To the Editor.—
In the April 15 issue of JAMA, Drs Kinosian and Eisenberg1 published an analysis of the cost-effectiveness of treating elevated levels of total serum cholesterol. Treatment regimens using cholestyramine resin, colestipol, and oat bran were compared. Based on the outcome of the Lipid Research Clinics Coronary Primary Prevention Trial, the cost per year of life saved was determined for each of these three agents.To date, there is no primary prevention trial that demonstrates that treating elevated serum cholesterol with hypolipidemic agents prolongs life. The Lipid Research Clinics Coronary Primary Prevention Trial2 and more recently the Helsinki Heart Study3 have demonstrated a significant decrease in cardiovascular mortality at the termination of the trials, using cholestyramine in the former and gemfibrozil in the latter. Unfortunately, overall mortality was unchanged in both trials owing to an excess of violent and accidental deaths in the treated groups.