Primary and secondary prevention of coronary heart disease: What can we afford?

In secondary prevention, statins are cost-affective and even more cost-effe ctive than other lipid lowering drugs. Statins are especially favorable in patients with previous myocardial infarction compared to those with angina pectoris. For secondary prevention of coronary heart disease, statins shoul d be administered generously. In primary prevention, statins are effective but nut cost-efficient. Unfavo rable results have to be expected especially in premenopausal women, younge r patients, and in those with a low risk factor profile. For population bas ed primary prevention, only dietary measures can be advocated; however, apa rt from a serious lack of compliance their efficiency has not yet been prov en. Preventive measures have their own prize; in general they are considered no t to prevent coronary heart disease but retard it. Therefore, such therapeu tic interventions can be assumed not to reduce but rather to increase the " direct" medical costs. Furthermore, successful prevention of coronary heart disease leads, due to life-prolongation, to an increase in people our of w ork and in disabled patients due to age and/or disease. Therefore, an incre ase especially of the "indirect" costs for unemployment, pension, nursing h omes, etc, must be expected.