While we have interesting debates about the scope of primary prevention of coronary artery disease, we should have little debate on secondary prevention. While I have not yet added that discussion to my Ward Attending site, I will at sometime.. We now have even more data as reported by the BBC - Call for heart drug lifesaver This study solidifies much that we already suspected. Statins help these patients greatly.

The study involved 20,000 UK adults with heart disease, diabetes or other kinds of arterial disease, who were given either a statin, or a dummy placebo for five years.

In the placebo group, 14.7% died during that period - compared with 12.9% in the statin group.

Deaths from heart problems were 18% lower than in the placebo group, and strokes and heart attacks were down approximately 25%.

While the article requires a subscription (which I don't have - thus the copy machine on Monday) - the editorial is free if you register and log in The Lancet - go to the July 6th issue, log in, and scroll to the commentary section.

Clear benefits were also seen in several subgroups of patients who were poorly represented in previous trials. These subgroups include those over 75 years of age, women, those with concentrations of LDL below 2·5 mmol/L, individuals with diabetes and no vascular events, and those with known cerebrovascular or peripheral arterial disease. The reduction in ischaemic stroke, without an excess of haemorrhagic stroke is noteworthy, and confirms the findings from previous trials. The reductions in vascular events were observed in addition to other effective therapies, such as aspirin, ß-blockers, and ACE inhibitors...

The past 25 years have seen the establishment of aspirin, ß-blockers, ACE-inhibitors, and lipid-lowering therapies to lower the risk of future vascular events, by about a quarter each, in high-risk patients (panel). The benefits of each intervention appear to be largely independent, so that when used together in appropriate patients it is reasonable to expect that about two-thirds to three-quarters of future vascular events could be prevented. Add to this the potential benefits of quitting in smokers (which lowers the risk of myocardial infarction by a half), and blood-pressure lowering (a 10 mm Hg reduction in systolic blood pressure could reduce the risk of vascular events by a quarter) in hypertensive patients, and it may be possible to lower the risk of future events by more than four-fifths in high-risk individuals. Therefore, the potential gains from the combination of currently known preventive strategies are large. Given that over 80% of cardiovascular disease occurs in developing countries,10 a priority is to make these interventions affordable, accessible, and convenient (perhaps even a combination pill). Ensuring that patients worldwide receive these treatments will lead to substantial clinical and public-health benefits.