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Cholesterol lowering treatments and death not related to illness

 

Many people are now trying to lower their serum cholesterol to prevent coronary heart disease. Because dietary treatments have a limited effect, cholesterol lowering drugs, particularly statins, are becoming increasingly popular. However, associations have been reported between low serum cholesterol concentrations and death from non-illness causes (i.e. suicide, accident or violence). This meta-analysis investigates the association between cholesterol lowering treatments and the risk of death from causes unrelated to illness.

Message

Cholesterol lowering treatments do not increase the risk of death from suicide, accident or violence.

Reference

MF Muldoon et al. Cholesterol reduction and non-illness mortality: meta-analysis of randomised clinical trials. British Medical Journal 2001 322: 11-15.

Search

The literature was searched using MEDLINE from 1966 to 2000. Bibliographies were also reviewed. Studies meeting the following criteria were selected: they were randomised controlled trials; the average serum cholesterol concentration in the non-treatment group remained relatively stable during the trial (i.e. less than 5% variation); other treatments (e.g. antihypertensive drugs, advice on stopping smoking or stress reduction) were not administered preferentially to participants receiving the cholesterol-lowering treatment; and trials were designed to measure the effects of treatment on mortality (rather than serum lipid concentrations).

Nineteen trials met the selection criteria. Trials were classified as primary prevention if all or most participants were free of coronary heart disease at the start of the trial. Secondary prevention trials consisted exclusively of participants with clinically evident coronary heart disease. The majority of participants were men, aged between 40 and 70 years, who were followed for one to ten years. There were a total of 70,704 participants, 42,500 in the primary prevention trials and 28,204 in the secondary prevention trials, with just about equal numbers in the treatment and non-treatment groups. The cholesterol lowering treatment was diet in five of the trials (12,530 participants), pharmacological in 13 (30,817 participants on statins and 26,519 on non-statins) and surgical in one (838 participants). Each treatment lowered the average serum cholesterol concentration in the treatment group relative to the non-treatment group, although the average reduction varied across studies from 3.5% to 26%.

There were a total of 243 deaths from non-illness causes (130 having received treatment and 113 not having received treatment).

Results

There was no significant increase in deaths from suicide, accident or violence among participants receiving a cholesterol lowering treatment compared with those not receiving a treatment (odds ratio 1.18, 95% confidence interval 0.91 to 1.52).

This was also the case for participants

Furthermore, no association was found between the magnitude of cholesterol reduction and the risk of death from non-illness causes.

Comment

Ten years ago, a meta-analysis (conducted by the same first author) found that cholesterol lowering treatments did increase the risk of death from non-illness causes. The difference in results between these two analyses stresses the importance of keeping up to date with the most currently available evidence.