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Letter to the editor

Sir, In a recent publication in the Journal, Øien et al. (1) present interesting results based on data from the ALERT study. They report no gender-related differences in cardiac events or total mortality in their large renal transplant population as followed prospectively during five yr. In discussing their results, the authors refer to a previous study from our group (2), and maintain that their findings contrast results of our study. Our study was a cross-sectional study of 406 Norwegian renal transplant patients surveyed in 1991. The prevalence of ischemic heart disease (IHD) in patients was compared with healthy background population. One of our findings was that IHD was more prevalent among male patients (angina pectoris: 13.1%, previous myocardial infarction: 4.5%) than among female patients (7.5%, 1.9%). Øien et al. correctly refer that IHD, in our study, was significantly associated with gender. The cross-sectional design of the study implies, however, that the observed relations between risk factors and disease do not necessarily infer a causal relationship. What is not correct is the statement of Øien et al. claiming that no follow-up data on IHD are available from our study. In fact, in 2004 in this Journal (3), we published a five-yr follow-up comprising 405 of the 406 patients surveyed at baseline. The results on IHD showed a univariate association between gender and a Major cerebrovascular event (p < 0.05) during follow-up, and a borderline significant association (p 1⁄4 0.07) to Major IHD event, but no association to Death of IHD. On multivariate analysis (Cox regression), gender was a borderline significant predictor of Major cerebrovascular event (p 1⁄4 0.05), but did not predict either Death from IHD or Major IHD event, much in concordance and not in contrast to the recent results of Øien et al.