Editor,—The article by Pickin and colleagues is a valuable demonstration of the cost effectiveness of statins in both secondary and primary prevention of coronary heart disease1; however, the study underestimates the benefits of statin treatment. The Scandinavian simvastatin survival study recruited patients with cholesterol between 5 and 8 mmol/l. The cholesterol distribution in coronary heart disease (CHD) patients in the UK is similar to the distribution in the long-term intervention with pravastatin in ischaemic disease (LIPID) study,2 with a range of 4–7 mmol/l, which also showed substantial benefits on mortality. Thus the average dose of 27.4 mg of simvastatin chosen for the cost- benefit analysis is an overstatement of the cost, even before the recent renegotiation of drug prices, as 88% not 67% would be controlled on 20 mg simvastatin. Pravastatin was used at 40 mg in the LIPID study. Although it was not specified in the recruitment criteria, the average calculated risks for patients in the LIPID and the cholesterol and recurrent events (CARE) studies was 2%/year. This is similar to the west of Scotland coronary prevention study (WOSCOPS) primary prevention population, with an average 1.8%/year risk. This happens to be the highest risk population in the UK for CHD and so is not representative of the country at large.3 Primary prevention data do exist for lower risk thresholds than the 3%/year …