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To the Editor: In their study of adherence to evidence-based pharmacotherapy and long-term mortality after acute myocardial infarction (AMI), Dr Rasmussen and colleagues¹ suggest that the relationship between high adherence and lower mortality is due to an active drug effect rather than to a "healthy adherer" effect. Adherence to placebo has also been associated with lower mortality,² suggesting that other factors may also be important. One of these factors may be depression, since depression is associated with poor adherence³ and with increased mortality after MI.³

If depression rather than drug effect were the causative agent, then the relationship of adherence to mortality should exist whether or not the drug is active. Rasmussen et al conclude that they are not observing a healthy adherer effect because high adherence to -blockers and statins was associated with improved survival, whereas high adherence to calcium channel blockers (CCBs) was not. The authors use adherence . . . [Full Text of this Article]

Kapil Parakh, MD, MPH
kparakh1@jhmi.edu

David E. Bush, MD; Roy C. Ziegelstein, MD
Department of Medicine
Johns Hopkins University School of Medicine
Baltimore, Md

Brett D. Thombs, PhD
Department of Psychiatry
McGill University
Montreal, Quebec

James A. Fauerbach, PhD
Department of Psychiatry and Behavioral Sciences
Johns Hopkins University School of Medicine

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Mortality and Adherence to Pharmacotherapy After Acute Myocardial Infarction—Reply
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Relationship Between Adherence to Evidence-Based Pharmacotherapy and Long-term Mortality After Acute Myocardial Infarction
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