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Age of patient is irrelevant when prescribing statins

The article on statin prescribing 'Colleague is flouting practice policy' (Features, May 24) was certainly thought provoking. I wonder if some of your panellists' opinions were rather ageist.

There are two theories of the mechanism of statins in preventing acute coronary episodes. Both may be valid and act together.

In one it is proposed that, by a gradual process, cholesterol plaque growth is arrested or, in some cases, reversed, leading to improvement of perfusion. 

The other suggests the critical action is to stabilise cholesterol plaques and reduce the risk of 'plaque rupture' which is the initiating event in coronary arterial occlusion.

Some suggest similar processes apply to other types of arterial disease – stroke and peripheral vascular disease, although this is more controversial.

Clearly, if plaque stability is important the predicted expectation of life of the patient is not relevant to the benefit of treating them with a statin.

Other studies have shown the cost per life saved by treating patients in their 80s is far lower than for those in their 40s or 50s in whom, I suspect, none of your panel would have advised such a cautious approach.

Dr Michael Blackmore

Independent GP

Ringwood, Hampshire

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