Coronary heart disease: cholesterol-lowering decreases death.

Clinical bottom line (level 1a)

  1. Patients with coronary heart disease who are given cholesterol-lowering therapy are less likely to die, than those given no cholesterol-lowering (NNT = 63 at unknown) .
  2. Patients who are given cholesterol-lowering therapy are less likely to die from CHD death (NNT = 56 at unknown) .
  3. Patients given other forms of cholesterol lowering therapies were not significantly less likely to die.
Gould et al: Circulation 1998; 97: 946-952
Expires March 2003

The study

Systematic review of published, randomised trials of
  • Patients: coronary heart disease (CHD)
  • Intervention: cholesterol-lowering therapy compared with no cholesterol-lowering
  • Outcome: mortality and cardiac morbidity


Articles found in unstated languages using no search strategy stated, no range of dates stated (search terms: none given )

Selection criteria: as above
Appraisal criteria: detailed in text
Articles excluded if: duration of trial less than 2 years

43 trials were included.

The evidence

Outcome Time to outcome CEREERRRR
(95% CI)		ARR
(95% CI)		NNT
(95% CI)
all deaths unknown 5110
(10.1%)		 3868
(8.49%)		 16.0%
(12.0% to 19.0%)		 1.60%
(1.23% to 1.96%)		 63
(51 to 81)
CHD death weeks 3236
(6.39%)		 2095
(4.60%)		 28.0%
(24.0% to 32.0%)		 1.79%
(1.50% to 2.08%)		 56
(48 to 67)

  • Calculated from numbers in article
  • The relationship between reduction cholesterol and in cardiovascular mortality was consistent between therapies. Non-statins had an increased risk of non-cardiovascular mortality, whereas statins did not affect this result.

Comments

  1. Note the studies included in this review of lipid lowering included the use of fibrates, estrogens, and diet, without evidence of significant benefit.
  2. Although no search strategy detailed, the trials included are those from similar meta-analyses on the same topic.

Citation

  1. Gould AL, Rossouw JE, Santanello NC, et al: Cholesterol reduction yields clinical benefit: Impact of statin trials. Circulation 1998; 97: 946-952
Contributor: Clare Wotton and Bob Phillips, January 2000
Reviewer: Daniel Sontheimer

Clinical Question.
Patient coronary heart disease
Intervention or Exposure cholesterol-lowering therapy
Comparison no cholesterol-lowering
Outcome mortality