Secondary prevention in coronary heart disease

doi:10.1136/bmj.317.7172.1592

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Secondary prevention in coronary heart disease

R E Ferner, Director

West Midlands Centre for Adverse Drug Reaction Reporting, City Hospital, Birmingham B18 7QH
Coronary Prevention Group, London WC1E 7DB

EDITOR—Campbell et al surveyed the true rates of treatment with various forms ofsecondary prophylaxis in patients with coronary heart disease, at least in those general practices that participated.1 The authors do not consider the utilitarian argument that it is best to do the greatest good for the greatest number. The figure shows the number of lives saved per £100 000 spent on drugs for secondary prevention, based on the approximate number of patient years of treatment needed to save one life. If “all bad things” are considered2 then aspirin (after the first five weeks)3 and simvastatin4 will both prevent about one bad thing for every 30-40 years of patient use, but £100 000 …