Cholesterol reduction and non-illness mortality: meta-analysis of randomised clinical trialsBMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7277.11 (Published 06 January 2001) Cite this as: BMJ 2001;322:11
- Matthew F Muldoon, associate professor ()a,
- Stephen B Manuck, professorb,
- Aaron B Mendelsohn, research specialistc,
- Jay R Kaplan, professord,
- Steven H Belle, associate professorc
- 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
- Accepted 11 September 2000
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.
Funding This work was supported in part by United States National Institutes of Health grants HL46328 and HL40962.
Competing interests None declared.
Details of the trials included in the meta-analysis and their full references are available on the BMJ's website