[Justification and imperatives of the campaign against excess cholesterol and prevention of atherosclerosis].
Recently, violent attacks have been orchestrated, by various media and the press against medical action, via diet or drug therapy, on excess cholesterol, in order to improve primary or secondary cardiovascular prevention. The amplitude of this campaign implies a dangerous risk of a deleterious effects both on the public and on medical guidelines. The opportunity for open discussion of this question, and of a clear reply, appears to be highly desirable for all concerned. Although it is quite true that total blood cholesterol levels in excess of 200 mg/dl (5.2 mmol/l) are not automatically dangerous, they nonetheless require complete profiling of cholesterol distribution among the different fractions and, if possible, a complementary study of ApoB, ApoA1 and Lpa fractions. It must be recalled that even modest rises in total cholesterol (250 +/- 30 mgs/dl) can be atherogenic, and particularly, when present in the non-HDL fractions, and involving a low HDL Cholesterol level (< 36 mg/dl or 0.9 mmol/l). In all these cases, the associated determination of triglyceride levels is absolutely necessary. Moreover these modest rises in cholesterol have to take into account the possible association of other risk factors, such as hypertension, cigarette smoking, diabetes, obesity and ... hyperfibrinogemia. The claims of the natural protection of French people against atherosclerosis and of the irrelevance of precocious cholesterol screening, then finally of non-demonstrated benefits of such prevention, with respect to other risks due to diet or drug treatment of cholesterol disorders must be precisely rediscussed and clarified. The crucial importance of the maintenance of our present efforts in cardiovascular prevention for clinicians, concerned patients, and the general public, must be especially stressed.
de Gennes
J L
JL
Service d'Endocrinologie-métabolisme, l'Hôpital, Paris.
D001161:Arteriosclerosis / Q000517:prevention & control*; D002784:Cholesterol / Q000097:blood*; D006801:Humans
D002784:Cholesterol
Justification et impératifs de la lutte contre les excès de cholestérol en prévention de l'athérosclérose.