Evidence map›Paper›PMID 8124144›Full record

SynthesisBMJ (Clinical research ed.)1994

Assessing possible hazards of reducing serum cholesterol.

M R Law, S G Thompson, N J Wald

Abstract readMeta-AnalysisSystematic Review
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. Cited by 65 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
65citing papers in PubMed, 4 pooled it
47.4field-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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

65 citing papers in PubMed, 4 syntheses or guidelines pooled it, 314 citations in OpenAlex.

  1. Pooled it
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  4. Guideline
  5. Trial
  6. Trial
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  8. Review
  9. Article
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  13. Article
  14. Tumor macroenvironment and metabolism.Seminars in oncology · 2014
    Review
  15. Incretin-based therapies: focus on effects beyond glycemic control alone.Diabetes therapy : research, treatment and education of diabetes and related disorders · 2013
    Article
  16. Article
  17. Article
  18. Article
  19. Article
  20. Statin use and cancer risk: a comprehensive review.Expert opinion on drug safety · 2010
    Review

5 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.
S G Thompson
N J Wald
St Bartholomew's Hospital · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo assess whether low serum cholesterol concentration increases mortality from any cause.

designSystematic review of published data on mortality from causes other than ischaemic heart disease derived from the 10 largest cohort studies, two international studies, and 28 randomised trials, supplemented by unpublished data on causes of death obtained when necessary.

main outcome measuresExcess cause specific mortality associated with low or lowered serum cholesterol concentration.

resultsThe only cause of death attributable to low serum cholesterol concentration was haemorrhagic stroke. The excess risk was associated only with concentrations below about 5 mmol/l (relative risk 1.9, 95% confidence interval 1.4 to 2.5), affecting about 6% of people in Western populations. For noncirculatory causes of death there was a pronounced difference between cohort studies of employed men, likely to be healthy at recruitment, and cohort studies of subjects in community settings, necessarily including some with existing disease. The employed cohorts showed no excess mortality. The community cohorts showed associations between low cholesterol concentration and lung cancer, haemopoietic cancers, suicide, chronic bronchitis, and chronic liver and bowel disease; these were most satisfactorily explained by early disease or by factors that cause the disease lowering serum cholesterol concentration (depression causes suicide and lowers cholesterol concentration, for example). In the randomised trials nine deaths (from a total of 687 deaths not due to ischaemic heart disease in treated subjects) were attributed to known adverse effects of the specific treatments, but otherwise there was no evidence of an increased mortality from any cause arising from reduction in cholesterol concentration.

conclusionsThere is no evidence that low or reduced serum cholesterol concentration increases mortality from any cause other than haemorrhagic stroke. This risk affects only those people with a very low concentration and even in these will be outweighed by the benefits from the low risk of ischaemic heart disease.

Indexed as

Cause of DeathAccidentsCardiovascular DiseasesCholesterolCohort StudiesFemaleHumansMaleNeoplasmsProspective StudiesRandomized Controlled Trials as TopicRisk FactorsSuicideCholesterol

Identifiers

PMID8124144
PMCPMC2539477
OpenAlexW2016464689

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.