Erika Friedmann

Relation between pet ownership and heart rate variability in patients with healed myocardial infarcts

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ADHERENCE AND ARRHYTHMIC MORTALITY IN THE CARDIAC ARRHYTHMIA SUPPRESSION TRIAL (CAST)

Patient adherence to therapy is essential to assess treatment efficacy, particularly in clinical trials. Active treatment usually is expected to benefit patients. The healthy adherer effect, the association or greater adherence to all health-promoting behaviors, including medication and overall concern for health, explains the improved survival of more adherent patients in both active and placebo medication groups of several clinical trials. The Cardiac Arrhythmia Suppression Trial (CAST), a placebo-controlled double-blind clinical trial of post-myocardial infarction (MI) patients with asymptomatic ventricular arrhythmias, in which active medication (encainide or flecainide) led to increased mortality, provided an opportunity to examine the relationship of adherence to survival from a different perspective. We consider whether adherence to active treatment was related to arrhythmic mortality and whether a healthy adherer effect might counteract the effect of treatment on mortality among patients taking active medication. Adherence (average pill count) at the first follow-up visit did not differ in the active treatment (92.2%, standard deviation (SD) = 11.97, n = 574) and placebo (90.8%, SD = 13.66, n = 579) groups. In a Cox proportional hazard regression model, medication adherence predicted arrhythmic mortality among the active (P < 0.0062) but not the placebo medication group. The effect of adherence on arrhythmic mortality was significant beyond the effects of ejection fraction, race, spouse, smoking status, diuretic medication, and history of MI. A 10% increase in adherence led to more than a threefold increase of risk of arrhythmic death. The design of the CAST, which included a titration phase, may have tended to select relatively adherent patients since only those whose arrhythmias were suppressed with active medication were randomized into the trial. The data do not support a strong healthy adherer effect in the CAST. There was no evidence in this study that a healthy adherer effect counterbalanced the effect of the active medication.

Menstrual and lunar cycles

A double-blind, prospective study during the fall of 1979 investigated the association between the menstrual cycles of 305 Brooklyn College undergraduates and their associates and the lunar cycles. All subjects were 19-35 years old and using neither OCs (oral contraceptives) nor the IUD. Approximately 1/3 of the subjects had lunar period cycles, i.e., a mean cycle length of 29.5 +/- l day. Almost 2/3 of the subjects started their October cycle in the light 1/2 of the lunar cycle, significantly more than would be expected by random distribution. The author concludes that there is a lunar influence on ovulation.