[Prevention of cardiovascular and degenerative diseases: I. Aspirin, statins, or vitamins?]

Coronary syndromes are induced by atherosclerosis which results from lipid deposit as well as inflammatory cells in vascular walls triggered by oxidative modification of LDL cholesterol. Treatment with antioxidant vitamins (vitamin C and E) has no evident effect on coronary events whereas aspirin and statins treatments result in a 25 to 30% reduced rate of fatal and non fatal myocardial infarction in primary and in secondary prevention trials. Both drugs are highly recommended in secondary prevention. In primary prevention they are useful and cost effective if the estimated risk of coronary event is 1.5% per year or higher. They are not cost-effective if this risk is 0.6% per year or less. With aspirin there is a 1.5 fold increase of hemorrhagic stroke and a 2 fold increase of gastrointestinal hemorrhage. Aspirin is less efficient in younger patients (< 50 years of age), in those with high blood pressure (> 145 mmHg) and those with low serum hsCRP (< 1 mg/l.). Statins are well tolerated and they could reduce not only C-V and global mortality but also the risk of stroke and of macular degeneration. They could also delay the occurrence of diabetes and kidney failure. Folate administration can lower elevated serum homocysteine level, which is a risk factor for C-V and Alzheimer's disease. However the clinical benefit resulting from folate treatment must still be demonstrated.