What's good for the doctor ... The Physicians ' Health Study Group has shown

a 44% reduction in myocardial infarction in physicians taking aspirin 325mg on alternate days [see Therapy section, this issue, p6] , but recommendations for primary prophylaxis for patients> 50 years of age with coronary heart disease are not yet appropriate. The total cardiovascular mortality in the study was unchanged because there were more sudden deaths (some presumably due to ischaemic events); and the fact that overall cardiovascular event rate was 15% of predicted was neither explained nor constituted an acceptable explanation for the lack of mortality benefit. Furthermore, there are grounds for concern over the increased incidence of stroke.

The results cannot be extrapolated to the general population because the study group was highly selected, did not include women and treatment was poorly tolerated (one third of participants withdrew during the run-in period). The study also failed to show any particular risk­factor group that would benefit.

Thus '", the recommendation to treat the population OVM 50 to prevent a first Infarct I, premature,. " Horton RC. Kendall MJ Aspmn and primary prophylaxIS in myocardIal InlarcttOn Lancet 2: 800. :ll Sep 1989 • ...,

0156-270389/1014- 0003/0$()1.00jO e ADIS Press INPHARMA ' 14 Oct 1989 3