Prevention of coronary heart disease: Author's reply

doi:10.1136/bmj.328.7436.405-c

BMJ 2004;328:405-406 (14 February), doi:10.1136/bmj.328.7436.405-c

Letter

Prevention of coronary heart disease

Author's reply

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

EDITOR—Correspondents responding to my article on bmj.comraise several interesting issues.¹ Nevertheless no correspondentdisputes either the approach (incremental cost effectivenessanalysis) or the fundamental findings: that aspirin and antihypertensivetreatment with bendrofluazide and atenolol are markedly morecost effective than statins and clopidogrel.

Conradi et al and O'Donnell indicate that statins may have moreside effects than is generally appreciated. Mann doubts theeffectiveness of clopidogrel in primary prevention.¹ Both pointsstrengthen the paper's conclusions. I agree with Mann's suggestionthat individuals need information on the risk reduction withtreatment in order to decide if it is worth while.

Cooke says that the development of further drugs to preventcoronary heart disease may not be cost effective. It is veryefficient to prevent coronary disease by using existing, lowcost treatments.

If, as Jacobs says, treatment effects are not independent, secondand third treatments may be even . . . [Full text of this article]

Tom Marshall, clinical lecturer

Department of Public Health and Epidemiology, University of Birmingham, Birmingham B15 2TT T.P.Marshall@bham.ac.uk

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