Dietary and drug therapies for primary prevention of atherosclerosis.

Atherosclerosis results from a multifactorial process. For that reason, pri mary prevention of cardiovascular diseases requires several measures that s hould exhibit antiatherogenic, antithrombotic, antioxidative and antihypert ensive properties. Two types of therapeutic strategies can be individualize d. Nutritional interventions are the first line measures for population wid e primary prevention in subjects at low risk of developing atheroscleric di seases. In high risk individuals who have either one major risk factor (LDL cholesterol above 190 mg/dL) or several additional risk factors, dietary m easures must be frequently combined with drug treatments. However, the cost -effectiveness ratio should be weighed prior to any treatment especially wi th statins. Dietary measures consist to reduce caloric intakes in overweigh t subjects or more generally to adopt eating patterns which correspond to t he following recommendations: (i) proteins = 15% of total calories; (ii) sa turated and polyunsatured fats = 10% each; (iii) carbohydmtes plus monounsa turated fats = 65 % Such dietary instructions permit individual dietary cha nges, just by adjusting the carbohydrates/monounsaturates balance, the sum of both nutrients remaining in all cases equal to two-thirds of total calor ies. Drug treatments are only indicated after secondary dietary failure. Th ey are generally based on the use of statins since the efficacy of these tr eatments has been clearly established try such preventive trials as the WOS COP Slurry, provided that the therapeutic interventions result in significa nt reduction of LDL cholesterol levels over several years. Antiplatelet age nts (aspirin), antihypertensive therapies, antioxidant supplementations wit h vitamins E or C are also recommended in some individuals for completing t he beneficial effects of the above mentioned measures. (C) 1999 Elsevier, P aris.