Effect of different antilipidemic agents and diets on mortality

Background: Guidelines for the prevention and treatment of hyperlipidemia are often based on trials using combinedclinicalendpoints.Mortalitydataarethemost reliabledatatoassessefficacyofinterventions.Weaimed to assess efficacy and safety of different lipid-lowering interventions based on mortality data. Methods: We conducted a systematic search of randomizedcontrolledtrialspublisheduptoJune2003,comparing any lipid-lowering intervention with placebo or usual diet with respect to mortality. Outcome measures were mortality from all, cardiac, and noncardiovascular causes. Results:Atotalof97studiesmeteligibilitycriteria,with 137140 individuals in intervention and 138976 individualsincontrolgroups.Comparedwithcontrolgroups, riskratiosforoverallmortalitywere0.87forstatins(95% confidenceinterval[CI],0.81-0.94),1.00forfibrates(95% CI, 0.91-1.11), 0.84 for resins (95% CI, 0.66-1.08), 0.96 for niacin (95% CI, 0.86-1.08), 0.77 for n-3 fatty acids (95% CI, 0.63-0.94), and 0.97 for diet (95% CI, 0.911.04). Compared with control groups, risk ratios for cardiac mortality indicated benefit from statins (0.78; 95% CI, 0.72-0.84), resins (0.70; 95% CI, 0.50-0.99) and n-3 fattyacids(0.68;95%CI,0.52-0.90).Riskratiosfornoncardiovascularmortalityofanyinterventionindicatedno associationwhencomparedwithcontrolgroups,withthe exception of fibrates (risk ratio, 1.13; 95% CI, 1.011.27).