Letter by Noda and Iso Regarding Article, “Low-Density Lipoprotein Cholesterol Concentrations and Death Due to Intraparenchymal Hemorrhage: The Ibaraki Prefectural Health Study”
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To the Editor:
We reported an association between low low-density lipoprotein (LDL) cholesterol and increased death due to intraparenchymal hemorrhage in the general Japanese population aged 40 to 79 years in the April 28, 2009, issue of Circulation.1 In his accompanying editorial, Dr Goldstein pointed out that the results were inconsistent between observational studies and randomized clinical trials (RCTs) and concluded, “This suggests no causal relationship between total cholesterol and LDL-C and bleeding risk,” based on the previous RCTs.2 However, the previous RCTs had several limitations and do not necessarily support a conclusion of no causal relationship between low-LDL cholesterol and risk of intraparenchymal hemorrhage. …