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COMMENTS AND OPINIONS
The Healthy Adherer Effect
Frank Andersohn, MD;
Stefan N. Willich, MD, MPH
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We read with interest the recent publication on adherence with statin therapy and all-cause mortality.1 The authors reported an approximate 50% reduction of all-cause mortality in adherent statin users compared with nonadherent users. According to the Central Bureau of Statistics in Israel, the proportion of deaths from cardiovascular diseases in 2005 ranged between approximately 25% (age, 55-74 years) and 45% (age, >85 years).2 To reduce all-cause mortality by 50%, regular statin use would have to prevent 100% of cardiovascular deaths and a substantial additional number of deaths from other causes. It is obvious that this cannot be true.
The "healthy adherer" or "healthy user" bias probably played the most prominent role in this study. Adherence to drugs and even placebo is associated with a substantial lower mortality.3-4 The fact that the authors did not identify a healthy adherer effect for levothyroxine sodium, . . . [Full Text of this Article]
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