Abstract

Introduction: The aim of this study was to compare different groups of cholesterol lowering drugs. Material: Randomized trials were included if: (1) they lasted for 2 years or more, (2) the intention to treat total mortality data was obtainable, (3) at least one death had occurred, (4) one cholesterol lowering drug (fibrate, nicotinic acid and its derivate acipimox, resin, statin or probucol) was used, (5) they were published before the end of 1997. Computerized database (MEDLINE), references from former meta-analyses, overviews and already located trials were the source of data. Method: Meta-analysis. We used the conventional pooled odds ratio (OR) method. OR was calculated for each drug and for each group of drugs. Results: 26 trials were included. Out of all drug groups the total mortality only decreased amongst statins OR=0.76 (95% CI 0.68-0.86). Fibrates OR=1.08 (95% CI 0.97Ð1.21), nicotinic acid together with acipimox OR=0.94 (95% CI 0.81-1.09), resins OR=0.86 (95% CI 0.66-1.11) had no effect on the total mortality. We found no trials with probucol. Similar results were obtained following an additional analysis using the same methods and involving trials with the percentage of patients with unknown vital conditions (5% and no cholestyramine. These conclusions could only be valid in the case of patients with hypercholesterolemia and mixed hyperlipidemia with only moderately elevated triglyceride levels. Randomized, long term trials did not involve patients with hypertriglyceridemia and mixed hyperlipidemia with considerably elevated triglyceride levels. Conclusions: There exists a difference in the total mortality between different groups of cholesterol lowering drugs. Only statins lowered the total mortality.

Keywords: Mortality, cholesterol lowering drugs, cholesterol level