Cholesterol Lowering Trials in Coronary Heart Disease: Frequency of Citation and Outcome

Overview

Journal BMJ

Specialty General Medicine

Date 1992 Jul 4

PMID 1638188

Citations 61

Authors

U Ravnskov

Affiliations

Soon will be listed here.

Abstract

Objective: To see if the claim that lowering cholesterol values prevents coronary heart disease is true or if it is based on citation of supportive trials only.

Design: Comparison of frequency of citation with outcome of all controlled cholesterol lowering trials using coronary heart disease or death, or both, as end point.

Subjects: 22 controlled cholesterol lowering trials.

Results: Trials considered by their directors as supportive of the contention were cited almost six times more often than others, according to Science Citation Index. Apart from trials discontinued because of alleged side effects of treatment, unsupportive trials were not cited after 1970, although their number almost equalled the number considered supportive. In three supportive reviews the outcome of the selected trials was more favourable than the outcome of the excluded and ignored trials. In the 22 controlled cholesterol lowering trials studied total and coronary heart disease mortality was not changed significantly either overall or in any subgroup. A statistically significant 0.32% reduction in non-fatal coronary heart disease seemed to be due to bias as event frequencies were unrelated to trial length and to mean net reduction in cholesterol value; individual changes in cholesterol values were unsystematically or not related to outcome; and after correction for a small but significant increase in non-medical deaths in the intervention groups total mortality remained unchanged (odds ratio 1.02).

Conclusions: Lowering serum cholesterol concentrations does not reduce mortality and is unlikely to prevent coronary heart disease. Claims of the opposite are based on preferential citation of supportive trials.

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References

Yusuf S, Peto R, Lewis J, Collins R, Sleight P . Beta blockade during and after myocardial infarction: an overview of the randomized trials. Prog Cardiovasc Dis. 1985; 27(5):335-71. DOI: 10.1016/s0033-0620(85)80003-7. View

Stehbens W . Diet and atherogenesis. Nutr Rev. 1989; 47(1):1-12. DOI: 10.1111/j.1753-4887.1989.tb02743.x. View

Frantz Jr I, Dawson E, Ashman P, Gatewood L, BARTSCH G, Kuba K . Test of effect of lipid lowering by diet on cardiovascular risk. The Minnesota Coronary Survey. Arteriosclerosis. 1989; 9(1):129-35. DOI: 10.1161/01.atv.9.1.129. View

McCormick J, Skrabanek P . Coronary heart disease is not preventable by population interventions. Lancet. 1988; 2(8615):839-41. DOI: 10.1016/s0140-6736(88)92795-x. View

FRICK M, ELO O, Haapa K, Heinonen O, Heinsalmi P, Helo P . Helsinki Heart Study: primary-prevention trial with gemfibrozil in middle-aged men with dyslipidemia. Safety of treatment, changes in risk factors, and incidence of coronary heart disease. N Engl J Med. 1987; 317(20):1237-45. DOI: 10.1056/NEJM198711123172001. View

Canner P, BERGE K, Wenger N, Stamler J, Friedman L, Prineas R . Fifteen year mortality in Coronary Drug Project patients: long-term benefit with niacin. J Am Coll Cardiol. 1986; 8(6):1245-55. DOI: 10.1016/s0735-1097(86)80293-5. View

Miettinen T, HUTTUNEN J, Naukkarinen V, Strandberg T, Mattila S, KUMLIN T . Multifactorial primary prevention of cardiovascular diseases in middle-aged men. Risk factor changes, incidence, and mortality. JAMA. 1985; 254(15):2097-102. View

Muldoon M, Manuck S, Matthews K . Lowering cholesterol concentrations and mortality: a quantitative review of primary prevention trials. BMJ. 1990; 301(6747):309-14. PMC: 1663605. DOI: 10.1136/bmj.301.6747.309. View

Larosa J, Hunninghake D, Bush D, Criqui M, Getz G, Gotto Jr A . The cholesterol facts. A summary of the evidence relating dietary fats, serum cholesterol, and coronary heart disease. A joint statement by the American Heart Association and the National Heart, Lung, and Blood Institute. The Task Force on.... Circulation. 1990; 81(5):1721-33. DOI: 10.1161/01.cir.81.5.1721. View

10.

Zarling E, Sexton H, Milnor Jr P . Failure to diagnose acute myocardial infarction. The clinicopathologic experience at a large community hospital. JAMA. 1983; 250(9):1177-81. View

11.

Dorr A, Gundersen K, Schneider Jr J, Spencer T, Martin W . Colestipol hydrochloride in hypercholesterolemic patients--effect on serum cholesterol and mortality. J Chronic Dis. 1978; 31(1):5-14. DOI: 10.1016/0021-9681(78)90076-0. View

12.

WOODHILL J, Palmer A, Leelarthaepin B, McGilchrist C, BLACKET R . Low fat, low cholesterol diet in secondary prevention of coronary heart disease. Adv Exp Med Biol. 1978; 109:317-30. DOI: 10.1007/978-1-4684-0967-3_18. View

13.

Rogers M . Sir John Scott Burdon-Sanderson (1828-1905): a pioneer in electrophysiology. Circulation. 1969; 40(1):1-2. DOI: 10.1161/01.cir.40.1.1. View

14.

Leren P . The effect of plasma cholesterol lowering diet in male survivors of myocardial infarction. A controlled clinical trial. Acta Med Scand Suppl. 1966; 466:1-92. View

15.

Carlson L, Rosenhamer G . Reduction of mortality in the Stockholm Ischaemic Heart Disease Secondary Prevention Study by combined treatment with clofibrate and nicotinic acid. Acta Med Scand. 1988; 223(5):405-18. DOI: 10.1111/j.0954-6820.1988.tb15891.x. View

16.

Rossouw J, Lewis B, Rifkind B . The value of lowering cholesterol after myocardial infarction. N Engl J Med. 1990; 323(16):1112-9. DOI: 10.1056/NEJM199010183231606. View

17.

Holme I . An analysis of randomized trials evaluating the effect of cholesterol reduction on total mortality and coronary heart disease incidence. Circulation. 1990; 82(6):1916-24. DOI: 10.1161/01.cir.82.6.1916. View

18.

Easterbrook P, Berlin J, Gopalan R, Matthews D . Publication bias in clinical research. Lancet. 1991; 337(8746):867-72. DOI: 10.1016/0140-6736(91)90201-y. View

19.

Jones R, Rawlins M . Prescribing at the interface between hospitals and general practitioners. BMJ. 1992; 304(6818):4-5. PMC: 1880916. DOI: 10.1136/bmj.304.6818.4. View

20.

Oliver M . Doubts about preventing coronary heart disease. BMJ. 1992; 304(6824):393-4. PMC: 1881301. DOI: 10.1136/bmj.304.6824.393. View