LOWERING CHOLESTEROL CONCENTRATIONS AND MORTALITY - A QUANTITATIVE REVIEW OF PRIMARY PREVENTION TRIALS
LOWERING CHOLESTEROL CONCENTRATIONS AND MORTALITY - A QUANTITATIVE REVIEW OF PRIMARY PREVENTION TRIALS
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DOI：
10.1136/bmj.301.6747.309
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发表时间：
1990-08-11
影响因子：
105.7
通讯作者：
MATTHEWS, KA
中科院分区：
文献类型：
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作者：
MULDOON, MF;MANUCK, SB;MATTHEWS, KA
目的：在随机一级预防试验中确定降低胆固醇浓度对总死亡率和死因特异性死亡率的影响。设计图：定性（荟萃分析）评价6项降低胆固醇的一级预防试验中冠心病、癌症和与疾病无关的原因的总死亡率（平均治疗持续时间4.8年）。患者：24847名男性参与者;平均年龄47.5岁。主要观察指标：总死亡率和死因特异性死亡率。结果：随访期共计119000人年，其中1147人死亡。与对照受试者的死亡率相比，接受降低胆固醇浓度干预的男性冠心病死亡率往往较低（p = 0.06），尽管总死亡率不受治疗影响。胆固醇浓度降低与癌症死亡率之间没有一致的关系，但与对照组相比，接受降低胆固醇浓度治疗的组中与疾病无关的死亡（事故，自杀或暴力死亡）显着增加（p = 0.004）。当单独分析药物试验时，发现治疗显著降低冠心病死亡率（p = 0.04）。结论：胆固醇浓度降低与疾病无关的死亡之间的关系值得进一步研究。此外，降低胆固醇未能影响总生存率，这证明了对普通人群中降低胆固醇浓度的可能益处进行更谨慎的评估是合理的。
Objective: To determine the effects of lowering cholesterol concentrations on total and cause specific mortality in randomised primary prevention trials. Design: Qualitative (meta-analytic) evaluation of total mortality from coronary heart disease, cancer, and causes not related to illness in six primary prevention trials of cholesterol reduction (mean duration of treatment 4.8 years). Patients: 24 847 Male participants; mean age 47.5 years. Main outcome measures: Total and cause specific mortalities. Results: Follow up periods totalled 119 000 persons years, during which 1147 deaths occurred. Mortality from coronary heart disease tended to be lower in men receiving interventions to reduce cholesterol concentrations compared with mortality in control subjects (p = 0.06), although total mortality was not affected by treatment. No consistent relation was found between reduction of cholesterol concentrations and mortality from cancer, but there was a significant increase in deaths not related to illness (deaths from accidents, suicide, or violence) in groups receiving treatment to lower cholesterol concentrations relative to controls (p = 0.004). When drug trials were analysed separately the treatment was found to reduce mortality from coronary heart disease significantly (p = 0.04). Conclusions: The association between reduction of cholesterol concentrations and deaths not related to illness warrants further investigation. Additionally, the failure of cholesterol lower to affect overall survival justifies a more cautious appraisal of the probable benefits of reducing cholesterol concentrations in the general population.