| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Circulation, Vol 82, 1916-1924, Copyright © 1990 by American Heart Association
I Holme
The primary aim of this study was to estimate the relation between
cholesterol reduction and total mortality and coronary heart disease (CHD)
incidence. Secondarily, the clinical issues of whether the efficacy of
cholesterol lowering is dependent on the treatment modality, presence of
CHD at baseline, or the simultaneous introduction of other interventions
was explored. All randomized clinical intervention trials of cholesterol
reduction were used in an overview analysis of total mortality rate and CHD
incidence; analysis was performed with weighted linear regression. The
trials include those that used primary and secondary intervention, diet and
drugs, and single or multifactor design. Nineteen trials were analyzed for
total mortality, and of the 19, 16 were analyzed for CHD incidence rate.
Net difference in cholesterol change between study groups was used as the
independent variable, and the three previously mentioned dichotomous design
characteristics were used as additional independent variables. For every 1%
reduction in cholesterol, an estimated 2.5% reduction in CHD incidence is
indicated (95% CL: 1.1, 3.9). With regard to CHD drug trials tended toward
better efficiency in cholesterol lowering than did dietary trials. With
regard to total mortality, this efficiency was higher in secondary than in
primary preventive trials. The efficiency was also somewhat dependent on
the baseline cholesterol level. This study shows that cholesterol reduction
is effective in lowering CHD incidence, but cholesterol reduction must be
at least 8-9% to be effective in lowering total mortality.
ARTICLES
An analysis of randomized trials evaluating the effect of cholesterol reduction on total mortality and coronary heart disease incidence [published erratum appears in Circulation 1991 Dec;84(6):2610-1]
Life Insurance Companies' Institute for Medical Statistics, Ullevaal Hospital, Oslo, Norway.
This article has been cited by other articles:
 |
|
 |
|
  C. D. Gardner, M. Messina, A. Kiazand, J. L. Morris, and A. A. Franke Effect of Two Types of Soy Milk and Dairy Milk on Plasma Lipids in Hypercholesterolemic Adults: A Randomized Trial J. Am. Coll. Nutr., December 1, 2007; 26(6): 669 - 677. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. J. Jenkins, C. W. Kendall, D. A Faulkner, T. Nguyen, T. Kemp, A. Marchie, J. M. Wong, R. de Souza, A. Emam, E. Vidgen, et al. Assessment of the longer-term effects of a dietary portfolio of cholesterol-lowering foods in hypercholesterolemia Am. J. Clinical Nutrition, March 1, 2006; 83(3): 582 - 591. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Prepared by: British Cardiac Society, British Hype JBS 2: Joint British Societies' guidelines on prevention of cardiovascular disease in clinical practice Heart, December 1, 2005; 91(suppl_5): v1 - v52. [Full Text] [PDF]
|
|
|
|
 |
|
 D. J.A. Jenkins, C. W.C. Kendall, and A. Marchie Diet and Cholesterol Reduction Ann Intern Med, May 3, 2005; 142(9): 793 - 795. [Full Text] [PDF]
|
|
|
|
 |
|
 C. Atkinson, W. Oosthuizen, S. Scollen, A. Loktionov, N. E. Day, and S. A. Bingham Modest Protective Effects of Isoflavones from a Red Clover-Derived Dietary Supplement on Cardiovascular Disease Risk Factors in Perimenopausal Women, and Evidence of an Interaction with ApoE Genotype in 49-65 Year-Old Women J. Nutr., July 1, 2004; 134(7): 1759 - 1764. [Abstract] [Full Text]
|
|
|
|
 |
|
 M. J Everly, P. C Heaton, and R. J Cluxton Jr {beta}-Blocker Underuse in Secondary Prevention of Myocardial Infarction Ann. Pharmacother., February 1, 2004; 38(2): 286 - 293. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R.S. Hornung Reducing cholesterol and atherosclerosis QJM, June 1, 2002; 95(6): 339 - 341. [Full Text] [PDF]
|
|
|
|
 |
|
 S. I. McFarlane, R. Muniyappa, R. Francisco, and J. R. Sowers Pleiotropic Effects of Statins: Lipid Reduction and Beyond J. Clin. Endocrinol. Metab., April 1, 2002; 87(4): 1451 - 1458. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R R WEST Evidence based medicine overviews, bulletins, guidelines, and the new consensus Postgrad. Med. J., July 1, 2000; 76(897): 383 - 389. [Full Text]
