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To the Editor: Dr Rasmussen and colleagues¹ reported reduced mortality in elderly survivors of MI who were adherent to statins and -blockers, but no association between adherence and mortality for CCBs. The rate of cancer-related admissions did not differ between adherers and nonadherers taking any of these medications. They concluded that healthy behaviors do not confer mortality benefits in a real-world population. However, previous studies showed that good adherence to placebo was associated with longer survival,² and lifestyle adaptations such as smoking abstinence and exercise may account for the mortality benefit of those who adhere to drug regimens.³ The discordant results of the current study may be due to bias introduced by the choice of medications and the methods of detecting outcomes.

Some CCBs may increase cardiovascular mortality after MI.⁴ Thus, a positive effect of healthy behaviors in CCB-adherent patients could have been obscured by harmful effects of the drug, . . . [Full Text of this Article]

Mitsuyo Kinjo, MD, MPH
mitsuyos220@worldnet.att.net

Kiyoshi Kinjo, MD, MS
Teine Keijinkai Hospital
Teine-ku
Sapporo City, Japan

Isao Iwata, MD, EdM
Caritas Carney Hospital
Dorchester, Mass

Soko Setoguchi, MD, DrPH
Division of Pharmacoepidemiology
Brigham and Women's Hospital
Boston, Mass

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