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Comment & Response |

The Link Between Sauna Bathing and Mortality May Be Noncausal—Reply

Tanjaniina Laukkanen, MSc1; Hassan Khan, MD, PhD2; Francesco Zaccardi, MD3
[+] Author Affiliations
1Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
2Department of Medicine, Emory University, Atlanta, Georgia
3Institute of Internal Medicine and Diabetes Care Unit, Catholic University School of Medicine, Rome, Italy
JAMA Intern Med. 2015;175(10):1719. doi:10.1001/jamainternmed.2015.3432.
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In Reply We thank both Kivimäki et al and Epstein and Shoenfeld for their comments about the association of sauna bathing and fatal cardiovascular events. We agree that observational studies cannot establish causality of the relationship given that the potential for residual confounding or reverse causation cannot be totally eliminated, as discussed in our article.1 However, we did observe graded inverse associations with sudden cardiac death (SCD), fatal coronary heart disease (CHD), and cardiovascular disease (CVD) events, which are the characteristics of a true inverse association between sauna bathing and outcomes. Furthermore, results were carefully adjusted for socioeconomic status (SES), physical activity, and cardiorespiratory fitness, all 3 of which are potential surrogate markers of healthy lifestyle.


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October 1, 2015
Mika Kivimäki, PhD; Marianna Virtanen, PhD; Jane E. Ferrie, PhD
1Department of Epidemiology and Public Health, University College London, London, United Kingdom
2Finnish Institute of Occupational Health, Helsinki, Finland
1Department of Epidemiology and Public Health, University College London, London, United Kingdom3School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
JAMA Intern Med. 2015;175(10):1718. doi:10.1001/jamainternmed.2015.3426.
October 1, 2015
Yoram Epstein, PhD; Yehuda Shoenfeld, MD
1Heller Institute of Medical Research, Sheba Medical Center, Tel-Hashomer, Israel2Department of Internal Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
JAMA Intern Med. 2015;175(10):1718-1719. doi:10.1001/jamainternmed.2015.3429.
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