[Statin therapy of individuals with high risk for coronary disease]

After the release of the results from the West of Scotland Prevention study (WOSCOPS) some questions have been raised with respect to validity of its finding on all cause mortality, which was reduced by 22% with pravastatin treatment (p = 0.051) compared with placebo. Also, since WOSCOPS was a primary preventive study its results could affect a large proportion of Norwegian men. Thus, it can also be asked whether statin treatment should be preferred to standard, specific treatment for certain diseases, e.g. hypertension, if economic restrictions by the government make it necessary to make priorities. For example, expensive drugs are now given free to many diabetics and hypertensives, who should probably be treated with statins, almost regardless of their cholesterol level. The total social costs of medication could then exceed accepted budgets and could lead to restrictions. The author discusses the validity of the WOSCOPS findings on all cause mortality, and compares the results obtained in this study with those randomised trials and other statin trials. Finally, a comparison is made between results from two metaanalyses: one of randomised hypertension trials and one of all randomised statin trials. It is concluded that more favourable results are obtained from the latter. Caution should be shown, however, when interpreting such a comparison.