Accueil > 2010 > août > Bientôt un Big Mac sauce statine ?
Bientôt un Big Mac sauce statine ?
Publié le 19/08/2010
jeudi 19 août 2010, par
Les statines sont des médicaments puissants qui permettent d’abaisser fortement les taux plasmatiques de LDL-cholestérol. Cet effet biologique s’accompagne d’une baisse significative de la morbi-mortalité cardiovasculaire chez les sujets à haut risque, tout au moins dans le domaine de la prévention secondaire. D’un point de vue quantitatif, les résultats sont impressionnants et il n’est pas excessif de penser que cette classe pharmacologique a transformé le pronostic de la maladie coronaire (MC), voire de la maladie cardiovasculaire (MCV).
L’idée d’associer une statine au sein de plats hautement athérogènes, dans son principe, n’est certes pas mauvaise, mais elle mérite tout de même d’être examinée de près ! A cet égard, les menus du McDonald’s sont le type même de la fast-food plutôt riche en calories, puisque leurs composants principaux sont les graisses athérogènes et les sucres d’absorption rapide. Certes, cette chaîne de restauration rapide a fait des efforts pour informer le consommateur et améliorer ses plats, mais il n’en reste pas moins qu’elle ne peut pas influer sur les comportements alimentaires individuels à base de goinfrerie, de laisser-aller et de grignotage…
Le principe du MacD-o-statine est simple : il faut neutraliser le risque athérogène lié à la consommation d’aliments type fast-food en lui « coupant l’herbe sous le pied » au moyen du médicament ad hoc, en l’occurrence une petite dose de statine prise en même temps que le repas… Une méta-analyse qui a porté sur sept essais randomisés et sur un total de 42 848 patients est à l’origine du concept MacD-o-statine. Ces études visaient la prévention primaire de la MC par la prise de statines. Les auteurs ont ainsi réussi à déterminer que la diminution du risque cardiovasculaire, induite par la prise quotidienne d’une statine, est plus importante que son augmentation liée à la consommation quotidienne d’un hamburger de 200 g environ, style Mac géant complété par du fromage, des frites et un milk-shake, soit un total de graisses saturées de l’ordre de 36 g…auxquels if faut rajouter 4 g d’acides gras trans.
Pour les auteurs, les statines représenteraient l’arme fatale pour mettre un terme aux conséquences cardiovasculaires néfastes de la « mal -bouffe » d’où quelle provienne. En clair, un peu de statines au menu pour neutraliser les effets négatifs du fast-food ! En raisonnant par analogie, il est vrai que certaines activités humaines à haut risque peuvent s’exercer en prenant des précautions ou en utilisant un antidote au moins potentiel. Un casque si vous vous déplacer sur un deux-roues ou encore un parapluie couplé à un paratonnerre si l’orage et la foudre menacent…
Oui, mais les statines ne sont pas dénués d’effets indésirables et, de plus, le raisonnement par analogie a ses limites en médecine, depuis la notion d’aléa thérapeutique et même bien avant. Au passage, ces médicaments ne sont pas encore OTC (over the counter). Cependant, la question est posée aux décideurs qui, pour l’instant, restent opposés à la vente libre des statines, mais pour combien de temps ? Peut-on imaginer un comprimé d’une statine collé sur les emballages contenant la fast-food, bien entendu, offerte au client avec les slogans publicitaires ad hoc ? Si ces médicaments étaient en vente libre, le problème se réglerait vite, certainement trop vite.
Les dangers potentiels d’une telle stratégie sont, pour certains évidents. Elle risque d’encourager les comportement alimentaires à haut risque, alors même que la neutralisation d’un mal par un bien est loin d’être acquise. Que dire des effets indésirables qui existent même s’ils ont été surestimés ? Que dire de la prise en charge globale de la MC et de la MCV ? Et le rapport bénéfice/risque et les individus qui n’ont pas et n’auront pas de dyslipidémie athérogène ?
Quant à la neutralisation des effets de la consommation de graisses contenues dans le menu McDonald par la prise de 5 ou 10 mg d’une statine, elle reste à démontrer. Pour cela, il faudrait une bonne étude randomisée menée à double insu et, en attendant, il n’est pas interdit de s’offrir un Mac drive sans statine, svp.
Dr Philippe Tellier
Ferenczi EA et coll. : Can a Statin Neutralize the Cardiovascular Risk of Unhealthy Dietary Choices ? Am J Cardiol 2010 ; 106 : 587-592.
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