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In Reply: We thank Dr Pilgeram for his comments regarding his groundbreaking mechanistic studies on several nontraditional risk factors for atherosclerosis. However, our review focused on the relevance of screening for and treating these risk factors in populations at risk for vascular disease. Thus, while these data provide a pathophysiologic basis linking nontraditional risk factors with atherogenesis, they do not illuminate their incremental predictive value above and beyond validated risk assessment tools such as the Prospective Cardiovascular Münster Study (PROCAM) score and the Framingham Risk Score. Moreover, the true test of these risk factors will be whether screening for such factors and/or modifying them improves clinical outcomes; studies evaluating this important hypothesis are still ongoing.^1-3

Daniel G. Hackam, BSc, MD, FRCPC
Division of Clinical Pharmacology
University of Toronto
Toronto, Ontario

Sonia S. Anand, MD, PhD, FRCPC
anands@mcmaster.ca
Department of Medicine
McMaster University
Hamilton, Ontario

1. Ridker PM, JUPITER Study Group. Rosuvastatin in the primary prevention of cardiovascular disease among patients with low levels of low-density lipoprotein cholesterol and elevated high-sensitivity C-reactive protein: rationale and design of the JUPITER Trial. Circulation. 2003;108:2292-2297. FREE FULL TEXT 2. The VITATOPS Trial Study Group. The VITATOPS (Vitamins to Prevent Stroke) Trial: rationale and design of an international, large, simple, randomised trial of homocysteine-lowering multivitamin therapy in patients with recent transient ischaemic attack or stroke. Cerebrovasc Dis. 2002;13:120-126. FULL TEXT | ISI | PUBMED 3. MacMahon M, Kirkpatrick C, Cummings CE, et al. A pilot study with simvastatin and folic acid/vitamin B12 in preparation for the Study of the Effectiveness of Additional Reductions in Cholesterol and Homocysteine (SEARCH). Nutr Metab Cardiovasc Dis. 2000;10:195-203. ISI | PUBMED

JAMA. 2004;292:2086.

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