Regarding 'management strategy for spontaneous isolated dissection of the superior mesenteric artery based on morphologic classification'

摘要

Spin in scientific writing has been defined as specific reporting that could distort the interpretation of results and mislead readers.1 We believe that the results of the study by Sohn and colleagues,2 who evaluated the association between statin use and lower extremity amputation (LEA) risk in nonelderly diabetic patients, represent an example of such a spin.Among 83,593 cholesterol drug-naive individuals in the study retrospective cohort,2 217 (0.3%) experienced a major LEA during a mean follow-up of 4.6 years (median, 5 years). Compared with those not receiving any cholesterol-lowering medications, users of statins were about 35% less likely to experience any LEA (barely significant with P = .045). In particular, among patients experiencing an LEA, 32% were treated with statins, whereas 55.5% were treated with statins among those who did not experience an amputation. These findings clearly suggest that the "reduction" of LEA by statin therapy represents only a delay in their clinical manifestation. But, this delay is likely very small.The Cholesterol and Recurrent Events (CARE)3 trial was a secondary prevention study with a median duration of follow-up similar to that of the retrospective study by Sohn and colleagues (5 years). In the CARE trial, patients at high risk (as defined as those with 5-year risk of major vascular events higher than 25%), randomized to pra-vastatin 40 mg showed also a similar relative reduction of the need for revascularization respect to the reduction of LEA in patients studied by Sohn and colleagues. It has been calculated that the average delay of revascularization in the CARE trial was 0.09 years (33 days) over 5 years.4 Although it is difficult to make a similar calculation for patients analyzed by Sohn and colleagues, it seems likely that the delay would be also lower than that observed in CARE.