[Framingham 36 years later]

Although cardiovascular mortality has decreased in recent years, it is still largely due to coronary disease: 1 out of 5 men and 1 out of 17 women are affected by that disease before the age of 60. Among the risk factors involved are lipid disturbances, themselves divided into three factors: LDL-cholesterol, triglycerides and HDL-cholesterol. A plasma LDL-cholesterol level above 150 units is a high risk factor. Triglyceride levels higher than 1.50 g/l, associated with HDL levels lower than 40 mg/dl constitute a new entity, a genetic disease associated with a special fragment on chromosome 11, characterized by high risk low HDL levels (below 40). Another risk factor, even in elderly people, is arterial hypertension. Cigarette smoking, lack of physical activity, diabetes and mental stress remain important factors, whereas obesity has become a separate factor. Finally, such factors as ECG abnormalities, plasma uric acide or plasminogen levels, familial context, etc., may be taken into consideration. All dietetic and therapeutic measures aimed at lowering the cholesterol level show a 2-3 p. 100 fall in the incidence of coronary disease for each 1 p. 100 reduction of blood cholesterol. A new programme, similar to those used in screening for high blood pressure subjects, will be set up in the U.S.A. to identify people with a blood cholesterol level higher than 2.40 g/l, treat them and bring that figure down below 2.00 g/l. The management of arterial hypertension is still based on treatments which do not increase blood cholesterol or increase HDL. They include alpha-blockers, beta-2 agonists and blockers of intracellular contractility. They have the additional advantage of improving capillary perfusion.