . . [Full Text of this Article]

Beverly Rockhill, PhD
School of Public Health
University of North Carolina, Chapel Hill

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