Should there be a moratorium on the use of cholesterol lowering drugs?

Abstract

2][3][4] The degree of disagreement is surprising as they review essentially the same data, from clinical trials of cholesterol lowering by drugs or by diet.There is agreement about a reduced risk for coronary events, but there are differing interpretations of the increase in mortality from non-cardiovascular causes that has generally been seen.Particular concern was generated by a recent meta-analysis that showed a significantly increased risk of death from accidents and violence when the results of six randomised primary prevention trials were pooled.3Despite the uncertainty an aggressive approach to cholesterol reduction features in most of the official guidelines for the primary prevention of coronary heart disease.`InBritain the introduction of the new general practitioner contract, with its focus on health promotion, is likely to result in an increase in cholesterol testing.High percentages of the British population would become candidates for drug treat- ment if the guidelines currently advanced by some authorities were put into practice.For middle aged men and women with other coronary risk factors the European Atherosclerosis Society recommends a cut off level, above which the use of lipid lowering drugs should be considered,6 well below the mean population cholesterol concentration.0`'2The entry criteria for the expanded clinical evaluation of lovastatin study (EXCEL)"5 would include a third of the British population.

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Affiliated Institutions

• London School of Hygiene & Tropical Medicine GB
• Institute for Molecular Medicine Finland FI
• University of London GB

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