From Merch Research Laboratories, West Point, Pa (A.L.G., N.C.S.,
J.F.H.); NIH, Bethesda, Md (J.E.R.); and Bowman Gray School of Medicine,
Winston-Salem, NC (C.D.F.).
Correspondence to A. Lawrence Gould, Merck Research Laboratories, BL3–2, West Point, PA 19486. E-mail goulda{at}merck.com
Background—We determined the effect
of incorporating the results of eight recently published trials of Hmg
CoA reductase inhibitors ("statins") on the conclusions
from our previously published meta-analysis regarding the
clinical benefit of cholesterol lowering.
Methods and Results—We used the same analytic approach as in our
previous investigation, separating the specific effects of
cholesterol lowering from the effects attributable to the
different types of intervention studied. The reductions in
coronary heart disease (CHD) and total mortality risk observed
for the statins fell near the predictions from our earlier
meta-analysis. Including the statin trial findings into the
calculations led to a prediction that for every 10 percentage points of
cholesterol 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 the values of
13% and 10%, respectively, reported previously.
Cholesterol lowering in general and by the statins in
particular does not increase non-CHD mortality risk.
Conclusions—Adding the results from the statin trials confirmed
our original conclusion that lowering cholesterol is
clinically beneficial. The relationships (slope) between
cholesterol lowering and reduction in CHD and total
mortality risk became stronger, and the standard error of the estimated
slopes decreased by about 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 proportional to the degree to which they lower
lipids.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Cholesterol Reduction Yields Clinical Benefit
Impact of Statin Trials
Key Words: cholesterol • meta-analysis • mortality
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