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Long-term mortality after primary prevention for cardiovascular disease.

In Reply. —In regard to Drs Bassler and Bassler, our study was a multifactorial prevention trial involving, in addition to hypolipidemic medications, other intervention measures. Consequently, the results can only be applied to all these measures combined, including treatment of hypertension, so that it is irrelevant to talk about the real hazard of cholesterol reduction alone. Accordingly, application of our mortality data to 60 million Americans targeted for cholesterol lowering is totally misleading. Subgroup analyses performed so far have not supported the idea that hypolipidemic treatment alone could have caused the difference in total mortality. In reply to Dr Holme, since the risk factor levels were similar in the two groups in 1985, we cannot see any special reason why they were much different after that. The death certificates were hardly biased in the intervention group because in virtually all cases without unequivocal lifetime hospital diagnosis, the cause of death