CHOLESTEROL REDUCTION YIELDS CLINICAL BENEFIT - IMPACT OF STATIN TRIALS

Background-We determined the effect of incorporating the results of ei ght recently published trials of Hmg CoA reductase inhibitors (''stati ns'') on the conclusions fi-om our previously published meta-analysis regarding the clinical benefit of cholesterol lowering. Methods and Re sults-We used the same analytic approach as in our previous investigat ion, separating the specific effects of cholesterol lowering from the effects attributable to the different types of intervention studied, T he reductions in coronary heart disease (CHD) and total mortality risk observed for the statins fell near the predictions from our earlier m eta-analysis. Including the statin trial findings into the calculation s led to a prediction that for every 10 percentage points of cholester ol lowering, CHD mortality risk would be reduced by 15% (P<.001), and total mortality risk would be reduced by 11% (P<.001), as opposed to t he values of 13% and 10%, respectively, reported previously. Cholester ol lowering in general and by the statins in particular does not incre ase non-CHD mortality risk. Conclusions-Adding the results from the st atin trials confirmed our original conclusion that lowering cholestero l is clinically beneficial. The relationships (slope) between choleste rol lowering and reduction in CHD and total mortality) risk became str onger, and the standard error of the estimated slopes decreased by abo ut half. Use of statins does not increase non-CHD mortality risk. The effect of the statins on CHD and total mortality risk can be explained by their lipid-lowering ability and appears to be directly proportion al to the degree to which they lower lipids.