Systematic review on the risk and benefit of different cholesterol-lowering interventions

Bucher et al., 1999 | Arterioscler Thromb Vasc Biol | Meta Analysis

Citation

Bucher H C, Griffith L E, Guyatt G H. Systematic review on the risk and benefit of different cholesterol-lowering interventions. Arterioscler Thromb Vasc Biol. 1999-Feb;19(2):187-95

Abstract

Meta-analyses have investigated the efficacy of cholesterol-lowering interventions in relation to the underlying risk of coronary heart disease and the extent and duration of cholesterol reduction. We systematically reviewed the efficacy of antilipidemic interventions on major mortality outcomes in relation to drug classes. We searched MEDLINE and EMBASE from 1966 through October 1996 for randomized, controlled trials of any cholesterol-lowering interventions reporting mortality data. We included 59 trials involving 85 431 participants in the intervention and 87 729 participants in the control groups. We pooled these trials into 7 pharmacological categories of cholesterol-lowering interventions: statins (13 trials), fibrates (12 trials), resins (8 trials), hormones (8 trials), niacin acid (2 trials), n-3 fatty acids (3 trials), and dietary interventions (16 trials). Of the cholesterol-lowering interventions, only statins showed a large and statistically significant reduction in mortality from coronary heart disease (risk ratio, 0.66; 95% confidence interval [CI], 0.54 to 0. 79) and from all causes (risk ratio, 0.75; 95% CI, 0.65 to 0.86). For both all-cause and cardiovascular mortality, the difference between statins and the combined estimate of the other classes of agents was unlikely to be due to chance (P<0.02 for both comparisons). Meta-regression analysis demonstrated that variability in results across trials could be largely explained on the basis of differences in the magnitude of cholesterol reduction. Statins have the largest effect on the reduction of cardiovascular and all-cause mortality, and this result recommends their use in preference to other antilipidemic agents. The greater effect of statins is likely due to the larger reduction in cholesterol.

Key Findings

The greater effect of statins is likely due to the larger reduction in cholesterol.

Outcomes Measured

• Requires manual extraction

Population

MeSH Terms

• Anticholesteremic Agents
• Cholesterol
• Coronary Disease
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors
• Multivariate Analysis
• Randomized Controlled Trials as Topic
• Risk Factors

Evidence Classification

• Level: Meta Analysis
• Publication Types: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Systematic Review
• Vertical: niacin

Provenance

• PMID: 9974397
• DOI: (not available)
• PMCID: Not in PMC
• Verified: 2026-04-09 via PubMed E-utilities API

Source extracted via PubMed E-utilities API on 2026-04-09