Secondary prevention in coronary heart disease

BMJ 1999;318:1419 ( 22 May )

Letters

Secondary prevention in coronary heart disease

Effects of statins have been in addition to those of aspirin and $beta$ blockers

Author's reply

Effects of statins have been in addition to those of aspirin and $beta$ blockers

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

EDITOR $---$ Ferner acknowledges the apparent similarity between the abilities of continuing aspirin and simvastatin to prevent"bad things."¹ He overlooks the fact that the positive outcomesof the secondary prevention statin studies were additional tothe use of both aspirin and $beta$ blockers according to the investigators'cardiological practices at the time (table).^2-4 Since the inceptionof the Scandinavian simvastatin survival study over a decade ago,subsequent trials have tested lipid modification with statinsagainst a background of increasingly optimal practice, comfortablyexceeding that described in the survey by Campbell et al.⁵

Table Removed (Available Only in the Full Text)

Ferner's argument is focused on cost effectiveness. The cost implications of aspirin, however, are negligible $---$ indeed, manypatients buy it themselves. The cost effectiveness of statinsin secondary prevention is established, equates to that of otheraccepted healthcare interventions, and will improve further aspatentsexpire.

The benefits of aspirin and $beta$ blockers are beyond doubt, but Ferner's message . . . [Full text of this article]

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