Dyslipidemia guidelines

The measures suggested by Jacques Genest and colleagues^1,2 for the prevention of vascular diseases, both cardiac and neurologic, indicate the magnitude of the problem of overweight in the United States and Canada. Here in Brazil, we observe a paradoxical situation: many people are afflicted with poverty and famine, yet they also have risk factors for cardiovascular problems. It thus appears that vascular risks have no regard for a country's economic status.

The new left-wing federal government in Brazil is making strong efforts in the area of social benefits, for example through the Fome Zero (Zero Hunger) program. However, public health doctors have no particular preoccupation with vascular disease, and suboptimal nutrition may occur among Brazilians even in the presence of adequate caloric intake, as evidenced by abnormal levels of C-reactive protein, apolipoprotein, homocysteine and other compounds.^3,4

Although Brazilian physicians apply evidence-based guidelines in the modern facilities that are available in our large cities, elsewhere they have adopted a system of what might be called “blind prevention,” whereby patients are given acetylsalicylic acid, a statin, folic acid and vitamin E (unpublished manuscript). Physicians in the developed world tend to disapprove of this approach because it does not take into account individual patient factors such as microalbuminuria or gastric problems. This issue was recently the subject of heated debate in the “rapid responses” section of the BMJ after Wald and Law⁵ proposed a “Polypill.”

Despite the differences in medical systems and patient populations in Canada and Brazil, the guidelines presented by Genest and colleagues^1,2 will be an important reminder to Brazilian health authorities that vascular disease also requires their attention.

Celio Levyman Neurologist Saó Paulo, Brazil