[Cholesterol: consensus and controversies, what is the trend in 1993?]

Anatomopathological, biological and epidemiological studies suggest that raised cholesterol concentrations are associated with heightened risk for coronary heart disease. Preventive measures have been recommended by consensus conferences (prudent diet and cholesterol lowering drugs) for a "desirable" level of plasma total cholesterol, i.e.: 1.80 g/l before thirty years and 2 g after thirty years. The debates about the advantage of plasma cholesterol lowering have boosted many controversies after the completion of randomized primary and secondary prevention trials analyses. It was showed an increase in total mortality and a no reduction in fatal coronary events. A series of papers have tried to discourage physicians from identifying subjects with high risk. One has to continue to detect subjects with familial hypercholesterolemia and to treat them following the recommendations of consensus conferences. In the other cases, one has to attach value to HDL-cholesterol and plasma triglyceride levels, especially in patients with hyperinsulinemia, insulin resistance, hypertension and visceral obesity. As lipid oxidation products toxicity, protective diets, as the traditional mediterranean diet containing antioxidant components are important too. Relationships between lipoprotein status and hypercoagulability remains to be investigated to identify predictive factors better than cholesterol for atherothrombosis diseases in subjects at risk.