A new therapeutic paradigm for patients with cirrhosis.Tsochatzis EA, Bosch J, Burroughs AK. Hepatology. 2012 Jun 22. [Epub ahead of print] Cirrhosis is a major health problem, being the 5(th) cause of death in UK and 12(th) in USA, but 4(th) in the 45 to 54 age group. Until recently cirrhosis was considered a single and terminal disease stage, with an inevitable poor prognosis. However it is now clear that 1-year mortality can range from 1% in early cirrhosis to 57% in decompensated disease. As the only treatment for advanced cirrhosis is liver transplantation, what is urgently needed, is strategies to prevent transition to decompensated stages. The evidence we present in this review, clearly demonstrates that management of patients with cirrhosis should change from an expectant algorithm that treats complications as they occur, to preventing the advent of all complications whilst in the compensated phase. This needs to maintain patients in an asymptomatic phase and not significantly affect their quality of life with minimal impairment due to the therapies themselves. This could be achieved with lifestyle changes and combinations of already licensed and low-cost drugs, similar to the paradigm of treating risk factors for cardiovascular disease. The drugs are propranolol, simvastatin, norfloxacin and warfarin, which in combination would cost £128/patient annually – equivalent to US $196/year. This treatment strategy requires randomized controlled trials to establish improvements in outcomes. In the 21(st) century, cirrhosis should be regarded as a potentially treatable disease with currently available and inexpensive therapies. (HEPATOLOGY 2012.).