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  2. Joint British recommendations on prevention of coronary heart disease in clinical practice: summary
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Joint British recommendations on prevention of coronary heart disease in clinical practice: summary

BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7236.705 (Published 11 March 2000) Cite this as: BMJ 2000;320:705

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Unmet Need in Secondary Prevention

Dear Editor

The BMJ Theme issue (No7236) on "risk in cardiovascular disease " was
very timely and informative. The "Heart disease framework" by the
government, however, seems more about headlines than any real substance.
The issue of secondary prevention in ischaemic heart disease in the
community remains un-addressed. The evidence of disease modification for
secondary prevention 1,2 is beyond refute which is not the case in
cardiac surgery in ischaemic heart disease. There is a pressing need to
tackle the huge numbers of patients who have established ischaemic heart
disease in the community who are on suboptimal treatment. We are
potentially sitting on a time bomb of litigation when a patient who had a
MI ten years ago realises that his MI last month could have been prevented
on the correct treatment. The evidence for this being six years old!3

The government needs to view ischaemic heart disease like other
chronic disease such as asthma and diabetes ( the evidence base being very
much poorer than that of ischaemic heart disease ). The main problem as
ever is money, in our practice of 8000 we estimated that to treat all
patients with established ischaemic heart disease would cost £100 000 for
statins alone, a 20% increase in our drugs budget. We have a very
important role of advocacy for our patients it is no longer acceptable
that patient are not cared for properly merely because of budget concerns.
Primary care should seize the evidence and resource agenda .

The issue of secondary prevention is less exciting than parading
around the Royal college of Surgeons but much more important and
considerably more expensive

1. British Cardiac Society, British Hyperlipidemia Association,
British Hypertension Society, British Diabetic Association. Joint British
recommendations on prevention of coronary heart disease in clinical
practice :Summary . BMJ 2000:320:705-8.

2. SIGN Publication Number 41. Secondary Prevention of Coronary Heart
Disease.

3. Randomised trial of cholesterol lowering in 4444 patients with coronary
heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet
1994 Nov 19;344(8934):1383-9

Yours Sincerely

Dr Des Spence

Maryhill Health Centre,
Glasgow G20 9DR

destwo@btinternet.com

Competing interests: No competing interests

19 April 2000
Des Spence
GP
Maryhill Health Centre
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