[Primary nutritional and drug prevention of atherosclerosis]

Atherosclerosis results from a multifactorial process. For that reason, primary prevention of cardiovascular diseases requires several measures that should exhibit antiatherogenic, antithrombotic, antioxidative and antihypertensive properties. Two types of therapeutic strategies can be individualized. Nutritional interventions are the first line measures for population wide primary prevention in subjects at low risk of developing atheroscleric diseases. In high risk individuals who have either one major risk factor (LDL cholesterol above 190 mg/dL) or several additional risk factors, dietary measures must be frequently combined with drug treatments. However, the cost-effectiveness ratio should be weighed prior to any treatment especially with statins. Dietary measures consist to reduce caloric intakes in overweight subjects, or more generally to adopt eating patterns which correspond to the following recommendations: (i) proteins = 15% of total calories; (ii) saturated and polyunsatured fats = 10% each; (iii) carbohydrates plus monounsaturated fats = 65%. Such dietary instructions permit individual dietary changes, just by adjusting the carbohydrates/monounsaturates balance, the sum of both nutrients remaining in all cases equal to two-thirds to total calories. Drug treatments are only indicated after secondary dietary failure. They are generally based on the use of statins since the efficacy of these treatments has been clearly established by such preventive trials as the WOSCOP Study, provided that the therapeutic interventions result in significant reduction of LDL cholesterol levels over several years. Antiplatelet agents (aspirin), antihypertensive therapies, antioxidant supplementations with vitamins E or C are also recommended in some individuals for completing the beneficial effects of the above mentioned measures.