To the Editor.—
I have read the interesting analysis by Wysowski and Gross1 of deaths due to accidents and violence in two cholesterol-lowering drug trials. The authors conclude, on the basis of a retrospective analysis of case records, that most deaths in the treatment arm of these trials occurred in dropouts or in subjects with known risk factors like alcohol intoxication and a history of psychiatric symptoms. A recent meta-analysis of cause specific and total mortality in six primary prevention trials by Muldoon et al,2 however, revealed a highly significant "association" between death due to suicides, accidents, and violence and treatment to lower the serum cholesterol level, with an odds ratio of death due to violence or suicide of 1.76 in the treated patients (95% confidence interval, 1.19to2.58; P<.004). This excess mortality was seen in both dietary and drug intervention studies and was believed to be inconsistent
Vasan RS. Lowering Cholesterol and Death due to Accidents, Suicides: Unresolved Issues. Arch Intern Med. 1992;152(2):414. doi:10.1001/archinte.1992.00400140150034
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