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

TLDR: An aggressive approach to cholesterol reduction features in most of the official guidelines for the primary prevention of coronary heart disease, and high percentages of the British population would become candidates for drug treatment if the guidelines currently advanced by some authorities were put into practice.

Abstract: Recent reviews of the primary prevention of coronary heart disease through lowering cholesterol concentrations have varied considerably in their evaluation of the benefits of the intervention. 1-4 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.3 Despite the uncertainty an aggressive approach to cholesterol reduction features in most of the official guidelines for the primary prevention of coronary heart disease.` In Britain 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 treatment 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`'2 The entry criteria for the expanded clinical evaluation of lovastatin study (EXCEL)\"5 would include a third of the British population. 10-12