|
|
|
|
|
|
D. B. Hunninghake, K. C. Maki, P. O. Kwiterovich Jr, M. H. Davidson, M. R. Dicklin, and S. D. Kafonek Incorporation of Lean Red Meat into a National Cholesterol Education Program Step I Diet: A Long-Term, Randomized Clinical Trial in Free-Living Persons with Hypercholesterolemia J. Am. Coll. Nutr., June 1, 2000; 19(3): 351 - 360. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Marshall, E. Kennedy, and S. Offutt Exploring a fiscal food policy: the case of diet and ischaemic heart disease • Commentary: Alternative nutrition outcomes using a fiscal food policy BMJ, January 29, 2000; 320(7230): 301 - 305. [Full Text]
|
|
|
|
 |
|
 A. Decensi, S. Gandini, A. Guerrieri-Gonzaga, H. Johansson, L. Manetti, B. Bonanni, M. T. Sandri, A. Barreca, A. Costa, C. Robertson, et al. Effect of Blood Tamoxifen Concentrations on Surrogate Biomarkers in a Trial of Dose Reduction in Healthy Women J. Clin. Oncol., September 1, 1999; 17(9): 2633 - 2633. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. H. Davidson, D. Hunninghake, K. C. Maki, P. O. Kwiterovich Jr, and S. Kafonek Comparison of the Effects of Lean Red Meat vs Lean White Meat on Serum Lipid Levels Among Free-living Persons With Hypercholesterolemia: A Long-term, Randomized Clinical Trial Arch Intern Med, June 28, 1999; 159(12): 1331 - 1338. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. McCormick, J. H. Gurwitz, D. Lessard, J. Yarzebski, J. M. Gore, and R. J. Goldberg Use of Aspirin, {beta}-Blockers, and Lipid-Lowering Medications Before Recurrent Acute Myocardial Infarction: Missed Opportunities for Prevention? Arch Intern Med, March 22, 1999; 159(6): 561 - 567. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. B. Anker, H. Refsum, P. M. Ueland, D. C. Johannessen, E. A. Lien, and P. E. Lonning Influence of Aromatase Inhibitors on Plasma Total Homocysteine in Postmenopausal Breast Cancer Patients Clin. Chem., February 1, 1999; 45(2): 252 - 256. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
British Cardiac Society, British Hyperlipidaemia Association, British Hypertension Society, and endorsed by the British Diabetic Association Joint British recommendations on prevention of coronary heart disease in clinical practice Heart, July 1, 1998; 80(90002): 1S - 29. [Full Text]
|
|
|
|
 |
|
 G. Fager and O. Wiklund Cholesterol Reduction and Clinical Benefit : Are There Limits to Our Expectations? Arterioscler. Thromb. Vasc. Biol., December 1, 1997; 17(12): 3527 - 3533. [Abstract] [Full Text]
|
|
|
|
 |
|
 E. Stein, D. Sprecher, K.S. Allenby, R.L. Tosiello, E. Whalen, and S.R. Ripa Cerivastatin, a New Potent Synthetic HMG Co-A Reductase Inhibitor: Effect of 0.2 mg Daily in Subjects With Primary Hypercholesterolemia Journal of Cardiovascular Pharmacology and Therapeutics, January 1, 1997; 2(1): 7 - 16. [Abstract] [PDF]
|
|
|
|
 |
|
 F. H. Epstein Cardiovascular Disease Epidemiology : A Journey From the Past Into the Future Circulation, May 1, 1996; 93(9): 1755 - 1764. [Full Text]
|
|
|
|
|
|
R. P. Byington, J. W. Jukema, J. T. Salonen, B. Pitt, A. V. Bruschke, H. Hoen, C. D. Furberg, and G. B. J. Mancini Reduction in Cardiovascular Events During Pravastatin Therapy : Pooled Analysis of Clinical Events of the Pravastatin Atherosclerosis Intervention Program Circulation, November 1, 1995; 92(9): 2419 - 2425. [Abstract] [Full Text]
|
|
|
|
|
|
L.H. Kuller, L. Shemanski, B.M. Psaty, N.O. Borhani, J. Gardin, M.N. Haan, D.H. O'Leary, P.J. Savage, G.S. Tell, and R. Tracy Subclinical Disease as an Independent Risk Factor for Cardiovascular Disease Circulation, August 15, 1995; 92(4): 720 - 726. [Abstract] [Full Text]
|
|
|
|
|
|
A. L. Gould, J. E. Rossouw, N. C. Santanello, J. F. Heyse, and C. D. Furberg Cholesterol Reduction Yields Clinical Benefit : A New Look at Old Data Circulation, April 15, 1995; 91(8): 2274 - 2282. [Abstract] [Full Text]
|
|
|
|
|
|
L Bonneux, J J Barendregt, U Ravnskov, L E Ramsay, W W Yeo, P R Jackson, T A Sheldon, F Song, J Millo, C L M Sudlow, et al. Ischaemic heart disease and cholesterol There's more to heart disease than cholesterol BMJ, April 16, 1994; 308(6935): 1038 - 1041. [Full Text]
|
|