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The quality of epidemiological data on coronary heart disease
Pergamon
0895-4356(94)00138-3
J Ctin Epidemiol Vol. 48. No. 2. pp, 293=295, 1995 Copyright g; 1995 Elscvier Scimcc Ltd Printed in Great Britain. All righta reswved 0895-4356/95 S9.50 + 0.00
Letters to the Editors THE QUALITY OF EPIDEMIOLOGICAL DATA ON CORONARY HEART DISEASE
The article by Stehbens (J Clin Epidemiol 46: 1337-l 346) suggests that epidemiologists accept without reserve the quality of mortality statistics. This is untrue and their accuracy is still far from perfect. It is a complete different matter to pretend that nothing can be learned from these statistics. We believe that they contain very useful information [l]. Much can already be learned from the mortality from all causes, which can be considered as accurate in developed countries. The tremendous decrease of mortality in Japan and increase in Hungary within a period of 20 years at r time that infectious diseases were already well controlled are sufficient to negate the concept of Stehbens trying to invoke genetic factors as an explanation [2]. Migrant studies also demonstrate the preponderant importance of environmental factors. Misclassification of a cause of death results in underclassification of one disease and overclassification of another. This becomes evident if one compares different countries with similar nutritional habits. Coronary heart disease is underclassified in Belgium, but still many times higher than in Japan. In Belgium a significant relation could be established between
dietary fat intake and serum lipids both in individuals [3,4] and between regions [2]. It is astonishing that the Journal of Clinical Epidemiology publishes a paper negating in a vituperative tone nearly all clinical, experimental and epidemiological evidence regarding the relationship between dietary saturated fat and atherosclerosis. Moreover it is doing injustice to the pioneering work of Ancel Keys. H. KESTELOOT
and J. V. JOOSSENS
Department of Epidemiology University of Lmven, Belgium
REFERENCES Joossens JV, Kesteloot H. The value of ischaemic heart disease vital statistics since 1968. Acts Cardiol 1989; 44: 389-405.
Kesteloot H. Nutrition and health. Eur Heart J 1992; 13: 12&128. Kesteloot H, Geboers J, Pietinen P. On the withinpopulation relationship between dietary habits and serum lipid levels in Belgium. Eur Heart J 1987; 8: 821-831. Kesteloot H, Geboers J, Joossens JV. On the withinpopulation relationship between nutrition and serum lipids: the B.I.R.N.H. study. Eur Heart J 1989; 10: 196-202.
Response
In their letter to the editors Kesteloot and Joossens take exception to my paper [l] drawing attention to the low quality of data in coronary
heart disease (CHD) epidemiology particularly in respect of CHD mortality rates. CHD epidemiologists rely heavily on WHO monocausal 293
0895-4356(94)00138-3
J Ctin Epidemiol Vol. 48. No. 2. pp, 293=295, 1995 Copyright g; 1995 Elscvier Scimcc Ltd Printed in Great Britain. All righta reswved 0895-4356/95 S9.50 + 0.00
Letters to the Editors THE QUALITY OF EPIDEMIOLOGICAL DATA ON CORONARY HEART DISEASE
The article by Stehbens (J Clin Epidemiol 46: 1337-l 346) suggests that epidemiologists accept without reserve the quality of mortality statistics. This is untrue and their accuracy is still far from perfect. It is a complete different matter to pretend that nothing can be learned from these statistics. We believe that they contain very useful information [l]. Much can already be learned from the mortality from all causes, which can be considered as accurate in developed countries. The tremendous decrease of mortality in Japan and increase in Hungary within a period of 20 years at r time that infectious diseases were already well controlled are sufficient to negate the concept of Stehbens trying to invoke genetic factors as an explanation [2]. Migrant studies also demonstrate the preponderant importance of environmental factors. Misclassification of a cause of death results in underclassification of one disease and overclassification of another. This becomes evident if one compares different countries with similar nutritional habits. Coronary heart disease is underclassified in Belgium, but still many times higher than in Japan. In Belgium a significant relation could be established between
dietary fat intake and serum lipids both in individuals [3,4] and between regions [2]. It is astonishing that the Journal of Clinical Epidemiology publishes a paper negating in a vituperative tone nearly all clinical, experimental and epidemiological evidence regarding the relationship between dietary saturated fat and atherosclerosis. Moreover it is doing injustice to the pioneering work of Ancel Keys. H. KESTELOOT
and J. V. JOOSSENS
Department of Epidemiology University of Lmven, Belgium
REFERENCES Joossens JV, Kesteloot H. The value of ischaemic heart disease vital statistics since 1968. Acts Cardiol 1989; 44: 389-405.
Kesteloot H. Nutrition and health. Eur Heart J 1992; 13: 12&128. Kesteloot H, Geboers J, Pietinen P. On the withinpopulation relationship between dietary habits and serum lipid levels in Belgium. Eur Heart J 1987; 8: 821-831. Kesteloot H, Geboers J, Joossens JV. On the withinpopulation relationship between nutrition and serum lipids: the B.I.R.N.H. study. Eur Heart J 1989; 10: 196-202.
Response
In their letter to the editors Kesteloot and Joossens take exception to my paper [l] drawing attention to the low quality of data in coronary
heart disease (CHD) epidemiology particularly in respect of CHD mortality rates. CHD epidemiologists rely heavily on WHO monocausal 293