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Declaring independence: why we should be cautious A review article identified 246 different risk factors for coronary heart disease.' Many of these 246 were risk factors asserted to be "independent", that is, their association with coronary heart disease was not due to relationships with other, confounding, factors. Establishing the independence ofeffects is central in analytical epidemiological studies and is seen as an important step in assigning causality to a relationship. But even given the obsession epidemiologists have for multifactorial theories of disease causation2 it seems unlikely that there actually are 246 separate causes of coronary heart disease. What might be going on here?
Smith et al. (Sat,) studied this question.