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approach which is substantially lower than the esti- K. F. FOX Editorials 1893mates in the paper by Marang-van de Mheen et al.[7] The model used differs in a number of ways, including use of discounting and lower projected statin costs, but if the UK estimate is regarded as a lower limit and the Netherlands estimate as the upper limit for cost per life year saved, screening does appear to be placed firmly in the area of a cost effective service. laemia should be part of everyday practice[9]. For those with FH, however found, management of the condition is needed. The timing of initiation of therapy remains controversial (and a key factor in costing a screening programme). To reduce the burden of atheroma, treatment as early as possible would seem appropriate. On the other hand delaying treatment until a certain level of risk is reached will reduce drug costs and may be safe, but risks events occurring in the pre-treatment years and the develop-ment of substantial subclinical atheroma. Lifestyle changes would of course still be appropriate but there is evidence that the burden of other risk factors (e.g. diabetes) is not substantial in FH patients [5]. Further evidence guiding management is needed in this area. The difficulties of estimating the cost of life years saved should not distract us from the core of the issue. We can debate the elements of the cost effectiveness models endlessly but I doubt the result would end up orders of magnitude different from the estimates in the papers from the Netherlands[7] and the UK.[8] FH is a lethal condition. We know how to identify cases and we know how to treat them effec-tively. Although when assessing the cost effectiveness of screening ‘the devil is in the detail ‘ we should not be distracted by it. European Heart Journal (2002) 23, 1893–1896 doi:10.1053/euhj.2002.3355, available online a

Do statins confer early benefit after acute coronary syndromes? The results from FLORIDA