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The writer questions a prior study by highlighting conflicting findings between models and by comparing odds ratios across comorbidity combinations, suggesting potential bias and discussing the differing apparent roles of age, sex, smoking, and disease synergy. The letter concludes by requesting authors’ responses and emphasizes the need for clinical relevance.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/is-the-relation-between-three-comorbidities-and-carotid-atherosclerosis-dependent-on-the-sum-or-not-letter-to-the-editor/436583/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/is-the-relation-between-three-comorbidities-and-carotid-atherosclerosis-dependent-on-the-sum-or-not-letter-to-the-editor/436583.png","ImageObject",300,407,{"name":42,"@type":43},"Aria Callaghan","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-30","2026-09-29",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",9,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What is the main question raised in the letter?","Question",{"text":63,"@type":64},"Whether the relationship between three comorbidities and carotid atherosclerosis depends on the sum (number) of comorbidities.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What concern does the author raise about the prior study’s modeling results?",{"text":68,"@type":64},"The letter notes that only one model supports the earlier conclusion, while the other model shows conflicting data regarding predictive value.",{"name":70,"@type":61,"acceptedAnswer":71},"How does the letter interpret differences in odds ratios across comorbidity combinations?",{"text":72,"@type":64},"It compares odds ratios across groups and argues that the pattern may suggest bias and that the risk is not simply additive by the number of comorbidities.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},436583,1790828520,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":97,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":22,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":143,"read_time":30,"preview_page_count":4},962084926284,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","J Chin MedAssoc  \nLETTER TO THE EDITOR  \nIs the relation between three comorbidities and carotid atherosclerosis dependent on the sum or not?  \nYiu-Tai Lia, Wen-Hsun Changb,c,d,*  \naDepartment of Obstetrics and Gynecology, Kuo General Hospital, Tainan, Taiwan, ROC; bDepartment of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; cInstitute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; dDepartment of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan, ROC  \nDEAR EDITOR,  \nWe have much interest in reading the article entitled “Combined effects of hypertension, hyperlipidemia, and diabetes mellitus on the presence and severity of carotid atherosclerosis in community-dwelling elders: A community-based study” published in the February issue of the Journal of the Chinese Medical Association.1 The authors found that the number of the comorbidities (hypertension, diabetes mellitus [DM], and hyperlipidemia) was one of the most predictive factors of presence (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.28-1. 81) and severity (OR 1.57, 95% CI 1.28-1.93) of carotid atherosclerosis in their model 1, but in the model 2, the number of the comorbidities seemed to fail to play any predictive value about either presence or severity of carotid atherosclerosis.1 However, the authors concluded that “the number of common cardiovascular disease (CVD) comorbidities was the most predictive determinant of carotid plaques and advanced carotid atherosclerosis.”1 At first, we congratulated the authors’ contribution to enhance the global health in Taiwan. To clarify the role of CVD comorbidities on carotid atherosclerosis, we would like to ask for the authors’ response to our concerns since some uncertainties are noted.  \nFirst, only one model supported their conclusion, but the other model showed conflicted data. If this parameter is so important, we are wondering to know why the importance of this parameter will disappear in the other model. At least three critical factors, such as age at enrollment (per 1 year), male gender, and cigarette smoking were always significantly associated with increased risk of presence and severity of carotid atherosclerosis. Second, if the number of CVD comorbidity is a critical factor, the risk should be dependent the number of CVD comorbidity, from lower risk factor by presence of one CVD comorbidity alone, intermediate risk by presence of two CVD morbidities, and high risk by presence of three CVD morbidities. However,  \nwe can find that the OR (5.29, 95% CI 2.39-11.75) was highest in the DM plus hypertension group and even higher risk of carotid atherosclerosis in the DM and hyperlipidemia group (OR 4.79, 95%% 1.63-14.09) compared to the OR of 4.07 (95% CI 2.20-7.51) in the all (DM plus hypertension plus hyperlipidemia) group for the moderate or severe carotid atherosclerosis, suggesting the bias of the authors’ study is high.  \nThird, if hypertension is so important, the authors’ data also failed to support their conclusion. The authors showed that OR in the hypertension and hyperlipidemia group is 2.71 (95% CI 1.68- 4.36), which was dramatically lower than those ORs (4.79 and 5.29, respectively) in the DM plus hyperlipidemia group and the DM and hypertension group, respectively. If the aforementioned data are real, does it mean the synergistic effect of DM is far and far critical compared to hypertension? In fact, previous studies have shown DM may share similar underlying pathophysiology for many diseases, and of course, atherosclerosis is also included.2,3  \nThe comments shown above did not argue the value of the authors’ contribution and effort to enhance the global health of human beings; however, clinical relevance may be more important to scientific finding.4,5 We hope to learn more from the authors’ positive response.  \nREFERENCES  \n1. Lu SX, Wu TW, Chou CL, Cheng CF, Wang LY. Combined effects of hypertension, hyperlipidemia,","cbCaijksvnfxrrmH","https://ap.wps.com/l/cbCaijksvnfxrrmH","pdf",303674,"English","# Letter to the Editor\n## Main concerns and model differences\n## Odds ratio comparisons and possible bias\n## Hypertension-related interpretation and synergy with diabetes\n## References and correspondence","[{\"question\":\"What is the main question raised in the letter?\",\"answer\":\"Whether the relationship between three comorbidities and carotid atherosclerosis depends on the sum (number) of comorbidities.\"},{\"question\":\"What concern does the author raise about the prior study’s modeling results?\",\"answer\":\"The letter notes that only one model supports the earlier conclusion, while the other model shows conflicting data regarding predictive value.\"},{\"question\":\"How does the letter interpret differences in odds ratios across comorbidity combinations?\",\"answer\":\"It compares odds ratios across groups and argues that the pattern may suggest bias and that the risk is not simply additive by the number of comorbidities.\"}]","Is the relation between three comorbidities and carotid atherosclerosis dependent on the sum or not? - Letter to the Editor | PDF",1790678449]