Achieving Secondary Prevention Low-Density Lipoprotein Particle Concentration Goals Using Lipoprotein Cholesterol-Based Data

BACKGROUND: Epidemiologic studies suggest that LDL particle concentration (LDL-P) may remain elevated at guideline recommended LDL cholesterol goals, representing a source of residual risk. We examined the following seven separate lipid parameters in achieving the LDL-P goal of <1000 nmol/L goal for very high risk secondary prevention: total cholesterol to HDL cholesterol ratio, TC/HDL, <3; a composite of ATP-III very high risk targets, LDL-C<70 mg/dL, non-HDL-C<100 mg/dL and TG<150 mg/dL; a composite of standard secondary risk targets, LDL-C<100, non-HDL-C<130, TG<150; LDL phenotype; HDL-C ≥ 40; TG<150; and TG/HDL-C<3. METHODS: We measured ApoB, ApoAI, ultracentrifugation lipoprotein cholesterol and NMR lipoprotein particle concentration in 148 unselected primary and secondary prevention patients. RESULTS: TC/HDL-C<3 effectively discriminated subjects by LDL-P goal (F = 84.1, p<10(-6)). The ATP-III very high risk composite target (LDL-C<70, nonHDL-C<100, TG<150) was also effective (F = 42.8, p<10(-5)). However, the standard secondary prevention composite (LDL-C<100, non-HDL-C<130, TG<150) was also effective but yielded higher LDL-P than the very high risk composite (F = 42.0, p<10(-5)) with upper 95% confidence interval of LDL-P less than 1000 nmol/L. TG<150 and TG/HDL-C<3 cutpoints both significantly discriminated subjects but the LDL-P upper 95% confidence intervals fell above goal of 1000 nmol/L (F = 15.8, p = 0.0001 and F = 9.7, p = 0.002 respectively). LDL density phenotype neared significance (F = 2.85, p = 0.094) and the HDL-C cutpoint of 40 mg/dL did not discriminate (F = 0.53, p = 0.47) alone or add discriminatory power to ATP-III targets. CONCLUSIONS: A simple composite of ATP-III very high risk lipoprotein cholesterol based treatment targets or TC/HDL-C ratio <3 most effectively identified subjects meeting the secondary prevention target level of LDL-P<1000 nmol/L, providing a potential alternative to advanced lipid testing in many clinical circumstances

Le divorce et la faute un couple harmonieux : Perspectives de rapprochement des droits français et allemand

To view divorce not as punishment for a fault, but as a consequence of the acknowledgement of the failure of marriage allows however to take into account the violation of the duties of marriage. Therefore to establish the notion of divorce as acknowledgement of failure of marriage doesn't necessarily entail a change of marriage in its essence. The compared study of French and Germon law on divorce reflects this perfectly. Even though French legislation, unlike the Germon one, doesn't come down in favour of the above notion, solutions offered to the different problems raised by divorce are much the same in France as in Germany. The coming reform offamily law in France apparently inaugurates a new coming together of French and Germon law on the matter.Voir dans le divorce non la sanction d'une faute, mais la conséquence de l'échec du mariage n'interdit pas toute prise en considération de la violation des obligations du mariage. Consacrer la conception du divorce-constat d'échec du mariage ne suppose donc pas nécessairement unejnodifi-cation de la signification du mariage. L'étude comparée des droits français et allemand du divorce illustre parfaitement cette affirmation. Même si le législateur français, contrairement au législateur allemand, s'est refusé à prendre position en faveur d'une conception du divorce fondée sur un constat d'échec du mariage, il n'en reste pas moins que les solutions données aux diverses difficultés que soulève le divorce sont assez proches. La réforme du droit de la famille récemment engagée en France semble annoncer un nouveau rapprochement sur ce point des législations française et allemande.Boizel Roger. Le divorce et la faute un couple harmonieux : Perspectives de rapprochement des droits français et allemand. In: Revue internationale de droit comparé. Vol. 52 N°4, Octobre-décembre 2000. pp. 891-912

Evaluation de l'insulinothérapie ambulatoire par pompe externe du CHU de Grenoble (janvier 2000-décembre 2003)

L'objectif de notre travail était double, d'une part de définir les caractéristiques et d'autre part de comparer les niveaux glycémiques sous pompe versus avant pompe des patients traités par I.A.P.E sur le CHU de Grenoble. Matériel et Méthode : Travail rétrospectif, portant sur les données épidémiologiques et sur les hémoglobines glyquées disponibles dans la base informatique du service de Janvier 2000 à Décembre 2003. Résultats : 223 patients ont été inclus dans l'analyse descriptive, majoritairement diabétiques de type I dans 95% des cas. L'analyse des HbA1c montrait une moyenne comprise entre 7.78% +- 1.07%, et 7.98% +- 1.17%. 47% des patients étaient en dessous de 7.5% en 2003. L'effet de l'I.A.P.E. sur le contrôle métabolique (estimé par la moyenne des HbA1c sous pompe - HbA1c basales), était de - 0.95% +- 0.19% sur trois ans (p<0.01) pour 79 patients restant analysables. Les patients à mauvais niveau métabolique de départ étaient les mieux améliorés. Conclusions : L'I.A.P.E. diminue l'hémoglobine glyquée des patients équipés sur le CHU de Grenoble. Elle apparaît comme une bonne alternative aux schémas multi-injection, surtout chez les patients à mauvais contrôle glycémique initiaGRENOBLE1-BU Médecine pharm. (385162101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Regulation of oxidative stress and inflammation by glycaemic control: evidence for reversible activation of the 5-lipoxygenase pathway in type 1, but not in type 2 diabetes

International audienc

One-year efficacy and safety of Web-based follow-up using cellular phone in type 1 diabetic patients under insulin pump therapy: the PumpNet study.

AIM: Conventional follow-up of type 1 diabetic patients treated with continuous subcutaneous insulin infusion (CSII) was compared with intensive coaching using the Web and the cellular phone network for retrospective data transmission and short message service (SMS). METHODS: Thirty poorly controlled patients (HbA1c 7.5-10%) were enrolled in a bicenter, open-label, randomized, 12-month, two-period, crossover study. After a 1-month run-in period, 15 patients were randomly assigned to receive weekly medical support through SMS based upon weekly review of glucose values, while 15 patients continued to download self-monitored blood glucose (SMBG) values on a weekly basis without receiving SMS. After 6 months, patients crossed over to the alternate sequence for 6 additional months. Visits at the clinic were maintained every 3 months. RESULTS: Patients with long-standing inadequately controlled diabetes (24 +/- 13 years) were included. A non-significant trend to reduction in HbA(1c) (-0.25+/-0.94%, P<0.10) and mean glucose values (-9.2+/-25 mg/dl, P=0.06) during the 6-month SMS sequence was observed as compared with the no-SMS period. No safety issue (hypoglycemia, glucose variability) was reported. Adherence to SMBG was not affected by the trial. Quality of life analysis suggests a significant improvement in DQOL global score, as well as the DQOL satisfaction with life subscale, during the SMS sequence. CONCLUSIONS: Long-term telemedical follow-up of insulin pump-treated patients using a cellular phone-, SMS- and Web-based platform is feasible, safe, does not alter quality of life and associated with a trend toward improved metabolic control

Impact of flexible insulin therapy on blood glucose variability, oxidative stress and inflammation in type 1 diabetic patients: The VARIAFIT study

International audienc

Basal insulin dose in 40 type 1 diabetic patients remains stable 1year after educational training in flexible insulin therapy

International audienc