Mediterranean Diet, Lifestyle Factors, and Mortality

ity, a 56% decrease in myocardial infarction, and a 51% decrease in congestive heart failure. Recent animal studies indicate that transfusion of stored blood results in profound tissue ischemia. Transfusion practice guidelines do not recommend transfusion for asymptomatic patients with anemia regardless of nadir hemoglobin or hematocrit values. We believe that the preponderance of evidence (observational, randomized clinical trial, systematic review, practice guideline, and experimental data), including the study by Rathore et al, argue against aggressive transfusion practices among patients who are hemodynamically stable. The National Heart, Lung, and Blood Institute is funding a trial to assess the effect of liberal transfusion on functional recovery in patients with cardiac disease undergoing hip arthroplasty, with mortality as the secondary end point. Our study clarifies the urgent need for more randomized trials, but until the results of these studies are available, we recommend that clinicians follow the transfusion guidelines and avoid blood transfusion to maintain arbitrary hematocrit levels in patients who are otherwise stable.