Population-based primary prevention strategies are the only affordable solution for most developing countries. However, wealthier countries have the luxury of being able to support the complementary strategies of primary and secondary prevention. Ideally, almost all patients with coronary heart disease (CHD) can change their behaviour (smoking cessation, healthy diets and exercise-based rehabilitation) and receive secondary prevention medications (antiplatelet therapy, statins, ACE inhibitors and β-blockers, if there are no specific clinical contraindications).1

Secondary prevention drugs are important; they may explain about 10% of the fall in CHD death rates seen in the UK population between 1981 and 2000, much as in the USA between 1980 and 2000 and elsewhere.2 3 Furthermore, secondary prevention medicine is relatively cheap and cost effective.4

Recognising that uptake by 100% of eligible patients with CHD might be unrealistic, the UK CHD National Service Framework (NSF) in 1999 sensibly started with 80% targets. Yet even these remain challenging, given the disappointing service performance across Europe, quantified by two Euro ASPIRE studies.5 6

In this issue of Heart, DeWilde and colleagues describe their review of UK trends in CHD secondary prevention therapies between 1994 and 2005 using DIN, a UK GP prescribing database (see article on page 83).7 This was a large dataset covering 201 general practices “comparable to the UK norm”. Some …