BMJ 2001;322:11-15 ( 6 January )

Papers

Cholesterol reduction and non-illness mortality: meta-analysis of randomised clinical trials

Matthew F Muldoon, associate professor, ^a Stephen B Manuck, professor, ^b Aaron B Mendelsohn, research specialist, ^c Jay R Kaplan, professor, ^d Steven H Belle, associate professor. ^c

^a Center for Clinical Pharmacology, University of Pittsburgh School of Medicine, PA 15260, Pittsburgh, USA, ^b Department of Psychology, University of Pittsburgh, ^c Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, ^d Comparative Medicine Clinical Research Center, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC 27103, USA

Correspondence to: M F Muldoon, 506 Old Engineering Hall, University of Pittsburgh, Pittsburgh, PA 15260, USA mfm10+{at}pitt.edu

Objective: To investigate the association between cholesterol lowering interventions and risk of death from suicide, accident, or trauma (non-illness mortality).
Design: Meta-analysis of the non-illness mortality outcomes of large, randomised clinical trials of cholesterol lowering treatments.
Studies reviewed: 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
Main outcome measure: 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).
Conclusion: 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.

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