Author Response to Lipid-Lowering in African Americans in ALLHAT—Optimism Bias?


We thank Dr Messerli and colleagues for their interest in the extended follow-up of the lipid-lowering component of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). The long-term benefit of pravastatin on coronary heart disease (CHD) mortality and combined fatal/nonfatal CHD in black participants was statistically significant and consistent with the benefit observed for fatal/nonfatal CHD during the trial. In contrast, the elevated risk for stroke mortality in blacks was nonsignificant as was the in-trial risk for stroke for the entire ALLHAT black cohort (hazard ratio 1.12, 95% confidence interval [CI], 0.86–1.48 vs 0.74, 95% CI, 0.57–0.96 in non-blacks). During the extended follow-up there was a nonsignificantly higher risk in blacks and a nonsignificantly lower risk in non-blacks for both kidney disease mortality and end-stage renal disease in the pravastatin group compared to usual care. Although this finding was not seen during the trial and could have arisen simply by chance as a result of multiple comparisons, a potential differential effect of statins on renal outcomes in blacks and non-blacks should be investigated in other long-term outcome studies. Further analyses of the ALLHAT data, including additional extended follow-up of the ALLHAT participants, may also prove informative.