[Treatment of risk factors of coronary atherosclerosis].

The treatment of coronary atherosclerosis risk factors is an essential part of secondary prevention of myocardial infarction. This should be started during the acute phase. Hypercholesterolemia is the principal causal factor and the occurrence of an infarct does not change the relative cardiovascular risk attributable to this factor. The absolute risk, positively correlated to total and LDL cholesterol and negatively to HDL cholesterol, is increased after myocardial infarction because of the higher prevalence of lethal or non-lethal ischemic cardiac events. The benefits of cholesterol reduction on cardiovascular mortality have been clearly established. They are greater with cholesterol-lowering drugs than with diet alone, and all the more significant when the initial cholesterol levels are high, but they are present at every value. A 1% reduction in total cholesterol is associated with a 2.5% reduction in coronary mortality both in secondary and primary prevention. After infarction, the cardiovascular benefits greatly exceed the risk of overmortality from other causes. Therapeutic effects may also be demonstrated by non-progression or regression of stenotic coronary lesions. The benefits of hypertension control are not as evident. Diastolic blood pressures inferior to 85 mmHg are associated with an increased coronary risk. While waiting for the results of specific therapeutic trials, reduction of high blood pressure without excessive lowering of the diastolic pressure is recommended. Stopping smoking is a measure of primary prevention which reduces the number of acute coronary events and of sudden deaths. However, the correlation with atherosclerosis is not remarkable. Treating diabetes, sedentarity and psychological behaviour seems to be useful. An evaluation of a personalized multifactorial approach to individual risk should be performed.