The results of a case‐control study showed a strong and statistically significant association between high triglyceride levels and heart attack that persisted after
Adjusting for age, sex, gender and blood cholesterol levels so the investigators
Concluded that the relationship was causal.This conclusion is:

Question

Quizplus · Accepted Answer

Not justified because having a heart attack might lead to increased
triglyceride levels.The blood samples were collected after the people had their possible
heart attack; it could be that the high levels in those with a heart attack were a
consequence and not a cause of their heart attack.This is a common problem in case‐
control studies when exposure is measured after the onset of disease and is sometimes
described as 'reverse causality' because the condition causes the exposure (high
triglyceride levels in this case) and not the other way around.(Note this does not mean
the association is not causal; the lack of confounding, statistical significance, and strong
association are all suggestive, but prospective studies are needed to remove the
potential for reverse causality in this instance.)

The Results of a Case‐control Study Showed a Strong and Statistically