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LETTERS: Tom Marshall Prevention of coronary heart disease: Author's reply BMJ 2004; 328: 405-c-406-c [Full text]

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Prevention of coronary heart Disease

Eric Frankel   (14 February 2004)

Prevention of coronary heart Disease 14 February 2004
Eric Frankel, Retired Physician, Whipps Cross Hospital,London,E11 Retired Send response to journal: Re: Prevention of coronary heart Disease	Editor--Many studies have been published showing that regular Statins and Aspirin administration over a long period of time reduce the incidence of coronary thrombosis, as both drugs reduce the narrowing of the walls of the coronary arteries by preventing deposition of low density cholesterol and of platelet thrombi. It is rarely mentioned in these reports that such prophylaxix is only effective, if the endothelial wall of the coronary or cerebral blood vessels is first injured. This injury occurs as a result of repeated, fluctuating hypertensive filling of these arteries in usually normotensive or hypertensive patients. Thus in the absence of initial injury Statins or Aspirin will have little effect, but may be useful in patients with fluctuating hypertension which is diagnosed at a later stage in life.If patients with fluctuating hypertension,e.g.those with a Type "A" personality, are prescribed drugs which prevent or lower hypertension, Statins and Aspirins my not be required and atheromatous,arterial changes could be slowed down or prevented. It is not sufficiently recognised that Aspirin, though statistically beneficial in preventing heart attacks, has a serious haemorrhagic tendency, particularly after trauma. Eric Frankel Retired Consultant Physician Whipps Cross Hospital London, E11 email address: efrankel@doctors.org.uk Competing interests: None