Background: The aim of the application of population and individual strategies for the control of cholesterolemia recommended by several commissions of experts in Spain is to obtain marked decreases in mortality by ischemic heart disease. This study is the first to estimate the potential benefits obtained by the application of both strategies in males from 35 to 64 years of age in Spain.
Methods: Upon fixing the population dietetic aims for the ingestion of fats and cholesterol, the foreseen decrease in mean serum cholesterol was estimated by predictive equations. For individuals at risk, more ambitious objectives were made in regard to decrease in cholesterolemia. The consequent reduction of coronary death risk was obtained for each strategy comparing the foreseen coronary risks by logistic functions for previous serum cholesterol values and those posterior to the health intervention.
Results: The population decrease of saturated fat to 7-10% of total calories of the diet and of the consumption of cholesterol to 300 mg/day would produce a reduction of serum cholesterol of between 6.5 and 21.4 mg/dl (0.2-0.6 mmol/l) which would represent nearly 200 mg/dl (5.2 mmol/l). This would then produce a decrease in coronary deaths of 5.5 to 17.1%. This population strategy must reach 934 to 2,857 people per death avoided. With the individual strategy, the reduction of 55 mg/dl (1.4 mmol/l) in mean cholesterolemia of subjects with more than 250 mg/dl (mean 7.1 mmol/l) or of 36 mg/dl (0.9 mmol/l) in those with more than 200 mg/dl (mean 6.2 mmol/l) would produce a decrease of population coronary death between 3.3 and 12.5% in the first group, and 5.2 to 20% in the second requiring 237 or 454 subjects in each group, respectively per death avoided. The joint application of both strategies would reduce the risk from 8.4 to 24.5%. This would delay the appearance of 570 to 1,640 coronary deaths each year.
Conclusions: The population strategy for cholesterolemia control provides greater health benefits, within a short term, than those of individual strategy although it must be applied to more subjects per unit of benefit. The joint application of both strategies may produce a modest but appreciable reduction, within a medium term, of coronary death in Spain.