Evidence map›Paper›PMID 8043072›Full record

SynthesisBMJ (Clinical research ed.)1994

By how much and how quickly does reduction in serum cholesterol concentration lower risk of ischaemic heart disease?

M R Law, N J Wald, S G Thompson

Registry-linked trialAbstract readMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ (Clinical research ed.), 1994. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01406106 (EFFECT OF PLANT STEROLS ON THE LIPID PROFILE OF PATIENTS WITH HYPERCHOLESTEROLAEMIA. RANDOMISED, EXPERIMENTAL STUDY), which is not on this map. Cited by 261 papers, 20 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
261citing papers in PubMed, 20 pooled it
81.0field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01406106 naunknown statusnot on this mapstarted 2010, after this paper: background citation

Effect of plant sterols on the lipid profile of patients with hypercholesterolaemia. randomised, experimental study

TypeinterventionalSponsorGerencia de Atención Primaria, AlbaceteRan2010 to 2012Enrolled182ConditionsHypercholesterolemiaArmsPlant stanol esters
3 · Its place in the literature

Who cites it

261 citing papers in PubMed, 20 syntheses or guidelines pooled it, 1,218 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
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  4. Reduction in saturated fat intake for cardiovascular disease.The Cochrane database of systematic reviews · 2020
    Pooled it
  5. Reduction in saturated fat intake for cardiovascular disease.The Cochrane database of systematic reviews · 2020
    Pooled it
  6. Lipid-lowering agents for nephrotic syndrome.The Cochrane database of systematic reviews · 2013
    Pooled it
  7. HMG CoA reductase inhibitors (statins) for dialysis patients.The Cochrane database of systematic reviews · 2013 · on this map
    Pooled it
  8. Reduced or modified dietary fat for preventing cardiovascular disease.The Cochrane database of systematic reviews · 2012
    Pooled it
  9. Reduced or modified dietary fat for preventing cardiovascular disease.The Cochrane database of systematic reviews · 2011
    Pooled it
  10. Pooled it
  11. Pooled it
  12. Pooled it
  13. Low density lipoprotein cholesterol, statins and cardiovascular events: a meta-analysis.Clinical research in cardiology : official journal of the German Cardiac Society · 2006
    Pooled it
  14. Pooled it
  15. Guideline
  16. Pharmacotherapy for weight loss in adults with type 2 diabetes mellitus.The Cochrane database of systematic reviews · 2005
    Pooled it
  17. Pooled it
  18. A strategy to reduce cardiovascular disease by more than 80%.BMJ (Clinical research ed.) · 2003 · on this map
    Pooled it
  19. Pooled it
  20. Plant sterol and stanol margarines and health.BMJ (Clinical research ed.) · 2000
    Pooled it

201 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

3 authors at 1 institution in 1 country.

M R LawDepartment of Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, St Bartholomew's Medical College, London.
N J Wald
S G Thompson
St Bartholomew's Hospital · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo estimate by how much and how quickly a given reduction in serum cholesterol concentration will reduce the risk of ischaemic heart disease.

designData on the incidence of ischaemic heart disease and serum cholesterol concentration were analysed from 10 prospective (cohort) studies, three international studies in different communities, and 28 randomised controlled trials (with mortality data analysed according to allocated treatment to ensure the avoidance of bias).

main outcome measureDecrease in incidence of ischaemic heart disease or mortality for a 0.6 mmol/l (about 10%) decrease in serum cholesterol concentration.

resultsFor men results from the cohort studies showed that a decrease of serum cholesterol concentration of 0.6 mmol/l (about 10%) was associated with a decrease in incidence of ischaemic heart disease of 54% at age 40 years, 39% at age 50, 27% at 60, 20% at 70, and 19% at 80. The combined estimate from the three international studies (for ages 55-64 years) was 38% (95% confidence interval 33% to 42%), somewhat greater than the cohort study estimate of 27%. The reductions in incidence of ischaemic heart disease in the randomised trials (for ages 55-64 years) were 7% (0 to 14%) in the first two years, 22% (15% to 28%) from 2.1-5 years, and 25% (15% to 35%) after five years, the last estimate being close to the estimate of 27% for the long term reduction from the cohort studies. The data for women are limited but indicate a similar effect.

conclusionsThe results from the cohort studies, international comparisons, and clinical trials are remarkably consistent. The cohort studies, based on half a million men and 18,000 ischaemic heart disease events, estimate that a long term reduction in serum cholesterol concentration of 0.6 mmol/l (10%), which can be achieved by moderate dietary change, lowers the risk of ischaemic heart disease by 50% at age 40, falling to 20% at age 70. The randomised trials, based on 45,000 men and 4000 ischaemic heart disease events show that the full effect of the reduction in risk is achieved by five years.

Indexed as

AdultAgedAged, 80 and overCholesterolCohort StudiesFemaleHumansHypercholesterolemiaIncidenceMaleMiddle AgedMyocardial IschemiaProspective StudiesRandomized Controlled Trials as TopicRisk FactorsTime FactorsCholesterol

Identifiers

PMID8043072
PMCPMC2539460
OpenAlexW2132931461

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.