[Do statins have a place for cardiovascular prevention in elderly people?]. / Quelle place pour la prévention cardio-vasculaire par statine chez les personnes agées?

Cardiovascular prevention should only be considered if the treatment reduces the incidence of coronary and cerebrovascular events and death. In elderly people, such treatment should also, and most importantly, help maintain a good quality of life, without increasing the risk of iatrogenic side-effects. These key-elements should be kept in mind when prescription of a statin is envisaged in the old (> 70 years) and especially the very old (> 80 years) individual. Randomised controlled trials in people above 70 years are rather rare. In the field of cardiovascular prevention, two studies provide information, on post-hoc analysis of the Heart Protection Study (HPS) with simvastatin and the PROSPER trial with pravastatin. The protection observed in the general population of HPS was also present in the subgroup of subjects aged above 70, both for coronary and cardiovascular events. The difference was less impressive in PROSPER, without any significant difference as far as the incidence of stroke was concerned. None of these two prospective trials provide specific data on individuals above 80. Interestingly, some experimental and epidemiological observations suggested that statins may prevent Alzheimer disease. However, the data from HPS and PROSPER are not convincing in this respect. Thus, results from new ongoing trials should be awaited, especially in patients with mild to moderate Alzheimer disease. Finally, it is noteworthy that low serum cholesterol level can be used as a marker of poor nutrition in very old people. Such condition is rather common, especially among institutionalised subjects, and is usually associated with a higher risk of morbidity and mortality.

[Smoking experimentation in adolescents. Is there a risk for health?]. / Tabagisme occasionnel de l'adolescent, où commence la nocivité?

It is clear that even low rate smoking is hazardous for health, the risk being independently increased by the daily number of cigarettes smoked and by the duration of smoking. The question raised is thus: will an adolescent experimenter be a non smoker, an experimenter for ever, a regular smoker, light or heavy? This short review shows that there are numerous factors from genetics, to familial environment not limited to tobacco issues, smoking situation at school as well as school performances of the student, and also individual psychological characteristics. The experimenter is a very good target for smoking cessation actions and should deserve particular attention from preventive medicine and, thus, from school medicine, before he becomes a regular smoker, who will be more resistant to smoking cessation programs.