Cholesterol lowering trials in coronary heart disease: Frequency of citation and outcome.
Open accessAbstract
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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Literature identified primarily from references or experts may be prone to citation or publication bias.
“Literature identified primarily from references or experts may be prone to citation or publication bias [131],[132].”
From The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration (2009) · cites this paper as [132]
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- Authors
- Ravnskov, U.
- Corresponding author
- Ravnskov, U.
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 1992-07-04
- Volume
- 305
- Issue
- 6844
- Pages
- 15-19
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC1882525
- OpenAlex
- W2024674799
- Cited by
- 313
- References
- 36
- Citations by year
- 2025: 1 · 2023: 2 · 2022: 3 · 2021: 3 · 2020: 3 · 2019: 5 · 2018: 6 · 2017: 1 · 2016: 4 · 2015: 3 · 2014: 6 · 2013: 1 · 2012: 8
- FWCI
- 50.85
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
- Health Sciences › Medicine › Surgery › Cholesterol and Lipid Metabolism
- Keywords
- cholesterol lowering, coronary artery disease, serum cholesterol, mortality, citation bias, trial outcomes, statins
- MeSH terms
- Choice Behavior, Cholesterol, Clinical Trials as Topic, Coronary Disease, Humans, Time Factors, Writing, Confidence Intervals, Odds Ratio, Treatment Outcome
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