[Cardiovascular risk and dyslipidemias].

The relationship between plasma lipid abnormalities and the risk for cardiovascular disease is now clearly established. In addition to quantitative abnormalities such as increased plasma LDL-cholesterol and decreased HDL-cholesterol levels, lipid qualitative abnormalities are likely to play an important role in the pathogenesis of atherosclerosis. Indeed, dense triglyceride-rich LDL particles are atherogenic. Moreover, oxidized LDL are associated with increased cardiovascular risk and may play a central role in the pathogenesis of the atherosclerotic plaque. Fasting triglyceride level has rarely been shown to be an independent risk factor for cardiovascular disease, in the general population, but plasma triglyceride levels, following an oral fat load, seem to be a better marker. Recent intervention studies have shown an early effect of HMGCoA-reductase inhibitors in reducing cardiovascular morbidity and mortality, suggesting possible additive actions of statins on the atherosclerotic plaque, on the endothelial function and on thrombosis. The Care study shows that a clinical benefit with pravastatin treatment, in secondary prevention, can be obtained in patients with LDL-cholesterol above 125 mg/dl. If all the primary and secondary intervention studies have shown reduction of cardiovascular morbidity and mortality with hypolipidemic drugs, we also have to keep in mind the positive results from the dietary intervention studies, showing beneficial actions of diets rich in vitamins, fibers and omega 3 fatty acids. In clinical practice, compliance of the patient to his treatment is often difficult to achieve and many studies have shown that control of hyperlipidemia is frequently inaccurate and needs to be reinforced. A comprehensive education of the hyperlipidemic patient is urgently needed in order to improve his knowledge about hypolipidemic diet and to obtain his motivation which is essential for a long term compliance.