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Salim Yusuf, MRCP, DPhil; Janet Wittes, PhD; Lawrence Friedman, MD
National Heart, Lung, and Blood Institute Bethesda, Md

JAMA. 1989;261(20):2953-2954.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

In Reply.—

We thank Drs Ketterer and Basinski and coworkers for their interest in our report.

In our article we chose to review the data on interventions where either a large number of small or one or two very large trials had been conducted. Although Dr Ketterer cites several studies of the relationship between type A behavior and coronary heart disease (CHD), only one¹ is a randomized, controlled trial. This moderate-sized study needs confirmation in larger, well-designed trials before one can conclude reliably that modification of type A behavior leads to a reduction in deaths due to CHD or recurrent infarction.

Interpretation of trials of lowering cholesterol levels is far more complex than the apparent results on one or another end point. The results of the trials should be viewed in the context of epidemiologic, animal, and angiographic data and the inherent limitations of the trials themselves. The epidemiologic . . . [Full Text PDF of this Article]

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