Title: TITLE: The Association Between Blood Pressure and Gallstones and the Age of First
Cholecystectomy in U.S. Adults: Results from a Cross-Sectional Study
Version: 1 Date: 09 Dec 2024
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-As with the earlier version of the study, the cross-sectional nature of the design limits the
ability to infer causal relationships. Although significant associations between hypertension
and gallstone disease are observed, the study cannot determine whether hypertension causes
gallstone formation or if the reverse is true.
-While several important confounders (e.g., age, gender, race, diabetes, hypercholesterolemia)
are controlled for, other factors such as obesity, diet, physical activity, and genetic
predispositions to gallstones may not be fully accounted for. These factors could influence both
hypertension and gallstone disease and should be considered in future analyses.
-While the study identifies a threshold effect for SBP at 170 mmHg, the explanation for this
threshold and its clinical significance could be expanded. The potential reasons behind this
threshold—whether it reflects a biological change or is merely a statistical artifact—are not fully
addressed.
-The authors mention that missing continuous variables were recoded as categorical, with
missing data being designated as "unclear." This approach, while common, may introduce bias,
as the reasons for missing data are not addressed. The method of handling missing values could
be discussed in more detail, including any potential impact on the results.
-The subgroup analysis shows variability in the association between hypertension and
cholecystectomy across different racial groups. In particular, the lack of significant associations
in Non-Hispanic Blacks and Mexican Americans raises concerns about potential bias or other
factors that may influence the results. It would be helpful to explore this further and consider
whether the observed disparities reflect true differences or other unmeasured confounders.
-The authors mention the potential for recall bias due to the reliance on self-reported data
for gallstone disease and cholecystectomy history. However, the discussion could further
elaborate on how this may affect the results. For example, individuals who have undergone
cholecystectomy may be more likely to remember and report their diagnosis, while others who
have gallstones but have not undergone surgery may be less likely to report it accurately.
Addressing this potential bias in more detail would help readers better understand the study's
limitations.
-While hypertension is the primary exposure variable in this study, it would be helpful for
the discussion to acknowledge the complexity of risk factors for gallstone disease. Other
factors, such as obesity, hypercholesterolemia, and diabetes, could also play important roles
in the development of gallstones, and a more balanced discussion of these factors alongside
hypertension would provide a more comprehensive view of the disease's etiology.
Title: TITLE: The Association Between Blood Pressure and Gallstones and the Age of First
Cholecystectomy in U.S. Adults: Results from a Cross-Sectional Study
Version: 1 Date: 09 Dec 2024
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-As with the earlier version of the study, the cross-sectional nature of the design limits the
ability to infer causal relationships. Although significant associations between hypertension
and gallstone disease are observed, the study cannot determine whether hypertension causes
gallstone formation or if the reverse is true.
-While several important confounders (e.g., age, gender, race, diabetes, hypercholesterolemia)
are controlled for, other factors such as obesity, diet, physical activity, and genetic
predispositions to gallstones may not be fully accounted for. These factors could influence both
hypertension and gallstone disease and should be considered in future analyses.
-While the study identifies a threshold effect for SBP at 170 mmHg, the explanation for this
threshold and its clinical significance could be expanded. The potential reasons behind this
threshold—whether it reflects a biological change or is merely a statistical artifact—are not fully
addressed.
-The authors mention that missing continuous variables were recoded as categorical, with
missing data being designated as "unclear." This approach, while common, may introduce bias,
as the reasons for missing data are not addressed. The method of handling missing values could
be discussed in more detail, including any potential impact on the results.
-The subgroup analysis shows variability in the association between hypertension and
cholecystectomy across different racial groups. In particular, the lack of significant associations
in Non-Hispanic Blacks and Mexican Americans raises concerns about potential bias or other
factors that may influence the results. It would be helpful to explore this further and consider
whether the observed disparities reflect true differences or other unmeasured confounders.
-The authors mention the potential for recall bias due to the reliance on self-reported data
for gallstone disease and cholecystectomy history. However, the discussion could further
elaborate on how this may affect the results. For example, individuals who have undergone
cholecystectomy may be more likely to remember and report their diagnosis, while others who
have gallstones but have not undergone surgery may be less likely to report it accurately.
Addressing this potential bias in more detail would help readers better understand the study's
limitations.
-While hypertension is the primary exposure variable in this study, it would be helpful for
the discussion to acknowledge the complexity of risk factors for gallstone disease. Other
factors, such as obesity, hypercholesterolemia, and diabetes, could also play important roles
in the development of gallstones, and a more balanced discussion of these factors alongside
hypertension would provide a more comprehensive view of the disease's etiology.
Please review this paper.
user
Title: TITLE: The Association Between Blood Pressure and Gallstones and the Age of First
Cholecystectomy in U.S. Adults: Results from a Cross-Sectional Study
Version: 1 Date: 09 Dec 2024
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-As with the earlier version of the study, the cross-sectional nature of the design limits the
ability to infer causal relationships. Although significant associations between hypertension
and gallstone disease are observed, the study cannot determine whether hypertension causes
gallstone formation or if the reverse is true.
-While several important confounders (e.g., age, gender, race, diabetes, hypercholesterolemia)
are controlled for, other factors such as obesity, diet, physical activity, and genetic
predispositions to gallstones may not be fully accounted for. These factors could influence both
hypertension and gallstone disease and should be considered in future analyses.
-While the study identifies a threshold effect for SBP at 170 mmHg, the explanation for this
threshold and its clinical significance could be expanded. The potential reasons behind this
threshold—whether it reflects a biological change or is merely a statistical artifact—are not fully
addressed.
-The authors mention that missing continuous variables were recoded as categorical, with
missing data being designated as "unclear." This approach, while common, may introduce bias,
as the reasons for missing data are not addressed. The method of handling missing values could
be discussed in more detail, including any potential impact on the results.
-The subgroup analysis shows variability in the association between hypertension and
cholecystectomy across different racial groups. In particular, the lack of significant associations
in Non-Hispanic Blacks and Mexican Americans raises concerns about potential bias or other
factors that may influence the results. It would be helpful to explore this further and consider
whether the observed disparities reflect true differences or other unmeasured confounders.
-The authors mention the potential for recall bias due to the reliance on self-reported data
for gallstone disease and cholecystectomy history. However, the discussion could further
elaborate on how this may affect the results. For example, individuals who have undergone
cholecystectomy may be more likely to remember and report their diagnosis, while others who
have gallstones but have not undergone surgery may be less likely to report it accurately.
Addressing this potential bias in more detail would help readers better understand the study's
limitations.
-While hypertension is the primary exposure variable in this study, it would be helpful for
the discussion to acknowledge the complexity of risk factors for gallstone disease. Other
factors, such as obesity, hypercholesterolemia, and diabetes, could also play important roles
in the development of gallstones, and a more balanced discussion of these factors alongside
hypertension would provide a more comprehensive view of the disease's etiology.
assistant