Use of statins

EDITOR—Two letters last December on the use of statins, by Betteridge et al (p 1619) and Reynolds et al (p 1620), criticised the Sheffield table.1 The rate of coronary heart disease events targeted (3% per year) is not “arbitrarily high,” as Reynolds et al say, but was proposed after consideration of the number needed to treat, cost effectiveness, proportion of adults needing treatment, and total cost of treatment at different thresholds of risk of coronary heart disease.2 The European task force's guidelines3 which suggested the 2% per year threshold for coronary heart disease preferred by the letters' authors predated the statin trials. We do not accept that high risk people over age 65 should be denied treatment,1 and treating those below age 65 with a relative risk of coronary heart disease of 41 seems unwise. A 35 year old woman with a total cholesterol concentration of 7.0 mmol/l, systolic blood pressure of 160 mm Hg, and no other risk factors has a relative risk …