Mortality Experience in Cholesterol-Reduction Trials

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Abstract
A national campaign to lower serum cholesterol concentrations on a population-wide basis began approximately six years ago, when accumulating evidence showed convincingly that cholesterol reduction prevents heart attacks. However, questions regarding the effects of cholesterol-lowering interventions on mortality have remained unanswered, because it is not feasible to conduct a clinical trial large enough to evaluate treatment effects on mortality confidently. In the October 18 issue of the Journal, Rossouw et al. report the findings of a quantitative review of all secondary prevention trials of cholesterol reduction.1 Working independently, we recently examined the randomized primary prevention trials, using the same meta-analytic techniques.2 Both articles address difficult issues concerning the effects of cholesterol-lowering interventions on cause-specific mortality and overall survival, and in this regard, meta-analytic evaluation can provide information that is otherwise unobtainable. A comparison of the findings of the two reviews ( Fig. 1 ) leads to several observations.

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