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Lipid lowering drugs for patients who continue to smoke?
  1. Medical Unit
  2. Dumfries and Galloway Royal Infirmary
  3. Dumfries DG1 4AP, UK
  5. Robertson Centre for Biostatistics
  6. University of Glasgow
  7. Glasgow G12 8QQ, UK

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For many of us, the issues raised by the prescription of lipid lowering drugs to patients who continue to smoke are perplexing. In particular there is the concern that the benefits of lowering serum cholesterol may be offset by the harmful effects of nicotine; and that general practitioners and hospital doctors who advise on one aspect of a patient's care to the exclusion of another may somehow be construed as approving, or at least accepting of, the fact that their patient continues to smoke.

Risks of smoking

Some smokers still cling to the belief, reinforced by the tobacco companies, that nicotine is not harmful. A sympathetic but firm explanation of the risks may therefore be helpful. The study of 35 000 British doctors followed from 1951 to 1991 showed that 50% of habitual smokers die of diseases that have nothing to do with smoking, 25% of smokers die of smoking related diseases in old age, but that 25% of smokers die of smoking related disease in middle age, so denying themselves 20–25 years of a non-smoker's life expectancy.1 This explanation acknowledges the fact that everyone knows at least someone who smoked happily until the age of 90 years before being run over by a bus, while at the same time puts the risk of premature death into chilling perspective: who among us would willingly hold a gun to his or …

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