BMJ  2004;328:404 (14 February), doi:10.1136/bmj.328.7436.404-a

Letter

Prevention of coronary heart disease

Statins are even less effective than paper shows

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

EDITOR—Marshall commendably questions current trends in preventive medicine.1 He looks at cost effectiveness of cardioprotective drug treatment, including simvastatin 40 mg, by assessing pooled data from different trials. Treatment effects are balanced with costs. The expenditure for simvastatin 40 mg is calculated as prescribing costs plus additional costs for administration and laboratory tests.

A close look at the heart protection study,2 3 Marshall's main reference for statins, quickly calls this equation into question. Simvastatin 40mg was less well tolerated and less effective than portrayed by the authors.

Firstly, tolerability: against all claims simvastatin was not well tolerated. A substantial number of patients did not enter the trial after a six week run in before randomisation (63 603 entered the original screening, 32 145 went forward to the run in phase and 11 609 patients dropped out then).

Secondly, independent treatment effects: Marshall assumes that statins work independently of other . . . [Full text of this article]

David Taylor, general practitioner principal

Birmingham B31 2HZ

Arnold Jenkins, general practitioner principal

Burnley BB10 1LG

Philipp Conradi, part time general practitioner

Birmingham B7 5DT pconradi@hotmail.com


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