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April 22, 1992

Long-term Mortality After Primary Prevention for Cardiovascular Disease

JAMA. 1992;267(16):2183. doi:10.1001/jama.1992.03480160041016

To the Editor.  —The Editorial by Paul and Hennekens1 ignores the importance of the landmark observations from Finland by Strandberg et al,2 namely, that a trivial and temporary lowering of serum cholesterol concentrations doomed the subjects to long-term, increased mortality.What is called for is immediate, long-term follow-up data from all cholesterol-lowering trials to confirm these observations. When Muldoon et al3 published their meta-analysis, they observed that the average length of follow-up was 4.8 years for the 12457 subjects of the six most important cholesterol-lowering trials. As we now know, 15 years are needed to document the real hazards of cholesterol reduction.Sixty million Americans have been targeted for cholesterol reduction. By projecting the Finland results onto this group, we estimate that 2 million lives could be lost if treatment is prescribed. And this increased mortality will not come cheap. The cost of cholesterol-lowering drugs for 60