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Lowering Cholesterol and Death due to Accidents, Suicides: Unresolved Issues-Reply

Diane K. Wysowski, PhD; Thomas P. Gross, MD, MPH
Arch Intern Med. 1992;152(2):414-417. doi:10.1001/archinte.1992.00400140150035.
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In Reply.—  We thank Vasan for his comments. Since he mentions the meta-analysis of primary prevention trials by Muldoon and colleagues,1 our reply2 to Muldoon et al is applicable to Vasan as well. We would like to offer the following additional comments.We believe that it would be useful to have standardized information similar to that recommended for the primary prevention trials (on dropout status, adherence to treatment regimen, history and presence of psychiatric symptoms, history and current use of alcohol and antidepressants, autopsy data including blood alcohol concentrations, and narrative concerning the circumstances of death) for individuals who died due to suicides, accidents, and homicides in secondary prevention trials of cholesterol lowering such as the Coronary Drug Project. The more information one has concerning the circumstances and nature of these deaths, the greater the ability to judge whether the cholesterol-lowering regimen might be considered causal in each


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