SynthesisBMJ (Clinical research ed.)1993
Cholesterol lowering and mortality: the importance of considering initial level of risk.
Synthesis in BMJ (Clinical research ed.), 1993. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 75 papers, 15 of them syntheses that pooled 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.
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.
Who cites it
75 citing papers in PubMed, 15 syntheses or guidelines pooled it, 428 citations in OpenAlex.
- Controversy and Debate : Questionable utility of the relative risk in clinical research: Paper 4 :Odds Ratios are far from "portable" - A call to use realistic models for effect variation in meta-analysis.Journal of clinical epidemiology · 2022Pooled it
- Controversy and Debate: Questionable utility of the relative risk in clinical research: Paper 2: Is the Odds Ratio "portable" in meta-analysis? Time to consider bivariate generalized linear mixed model.Journal of clinical epidemiology · 2022Pooled it
- Reduction in saturated fat intake for cardiovascular disease.The Cochrane database of systematic reviews · 2020Pooled it
- Reduction in saturated fat intake for cardiovascular disease.The Cochrane database of systematic reviews · 2020Pooled it
- Reduced or modified dietary fat for preventing cardiovascular disease.The Cochrane database of systematic reviews · 2012Pooled it
- Reduced or modified dietary fat for preventing cardiovascular disease.The Cochrane database of systematic reviews · 2011Pooled it
- Multiple risk factor interventions for primary prevention of coronary heart disease.The Cochrane database of systematic reviews · 2011Pooled it
- Multiple risk factor interventions for primary prevention of coronary heart disease.The Cochrane database of systematic reviews · 2006Pooled it
- JBS 2: Joint British Societies' guidelines on prevention of cardiovascular disease in clinical practice.Heart (British Cardiac Society) · 2005Guideline
- Dietary fat intake and prevention of cardiovascular disease: systematic review.BMJ (Clinical research ed.) · 2001Pooled it
- Use of lipid lowering drugs for primary prevention of coronary heart disease: meta-analysis of randomised trials.BMJ (Clinical research ed.) · 2000Pooled it
- Joint British recommendations on prevention of coronary heart disease in clinical practice. British Cardiac Society, British Hyperlipidaemia Association, British Hypertension Society, endorsed by the British Diabetic Association.Heart (British Cardiac Society) · 1998Guideline
- Can dietary interventions change diet and cardiovascular risk factors? A meta-analysis of randomized controlled trials.American journal of public health · 1997Pooled it
- North of England evidence based guidelines development project: summary version of evidence based guideline for the primary care management angina. North of England Stable Angina Guideline Development Group.BMJ (Clinical research ed.) · 1996Guideline
- Assessing possible hazards of reducing serum cholesterol.BMJ (Clinical research ed.) · 1994Pooled it
- Randomised trial of lipid lowering dietary advice in general practice: the effects on serum lipids, lipoproteins, and antioxidants.BMJ (Clinical research ed.) · 1995Trial
- Influence of method of reporting study results on decision of physicians to prescribe drugs to lower cholesterol concentration.BMJ (Clinical research ed.) · 1994Trial
- Prescribing propensity: influence of life-expectancy gains and drug costs.Journal of general internal medicine · 1994Trial
- A breeding strategy for high-oleic acid content and high-yield peanut using Tag SNPs and genomic selection.BMC plant biology · 2026Article
- Major Depressive Disorder (MDD) and Antidepressant Medication Are Overrepresented in High-Dose Statin Treatment.Frontiers in medicine · 2021Article
15 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
- Commented on by
- Commented on by
- Commented on by
- Erratum issued
Authors and funding
3 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo investigate the level of risk of death from coronary heart disease above which cholesterol lowering treatment produces net benefits.
designMeta-analysis of results of randomised controlled trials of cholesterol lowering treatments.
methodsPublished and unpublished data from all identified randomised controlled trials of cholesterol lowering treatments with six months or more follow up and with at least one death were included in the meta-analysis. The analyses were stratified by the rate of death from coronary heart disease in the control arms of the trials.
main outcome measuresDeath from all causes, from coronary heart disease, and from causes other than coronary heart disease.
resultsIn the pooled analysis, net benefit in terms of total mortality from cholesterol lowering was seen only for trials including patients at very high initial risk of coronary heart disease (odds ratio 0.74; 95% confidence interval 0.60 to 0.92). In a medium risk group no net effect was seen, and in the low risk group there were adverse treatment effects (1.22; 1.06 to 1.42). In a weighted regression analysis a significant (p < 0.001) trend of increasing benefit with increasing initial risk of coronary heart disease was shown. Raised mortality from causes other than coronary heart disease was seen in trials of drug treatment (1.21; 1.05 to 1.39) but not in the trials of non-drug treatments (1.02; 0.88 to 1.19). Cumulative meta-analysis showed that these results seem to have been stable as new trials appeared.
conclusionCurrently evaluated cholesterol lowering drugs seem to produce mortality benefits in only a small proportion of patients at very high risk of death from coronary heart disease. Population cholesterol screening could waste resources and even result in net harm in substantial groups of patients. Overall risk of coronary heart disease should be the main focus of clinical guidelines, and a cautious approach to the use of cholesterol lowering drugs should be advocated. Future trials should aim to clarify the level of risk above which treatment is of net benefit.
Indexed as
Identifiers
What OpenQuestion holds
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.