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To the Editor: Dr Zacharski and colleagues¹ reported no significant association between reduction of iron stores by phlebotomy and all-cause mortality, or death plus nonfatal myocardial infarction and stroke, the primary and secondary end points of the study, respectively. In post hoc analyses, they found that age significantly interacted with their primary and secondary end points and concluded that "iron reduction appeared to improve outcome to a significantly greater extent in younger compared with older patients."

The stated conclusions of the post hoc analyses were misleading. Analysis by age was not described in the initial study plan, the study was not sufficiently powered for an analysis by subgroups, and potential confounders of this seeming age effect were not included in the analysis. Great care should always be taken in interpreting and reporting subgroup analyses that are not part of the initial study design, particularly if they are used to make . . . [Full Text of this Article]

Robert D. Allison, MD, MPH
allisonr@mail.nih.gov

Barbara J. Bryant, MD; Sumithira Vasu, MD; Susan F. Leitman, MD
Department of Transfusion Medicine
Warren G. Magnuson Clinical Research Center
National Institutes of Health
Bethesda, Md

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