From Peter Elwood
Your article wondering whether doctors will now be dolling out cholesterol
pills like sweets has a most unfortunate opening: “Step aside aspirin—here
come statins”
(24 November, p 7)
Aspirin has a totally different action to statins and in no way are they
rivals. Aspirin affects blood platelets, reducing their ability to aggregate,
form a plug and block a coronary or a cerebral blood vessel. Over 150 randomised
controlled trials have established the efficacy of aspirin in reducing the risk
of a heart attack or stroke by about 30 per cent. In this context it is probably
the most thoroughly investigated drug used in clinical practice and at about
£100 per heart attack prevented, it is undoubtedly the most inexpensive
drug available for reducing cardiac risk.
To suggest that aspirin is a rival to a drug that lowers blood cholesterol,
and that aspirin should therefore “step aside” in favour of statins is quite
inappropriate. Although there is as yet no evidence from trials, it is
reasonable to expect that people might want to take both a low-dose aspirin and
a statin.
Andy Coghlan writes: Elwood is absolutely right. In fact, two-thirds of the
patients who benefited from statins in the trial we reported were also taking
aspirin because, as Elwood points out, the two drugs have different but
complementary effects. This did appear in my original text but had to be cut for
space reasons.
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