Serum Cholesterol and Death From Coronary Heart Disease

To the Editor.— I am writing to protest the conclusions of the recent article by Stamler et al1entitled "Is Relationship Between Serum Cholesterol and Risk of Premature Death From Coronary Heart Disease Continuous and Graded?" Stamler et al conclude that "these data of high precision show that the relationship between serum cholesterol and CHD [coronary heart disease] isnota threshold one, with increased risk confined to the two highest quintiles, but rather is a continuously graded one that powerfully affects risk for the great majority of middle-aged American men." The problem with the article by Stamler et al is that they do not provide convincing evidence that the CHD mortality in the lowest three quintiles is significantly different from that in the first. Ninety-five percent confidence limits are not given for any of the data in any of the quintiles, so it is very difficult to interpret