Impact of cholesterol reduction on total mortality

Cholesterol lowering with statins or diet is beneficial for cardiovascular and total mortality. Hormones and fibrates may increase non-cardiovascular mortality and total mortality, and hormones may increase cardiovascular mortality.

A systematic review including 35 studies (primary and secondary prevention with a total of 77,079 subjects was abstracted in DARE.

Cardiovascular mortality was reduced by 13–14% for every 10% reduction in serum cholesterol.

Non-cardiovascular mortality: Fibrate use resulted in a 30% increase in risk (p=0.01). Hormone use was also associated with an increased risk (55% increase, p<0.05).

Total mortality: For every 10% reduction in serum cholesterol, mortality risk was reduced by 8–10%. However, fibrate use was associated with increased total mortality for all trials (17% increase, p=0.02). Hormones were not used in the primary prevention trials included in this analysis, but in all other sets of trials hormone use was associated with increased mortality (32–33% increase, p=0.01).

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1. Gould AL, Rossouw JE, Santanello NC, Heyse JF, Furberg CD. Cholesterol reduction yields clinical benefit. A new look at old data. Circulation 1995 Apr 15;91(8):2274-82.