The conclusion in the first paragraph of the letter from Prof. Dören seems to match the statements and interpretations of our study and does not seem to require a reply. The second paragraph addresses the results of the MONICA (Augsburg) and KORA studies, especially the increase in myocardial infarctions in younger patients (25-54) from 1985/87-2001/03. No confidence intervals are given for the mentioned incidence rates in younger women in the cited study; no statistical test was conducted either. In view of the small number of cases in this sub-group it might almost be presumed that the described increase in the incidence of myocardial infarction in younger women does not reach significance. However, the rise in incidence rates in this cohort may be explained by "increased awareness among doctors" in this cohort—an assumption that is supported by only little empirical proof, as far as we’re aware. In reverse, a clear increase in smoking—a crucial, behavior related risk factor that is bound to result in an increase in myocardial infarction—has been shown for younger women in Germany in several large population based studies.
Footnotes
Conflict of interest statement
The authors declare that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.
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