CMAJ • July 20, 2004; 171 (2). doi:10.1503/cmaj.1031819.
© 2004 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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Letters
Correspondance

Dyslipidemia guidelines

Celio Levyman

Neurologist, Saó Paulo, Brazil

The measures suggested by Jacques Genest and colleagues1,2 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be called "blind prevention," whereby patients are given acetylsalicylic acid, a statin, folic acid and vitamin E (unpublished manuscript).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 colleagues1,2 will be an important reminder to Brazilian health authorities that vascular disease also requires their attention.

Celio Levyman Neurologist Saó Paulo, Brazil

Footnotes

Competing interests: None declared.


References

  1. Genest J, Frohlich J, Fodor G, McPherson R (the Working Group on Hypercholesterolemia and Other Dyslipidemias). Recommendations for the management of dyslipidemia and the prevention of cardiovascular disease: summary of the 2003 update. CMAJ 2003;169(9):921-4.[Free Full Text]
  2. Genest J, Frohlich J, Fodor G, McPherson R (the Working Group on Hypercholesterolemia and Other Dyslipidemias). Recommendations for the management of dyslipidemia and the prevention of cardiovascular disease: 2003 update. CMAJ 2003; 169 (9):Online-1 to Online-10. Available: www.cmaj.ca/cgi/data/169/9/921/DC1/1 (accessed 2004 Jun 1).
  3. Toole MJ, Waldman RJ. Refugees and displaced persons. War, hunger, and public health. JAMA 1993;270(3):600-5.[Abstract/Free Full Text]
  4. Rice AL, Sacco L, Hyder A, Black RF. Malnutrition as an underlying cause of childhood deaths associated with infectious diseases in developing countries. Bull World Health Organ 2000; 78 (10):1207-21.[Medline]
  5. Wald NJ, Law MR. A strategy to reduce cardiovascular disease by more than 80%. BMJ 2003;326:1419-24.[Abstract/Free Full Text]




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