Jeremy D. Kark, MD, PhD; Joseph H. Abramson, MB, BCh; Irwin H. Rosenberg, MD
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
Kark J., Abramson J., Rosenberg I.; Nonfasting Plasma Total Homocysteine Level and Mortality. Ann Intern Med. 2000;132:760. doi: 10.7326/0003-4819-132-9-200005020-00018
Download citation file:
Published: Ann Intern Med. 2000;132(9):760.
Dr. Eisner contends that despite the significant tests for trend in Table 3 of our paper, the data “clearly indicate a nonlinear risk pattern” on the basis of the similarity of the degree of risk elevation in the middle three quintiles of the homocysteine distribution. He expresses concern that imprecise modeling of the association has consequences for assessing causality and for public health intervention.
The mortality hazard ratios (adjusting for all confounders) in successive quintiles were 1.00, 1.42, 1.28, 1.53, and 1.97 for the total study sample; we referred to the association as nonmonotonic. But reliance on these figures alone, without taking their confidence intervals into account, may be misleading. Although the findings might suggest a nonlinear association, they are clearly not inconsistent with a linear association when the confidence intervals displayed in Table 3 are considered (0.92 to 2.18, 0.84 to 1.96, 1.01 to 2.33, and 1.31 to 2.98 for quintiles 2 to 5, respectively). If, instead of presenting the hazard ratios for quintiles, we had used homocysteine categories as modified from Nygard and colleagues (1)—less than 9.0, 9.0 to 11.9, 12 to 14.9, 15.0 to 19.9, and 20 µg/dL or more—the association would have been monotonic. The successive multivariate-adjusted mortality hazard ratios would then become 1.0, 1.16, 1.28, 1.54, and 1.94 (Wald statistic, 11.06; P = 0.026).
to gain full access to the content and tools.
Learn more about subscription options.
Register Now for a free account.
Copyright © 2016 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use
This PDF is available to Subscribers Only