Published 27 May 2009, doi:10.1136/bmj.b2097
Cite this as: BMJ 2009;338:b2097

Letters

Secondary prevention in stroke

When we might extrapolate

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

Hepple rightly asks for the evidence for lipid lowering treatment in patients over the age of 80.1

But absence of evidence is not the same thing as evidence of absence. Nobody, to my knowledge, has performed randomised controlled studies on north Pembrokeshire Welshmen, but I extrapolate daily that the Scandinavian 4S or Scottish WOSCOPS studies should apply to my patients.

The same challenge was mounted against treating blood pressure in patients over 80. Slowly the evidence emerges that benefits of lowering blood pressure along with cholesterol concentration are directly correlated with risk of cardiovascular disease, which, as everyone knows, increases with age and varies by sex.

Why might people over 80 be expected to behave differently?

Well, they haven’t got long to live, and hence treatment might not prove cost effective. But is that true? Cost effectiveness studies of the heart protection study showed that lipid lowering depended not only . . . [Full text of this article]

L Sam Lewis, GP trainer1

1 Surgery, Newport, Pembrokeshire SA42 0TJ

sam@garthnewydd.freeserve.co.uk


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