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

BMJ 2001; 322 doi: (Published 06 January 2001) Cite this as: BMJ 2001;322:11
  1. Matthew F Muldoon, associate professor (mfm10+{at},
  2. Stephen B Manuck, professorb,
  3. Aaron B Mendelsohn, research specialistc,
  4. Jay R Kaplan, professord,
  5. Steven H Belle, associate professorc
  1. a Center for Clinical Pharmacology, University of Pittsburgh School of Medicine, PA 15260, Pittsburgh, USA
  2. b Department of Psychology, University of Pittsburgh
  3. c Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh
  4. d Comparative Medicine Clinical Research Center, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC 27103, USA
  1. 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.

  • Embedded Image
    Details of the trials included in the meta-analysis and their full references are available on the BMJ's website

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