Coronary heart disease (CHD), which usually presents as a heart attack (or myocardial infarction, MI) is the most common cause of death and disability both in the UK and globally. The way in which CHD is treated and prevented therefore has huge implications for patients, health professionals and policymakers. Once a person has a heart attack, prevention of further heart attacks, stroke or death, or secondary prevention, is crucial. There is strong evidence for benefit of several drugs and treatments after heart attacks to this end, including aspirin, statins, ACE inhibitors and beta-blockers.

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Last week, the press reported that relatives of people with familial hypercholesteraemia are not being adequately screened in the UK, despite their increased risk of heart attacks, which could be prevented by early treatment with statins. However, the more important story was about statins themselves.

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We first criticized this drug in 2006, when in the BMJ we first mooted rosiglitazone in the DREAM trial – which cost $23million - caused a significant increase in heart failure, despite the population being at low risk of such a problem. The drug showed no clear benefit at 3 years on clinical outcomes and the rate of all cardiovascular events tended to be higher in the treatment group.

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Since medical school, I have always been struck by the number of patients of all ages who live life by the “aspirin-a-day” mantra. In people who have had heart attacks or strokes, aspirin reduces further events by 25%. This beneficial effect is known as “secondary prevention”, and outweighs aspirin’s bleeding risk [1, 2].

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