To the Editor: In their prospective cohort study, Dr Freiberg and colleagues1 found that patients with elevated nonfasting triglyceride levels had an increased adjusted relative risk for ischemic stroke. The estimation of the hazard ratio was performed using Cox regression adjusted for age, sex, and other major cardiovascular risk factors such as hypertension, total cholesterol level, and smoking. However, depression as a risk factor was not included in the multivariate model, although some studies have demonstrated an association between stroke and mood disorders.2
Depressed patients may have an increased risk of cardiovascular disease, and depression may be a predictor of recurrent cerebrovascular events, leading to higher morbidity and mortality rates.3 Furthermore, depression, through mechanisms not yet elucidated, may affect other modifiable risk factors for stroke, such as hypertension, smoking, and levels of physical activity. A cohort study4 has suggested an association between high triglyceride levels and certain “type A” personality traits, such as hostility, anger, and domineering attitudes, which in turn may indirectly influence the risk of coronary and stroke events.5 Thus, adjustment for depression and its interaction with other known risk factors may result in a more accurate estimation of the additional risk of stroke in patients with hypertriglyceridemia.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
Instructions
Comments are moderated and will appear on the site at the discretion of the Journal of American Medical Association editors. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest* Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Customize your page view by dragging & repositioning the boxes below.
and access these and other features:
Register Now
Enter your username and email address. We'll send you a reminder to the email address on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.