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Ordinal reanalysis of the SHEP trial.

To the Editor:

The article by Patel and colleagues relating to long-term follow-up of patients in the SHEP study1 highlights a common problem in vascular prevention trials, namely that the sample size needed to detect an effect on ‘all’ stroke (or the composite of stroke, myocardial infarction, and vascular death) is insufficient to assess effects on fatal events alone. In the case of SHEP, chlorthalidone-based antihypertensive therapy significantly reduced all stroke (269 events) but not fatal …