Cholesterol Reduction Yields Clinical Benefit: Impact of Statin Trials
Abstract
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.
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Alpha-linolenic acid is less effective than long-chain n-3 fatty acids at altering triglyceride levels.
“α-Linolenic acid is less effective at altering TG levels [156,193].”
From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [193]
Pharmacological doses of long-chain n-3 fatty acids of 2-3 g/day reduce triglycerides by about 30% and reduce post-prandial lipaemia, but higher doses may raise LDL-C.
“Pharmacological doses of long-chain n-3 fatty acids (2-3 g/day) reduce TG levels by about 30% and also reduce the post-prandial lipaemic response, but a higher dosage may increase LDL-C levels.”
From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [193]
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- Authors
- Gould, A. L., Rossouw, J. E., Santanello, N. C., Heyse, J. F., & Furberg, C. D.
- Affiliations
- Atrium Health Wake Forest Baptist (US)
- Venue
- Circulation
- Published
- 1998-03-17
- Volume
- 97
- Issue
- 10
- Pages
- 946-952
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2156857720
- Cited by
- 442
- References
- 50
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 3 · 2023: 2 · 2022: 4 · 2021: 5 · 2019: 6 · 2018: 4 · 2017: 4 · 2016: 5 · 2015: 12 · 2014: 9 · 2013: 12 · 2012: 16
- FWCI
- 11.64
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer, Lipids, and Metabolism
- Health Sciences › Medicine › Surgery › Cholesterol and Lipid Metabolism
- Keywords
- cholesterol lowering, statins, coronary heart disease mortality, all-cause mortality, lipid-lowering therapy
- MeSH terms
- Cholesterol, Clinical Trials as Topic, Coronary Disease, Humans, Hydroxymethylglutaryl CoA Reductases
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