Secondary prevention in coronary heart disease

BMJ 1998;317:1592 ( 5 December )

Letters

Secondary prevention in coronary heart disease

Cost effectiveness of treatment must be borne in mind

Payment for chronic disease management should include coronary heart disease

Cost effectiveness of treatment must be borne in mind

The first 150 words of the full text of this article appear below.

EDITOR $---$ Campbell et al surveyed the true rates of treatment with various forms of secondary prophylaxis in patients with coronaryheart disease, at least in those general practices that participated.¹The authors do not consider the utilitarian argument that it isbest to do the greatest good for the greatest number. The figureshows the number of lives saved per £100 000 spent on drugs forsecondary prevention, based on the approximate number of patientyears of treatment needed to save one life. If "all bad things"are considered² then aspirin (after the first five weeks)³and simvastatin⁴ will both prevent about one bad thing forevery 30-40 years of patient use, but £100 000 of aspirin (halfa 300 mg tablet a day) will prevent about 1300 events, while £100 000of simvastatin (20 mg a day) will prevent only eight.

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I do not argue that we should abandon secondary prevention with lipid lowering agents, . . . [Full text of this article]

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