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July 1991

Does Cholesterol Lowering Increase Non—Illness-Related Mortality?-Reply

Author Affiliations

Rockville, Md

Arch Intern Med. 1991;151(7):1453-1454. doi:10.1001/archinte.1991.00400070195030

In Reply. —  We thank Muldoon and colleagues for their comments. They recommend that deaths due to homicide, suicide, and accidents in other randomized primary prevention trials be investigated as we did for the two most recent trials, the Lipid Research Clinics—Coronary Primary Prevention Trial (LRC-CPPT) of cholestyramine and the Helsinki Heart Study (HHS) of gemfibrozil.1 We agree that would be useful providing there is standardized information available on dropout status, adherence to treatment regimen, history and presence of psychiatric symptoms, use of alcohol and antidepressants, autopsy data including blood alcohol concentrations, and narrative concerning the circumstances of death. However, results from such an investigation of older trials would not alter or detract from our findings in these two most recent trials of cholesterol lowering.Muldoon et al2 undertook a meta-analysis of six primary prevention trials of cholesterol lowering, including the LRC-CPPT and the HHS, without having first

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