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July 1991

Does Cholesterol Lowering Increase Non—Illness-Related Mortality?

Author Affiliations

Pittsburgh, Pa

Arch Intern Med. 1991;151(7):1453. doi:10.1001/archinte.1991.00400070195029

To the Editor.—  We applaud the efforts of Wysowski and Gross1 to examine the individual cases of death by accident, suicide, and violence in two cholesterol reduction trials. However, their case record review is incomplete and their interpretation is based, in part, on dubious premises.Wysowski and Gross refer to the excess of suicides and violent deaths as small in number and statistically insignificant. Such statements reflect an incomplete appreciation of the outcomes of clinical trials of cholesterol reduction. The authors included only two randomized, primary prevention trials; in fact, all six existing trials observed a numerical excess of suicide and violent death among treated subjects, compared with controls. While this association is not statistically significant in any individual trial, we2 recently reported that when all trials are considered in aggregate (ie, subjected to meta-analytic evaluation), the increase in unnatural mortality (suicides, accidents, and violence) among treated men

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