Optimal therapy for acute coronary syndromes: the more the better?

Abstract

To the Editor: In their comments on the report by Mukherjee et al,1 White and Willerson2 emphatically claim that as many as 4 drugs should be routinely started in patients with acute coronary syndromes (on a lifelong basis?) so as to reduce mortality. By contrast, not so long ago, Bogaty and Brophy3 asked whether the increasing burden of treatment in acute coronary syndromes was really justified. Where does the right approach lie? The core of Bogaty and Brophy’s3 criticism was that the blanket prescription of evidence-based interventions resulted in an overwhelming proportion of treated patients deriving no benefit because of the tiny difference in absolute risk reduction when the event rate is low, no matter how great the relative reduction. They recommended a research effort to identify those patients most likely to benefit from treatment. This effort is unlikely to come from most promoters. The Mukherjee et al1 study makes no use of absolute …