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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.
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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.
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