Lowering cholesterol concentrations and mortality: a quantitative review of primary prevention trials.
OBJECTIVE
To determine the effects of lowering cholesterol concentrations on total and cause specific mortality in randomised primary prevention trials.


METHODS
Qualitative (meta-analytic) evaluation of total mortality from coronary heart disease, cancer, and causes not related to illness in six primary prevention trials of cholesterol reduction (mean duration of treatment 4.8 years).


METHODS
24,847 Male participants; mean age 47.5 years.


METHODS
Total and cause specific mortalities.


RESULTS
Follow up periods totalled 119,000 person years, during which 1147 deaths occurred. Mortality from coronary heart disease tended to be lower in men receiving interventions to reduce cholesterol concentrations compared with mortality in control subjects (p = 0.06), although total mortality was not affected by treatment. No consistent relation was found between reduction of cholesterol concentrations and mortality from cancer, but there was a significant increase in deaths not related to illness (deaths from accidents, suicide, or violence) in groups receiving treatment to lower cholesterol concentrations relative to controls (p = 0.004). When drug trials were analysed separately the treatment was found to reduce mortality from coronary heart disease significantly (p = 0.04).


CONCLUSIONS
The association between reduction of cholesterol concentrations and deaths not related to illness warrants further investigation. Additionally, the failure of cholesterol lowering to affect overall survival justifies a more cautious appraisal of the probable benefits of reducing cholesterol concentrations in the general population.
Muldoon
M F
MF
Department of Medicine, University of Pittsburgh, PA 15260.
Manuck
S B
SB
Matthews
K A
KA
D000368:Aged; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D002423:Cause of Death; D002784:Cholesterol / Q000097:blood*; D003327:Coronary Disease / Q000401:mortality / Q000517:prevention & control; D004032:Diet; D006801:Humans; D008297:Male; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D009026:Mortality; D009369:Neoplasms / Q000401:mortality; D011322:Primary Prevention
D000924:Anticholesteremic Agents; D002784:Cholesterol