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Clinical Decisionmaking

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Lipid-lowering medications are not associated with increased risk of injury

Early trials of lipid-lowering medications to lower blood cholesterol levels showed reductions in coronary heart disease problems and death, but these may have been offset by increased injury-related deaths. In addition, it was speculated that lipid lowering could lead to psychiatric conditions such as depression or hostility and, in turn, self-destructive and violent behavior. However, a recent study suggests no association between lipid-lowering medications and elevated risk of injury and supports recent clinical trials and current recommendations for use of these medications to lower blood cholesterol. The study was supported by the Agency for Healthcare Research and Quality (HS08469) and led by Viktor E. Bovbjerg, Ph.D., of the University of Virginia School of Medicine.

Dr. Bovbjerg and colleagues studied death registries, hospital discharge diagnoses, pharmacy databases, and medical records of adult members of a large health maintenance organization. They identified patients prescribed lipid-lowering agents over a period of 7 years and those who were injured or died from motor vehicle collisions, self-inflicted injury, or assault. They examined the association of lipid-lowering medication use with fatal and nonfatal injuries in 298 cases and 332 controls.

The researchers found no increased injury risk among current users of lipid-lowering medications (odds ratio, OR, 0.46; 1 is equal odds) or past users (OR, 0.92), after adjustment for behavioral disorders, medical conditions, and health status. In fact, current use of these medications was associated with lower risk of injury among patients who did not have behavioral disorders. Both current and past use were associated with reduced injury risk in those with clinical cardiovascular disease (CVD) but not among those without CVD.

More details are in "Lipid-lowering medication and risk of injury," by Dr. Bovbjerg, David S. Siscovick, M.D., Bruce M. Psaty, M.D., and others, in the Journal of Clinical Epidemiology 52(12), pp. 1197-1200.

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