Prasad V et al. - Large studies must show improvements in overall mortality before novel agents are recommended and used. The implications of this proposal are considered.
- Recent trials in cardiovascular medicine have contradicted current practice, and, accordingly, are medical reversals.
- Extended-release niacin and fenofibrate have failed to provide mortality benefit when added to statin therapy, though both drugs have been used for this purpose for years.
- Cardiovascular primary prevention is no small matter.
- Annual spending on statins exceeded $19 billion in 2005, ezetimibe cost over $5 billion in 2007, and fenofibrate costs passed $1 billion in 2009.
- Given the tremendous price of these medications, and recent trials that have undermined years of practice, the authors propose that the bar for cardiovascular primary prevention has been raised.