Évaluation de la connaissance des facteurs de risque cardiovasculaire chez les patients en médecine générale

Introduction: each year, 17.5 million deaths worldwide are attributable to cardiovascular disease, accounting for 31% of global deaths. In order to fight cardiovascular disease, a reduction in exposure to cardiovascular risk factors is necessary. Goal: to assess the level of overall knowledge of the various cardiovascular risk factors of 400 patients of general medicine, of 4 parisian districts. Method: a descriptive, prospective and multicenter epidemiological study, carried out in 4 parisian districts, including 400 patients (100 per district), of 2 general practice offices and 2 health centers. The data collection was carried out by self-questionnaire. Each questionnaire item was reported on the Excel table. Results: 400 patients were included in this study. In univariate analysis, tobacco ranks first among all risk factors; obesity, dyslipidemia, oily diet, high blood pressure and alcohol are known risk factors for more than 55% of the population studied, the other factors being below the 40% mark. In bivariate analysis, we show that sex, level of study and information sources, in particular television, make it possible to better understand certain cardiovascular risk factors in a statistically significant way. Conclusion: we find that knowledge of cardiovascular risk factors varies widely among patients. The general practitioner must evaluate them in each of his patients. He must then propose a prevention taking into account their ignorance in order to reduce cardiovascular morbidity.Introduction : chaque année, 17,5 millions de décès dans le monde sont imputables aux maladies cardiovasculaires, soit 31% de la mortalité mondiale totale. Afin de lutter contre les maladies cardiovasculaires, une réduction de l’exposition aux facteurs de risque cardiovasculaire est nécessaire. Objectif : évaluer le niveau de connaissance globale des différents facteurs de risque cardiovasculaire de 400 patients de médecine générale, de 4 arrondissements parisiens. Méthode : étude épidémiologique descriptive, prospective et multicentrique, réalisée dans 4 arrondissements parisiens, incluant 400 patients (100 par arrondissement), de 2 cabinets de médecine générale et de 2 centres de santé. Le recueil des données a été réalisé par auto-questionnaire. Chaque item des questionnaires a été reporté sur tableau Excel. Résultats : 400 patients ont été inclus dans cette étude. En analyse univariée, le tabac arrive en première position parmi tous les facteurs de risque exprimés; l’obésité, les dyslipidémies, l’alimentation grasse, l’hypertension artérielle et l’alcool sont des facteurs de risque connus pour plus de 55% de la population étudiée, les autres facteurs étant en dessous de la barre des 40%. En analyse bivariée, nous mettons en évidence que le sexe, le niveau d’étude et les sources d’information en particulier la télévision permettent de mieux connaître de manière statistiquement significative certains facteurs de risque cardiovasculaire. Conclusion : la connaissance des facteurs de risque cardiovasculaire est très contrastée selon les patients. Le médecin généraliste doit les évaluer chez chacun de ses patients. Il doit alors proposer une prévention en tenant compte de leur méconnaissance afin de diminuer la morbidité cardiovasculaire

Occurrence of Major Local Lower Limb Events in Type 2 Diabetic Patients with Lower Extremity Arterial Disease: Impact of Metformin

International audienceBackgroundsPatients with type 2 diabetes mellitus (T2DM) are particularly at risk of developing major adverse cardiovascular events (MACE) and peripheral artery disease (PAD) due to an acceleration of the atherosclerotic process linked to hyperglycemia and inflammation with a greater risk of local complications. We aimed to identify the predictive factors for major adverse limb events (MALE) in T2DM patients with PAD to manage modifiable factors at an early stage.MethodsThis is a prospective study in which T2DM patients with PAD were included from November 2017 to May 2018 and followed over 12 months. The predictive factors for the onset of MALE, MACE, and death from all causes have been identified.ResultsA total of 100 patients were included; 37% of the patients developed a MALE. After multivariate analysis, metformin was associated with a decrease of MALE (odds ratio (OR) = 0.26; 95% confidence interval (CI) [0.10; 0.68]; P = 0.007), and a history of the treatment of intravenous iloprost was associated with an increased risk of MALE (OR = 5.70; 95% CI [1.31; 31.93]; P = 0.029). Regular physical activity was associated with a decreased risk of MACE (OR = 0.07; 95% CI [0; 0.44]; P = 0.021). A history of stroke and a history of venous thromboembolism were associated with an increased all-cause mortality risk with OR = 3.68; 95% CI [1.17; 11.5]; P = 0.025 and OR = 3.78; 95% CI [1.16; 12.3]; P = 0.027.ConclusionsMetformin is protective against local complications in people with diabetes with PAD and should be prescribed to diabetic patients with PAD at an early stage