ONE OF THE JOYS of visiting France is that there is still enough traditional farming to fashion the countryside. The villages have farms with small dairy herds and the cream from them would make the simplest sauce a dish for a Napoleon, or any other emperor.

Doctors may be one of the few groups who object to the cream and rich cheeses, but when it comes to foie gras the attacks come from two directions, with medicine and the animal rights organisations uniting in their disapproval. But while French food is famously good and notoriously rich, surprisingly their statistics for cardiovascular disease are no worse than ours.

The usual patient who has cholesterol problems — with or without a slightly raised triglyceride level — likes an English breakfast of bacon, bangers and eggs, doesn’t spare the cream, wouldn’t eat toast unless it was well buttered, and can’t resist fish and chips. They are overweight with a girth of more than 40 inches if a man, or 35 if a woman.

If the blood sugar is already rather higher than usual, they may well need to take a statin. If they don’t respond to diet and more exercise they will certainly need statin therapy. If they don’t respond to this — ie, acquiring a normal, or slightly lower than normal, cholesterol and low-density lipoprotein (LDL) level — their doctor might like to consider prescribing Inegy. This is a combination of a statin, simvastatin (originally marketed as Zocor) with Ezetrol (ezetimibe). The Ezetrol component of Inegy boosts the effect of the statin so that smaller doses of statin can be used.

Inegy is available with either 20mg, 40mg or 80mg of simvastatin. It is taken in the evening unless the patient suffers from insomnia. Inegy is useful for those whose cholesterol levels are not being adequately controlled even when taking the more effective statins such as Lipitor or Crestor. Studies have shown that up to 50 per cent of people who are taking statins to treat a high cholesterol or triglyceride level are not achieving the recommended levels.

Dr Clive Weston, a consultant cardiologist in Swansea, speaking in London recently, said: “These patients are taking their statin pills and may feel reassured by this. However, they may still have an elevated risk from complications of heart disease and are missing out on the best treatment available.”

The tendency for someone to develop abnormal blood levels of cholesterol often has a genetic component. Their abnormal levels — raised overall cholesterol blood levels, too much LDL cholesterol (the dangerous form of cholesterol), or too much triglyceride — may owe as much to their genetic inheritance as it does to their diet and lack of exercise.

If genetic tendency is combined with a poor diet and slothful lifestyle (even, perhaps, smoking too) the patient is in for trouble.

As well as the problems caused for the many families in which there is a tendency for high blood fat levels, there are other families in which there is a more obvious pattern of inheritance.

There are 120,000 of these patients in the UK, but they may discover that they have a dangerously raised cholesterol only when they have problems with their coronary arteries— such as angina or a heart attack — or their high cholesterol levels are detected with a routine test. The difficulty in diagnosis is because they are often apparently and outwardly healthy, have a restrained diet and half an hour’s brisk exercise a day. Unfortunately, they also have one or two relatives with cardiovascular disease, or history of a raised cholesterol.

These 120,000 people are said to suffer from familial hyperlipidaemia. The genetic pattern of the many different types of familial hyperlipidaema is complex and their classification confusing.

In some of these families there are specific diagnostic signs as well as a family history of raised cholesterol. These include fatty deposits around the orbits (eye sockets), an early arcus (white rim around the edge of the iris of the eye), or fatty infiltration of some of the tendons.

In one rare form of familial high cholesterol levels, homozygous hypercholesterolaemia, the raised cholesterol levels start in childhood and the affected children may suffer heart attacks, or other cardiovascular problems, while still in their teens or early twenties. In the other forms of familial hypercholesterolaemia, the raised cholesterol may be associated with a raised triglyceride fat level, or it may be only the triglyceride fat level that is high. Triglyceride is a very low density lipoprotein (VLDL).

When someone has a high level of triglyceride in their blood they are not only likely to suffer from heart and other cardiovascular problems, but pancreatitis and occasionally the blocking of the vein leading from the eye, and hence blindness.

Anyone with an obvious familial hypercholesterolaemia will certainly need to go straight on to statins, followed, if they don’t respond, by Inegy. As with all anti-cholesterol treatment the dose may have to be increased slowly until the desired effect is achieved.

Anyone with a raised cholesterol shouldn’t allow it to destroy their equanimity. They shouldn’t even think of cancelling their holiday in France. However, they should rectify their cholesterol levels, by taking advantage of modern medicines and be wary of foie gras and similar fatty delicacies.

E-mail Dr Thomas Stuttaford your questions on statins