Cholesterol reduction and non-illness mortality: meta-analysis of randomised clinical trials.
OBJECTIVE
To investigate the association between cholesterol lowering interventions and risk of death from suicide, accident, or trauma (non-illness mortality).


METHODS
Meta-analysis of the non-illness mortality outcomes of large, randomised clinical trials of cholesterol lowering treatments.


METHODS
19 out of 21 eligible trials that had data available on non-illness mortality. INTERVENTIONS REVIEWED: Dietary modification, drug treatment, or partial ileal bypass surgery for 1-10 years.


METHODS
Deaths from suicides, accidents, and violence in treatment groups compared with control groups.


RESULTS
Across all trials, the odds ratio of non-illness mortality in the treated groups, relative to control groups, was 1.18 (95% confidence interval 0.91 to 1.52; P=0.20). The odds ratios were 1.28 (0.94 to 1.74; P=0.12) for primary prevention trials and 1.00 (0.65 to 1.55; P=0.98) for secondary prevention trials. Randomised clinical trials using statins did not show a treatment related rise in non-illness mortality (0.84, 0.50 to 1.41; P=0.50), whereas a trend toward increased deaths from suicide and violence was observed in trials of dietary interventions and non-statin drugs (1.32, 0.98 to 1.77; P=0.06). No relation was found between the magnitude of cholesterol reduction and non-illness mortality (P=0.23).


CONCLUSIONS
Currently available evidence does not indicate that non-illness mortality is increased significantly by cholesterol lowering treatments. A modest increase may occur with dietary interventions and non-statin drugs.
Muldoon
M F
MF
Center for Clinical Pharmacology, University of Pittsburgh School of Medicine, PA 15260, Pittsburgh, USA. mfm10_@pitt.edu
Manuck
S B
SB
Mendelsohn
A B
AB
Kaplan
J R
JR
Belle
S H
SH
D000059:Accidents / Q000401:mortality* / Q000706:statistics & numerical data; D000328:Adult; D000368:Aged; D000924:Anticholesteremic Agents / Q000008:administration & dosage; D016009:Chi-Square Distribution; D002791:Cholesterol, Dietary / Q000008:administration & dosage; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage; D006937:Hypercholesterolemia / Q000150:complications / Q000523:psychology / Q000628:therapy*; D007581:Jejunoileal Bypass; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D013405:Suicide / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000150:complications / Q000401:mortality*
D000924:Anticholesteremic Agents; D002791:Cholesterol, Dietary; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors