Cholesterol-lowering: does not lead to an increase in violent death or suicide

Clinical bottom line (level 1a)

  1. Patients on cholesterol-lowering therapy compared with control are not more likely to have non-illness related death.
Muldoon et al: BMJ 2001; 322 : 11-15
Expires February 2004

The study

Systematic review of all randomised controlled trials of
  • Patients: hypercholesterolaemia
  • Intervention: diet, statins, non-statins, surgery compared with control
  • Outcome: death from suicide, accidents or violence
Articles found in ?all languages using Medline, 1966 to March 2000 (search terms: controlled clinical trial with cholesterol, diet (fat restricted) and anticholesterolemic drugs ) and and searching citation lists of retrieved articles

Selection criteria: see above and below
Appraisal criteria: not given
Articles excluded if:
  • multifactorial risk interventions
  • studies not designed to clinical events and cause-specific mortality
21 RCTs found - the primary prevention trials involving 42500 patients, and the secondary prevention trials 28204 patients.
Studies were not found to be heterogeneous.

The evidence

Outcome Time to outcome OR
(95% CI)
non-illness mortality weeks 1.18
(0.91 to 1.52)

  • Subgroup analysis based on primary prevention, secondary prevention, statins, or non-statin treatment failed to find any difference between subgroups.

Comments

  1. By limiting the search to Medline, important articles may have been missed.

Citation

  1. Muldoon MF, Manuck SB, Mendelsohn AB, et al: cholesterol reduction and non-illness mortality: meta-analysis of randomised clinical trials. BMJ 2001; 322 : 11-15
Search Terms: from ACP Journal Club other articles noted
Contributor: Chris Ball, February 2002
Reviewer:

Clinical Question.
Patient hypercholesterolaemia
Intervention or Exposure diet, non-statin drugs, statins, surgery
Outcome deaths from suicides, accidents, and violence