JUSTIFICATION AND IMPERATIVE REQUIREMENTS FOR CORRECTION OF EXCESS CHOLESTEROL IN THE 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. T he opportunity for open discussion of this question, and of a clear re ply, 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 nonethless require complete profiling of cholesterol distribution among the different fra ctions and, if possible, a complementary study of ApoB, ApoA1 and Lpa fractions. It must be recalled that even modest rises in total cholest erol (250 +/- 30 mgs/dl) can be atherogenic, and particularly, when pr esent in the non-HDL fractions, and involving a low HDL Cholesterol le vel (< 36 mg/dl or 0.9 mmol/l). In all these cases, the associated det ermination of triglyceride levels is absolutely necessary. Moreover th ese modest rises in cholesterol have to take into account the possible association of other risk factors, such as hypertension, cigarette sm oking, diabetes, obesity and... hyperfibrinogemia. The claims of the n atural protection of French people against atherosclerosis and of the irrelevance of precocious cholesterol screening, then finaly of non-de monstrated benefits of such prevention, with respect to other risks du e 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, co ncerned patients, and the general public, must be especially stressed.