Artériopathie oblitérante des membres inférieurs en Afrique Centrale : Epidémiologie, facteurs de risque, marqueur pronostique

With the aging of the global population, the prevalence of non-communicable, including cardiovascular, diseases is increasing. While epidemiological studies on peripheral artery disease (PAD) have been mainly conducted in high-income countries, a few have been carried out in low-and middle-income countries, including in Africa. EPIDEMCA (Epidemiology of Dementia in Central Africa) is a cross-sectional population-based study in rural and urban areas of two countries of Central Africa: Central African Republic (CAR) and the Republic of Congo (ROC). Overall, its aim was to investigate the health status in aging population in Central Africa, with a special focus on cognitive disorders, PAD (Ankle-Brachial Index (ABI) ≤0.90). and cardiovascular risk factors as well as their inter-relationship. The EPIDEMCA program was carried out, among people aged 65 years and over, between 2011 and 2012. Among 2002 subjects who agreed to participate, reliable demographic and vascular data were available in 1871 subjects.Overall, the prevalence of PAD was 14.8% reachting 22.2% after the age of 80. The prevalence was higher in ROC than in CAR (17.4% vs. 12.2%, p=0.0071) and in females than males (16.6% vs. 11.9%, p=0.0122). Higher rates of PAD were found in urban area in ROC (20.7% vs. 14.4% in rural area, p=0.0114), not in CAR (11.5% vs. 12.9%, p=ns). In the multivariate analysis, PAD significantly associated factors were described: age (OR: 1.03; p=0.0039), dyslipidemia (OR: 1.88; p=0.0034), smoking (OR: 1.78; p=0.0026), and more specifically undernutrition (OR: 2.09, p=0.0009). Undernutrition was still significantly associated with PAD after adjustment to all potential confounding factors in males as well as in females (OR: 2.82, p= 0.0038 respectively OR: 1.75, p= 0.0492). As epidemiological research on the implication of atherosclerosis in the development of cognitive impairment in general population is lacking in Africa, we focused on the role of ABI as an available marker of atherosclerosis, providing independent and incremental information on subjects’ susceptibility to present cognitive disorders.The prevalence of cognitive impairment among the study participants was 13.6%, higher in subjects with ABI≤0.9 and ABI≥1.4 than those with 0.9<ABI<1.4 (20.1% and 17% vs. 12%, p=0.0024). Cognitive impairment was significantly associated with age (OR: 1.09; p<0.0001), female gender (OR: 2.36; p<0.0001), smoking (OR: 1.78; p=0.0026) and low (≤0.90) ABI (OR: 1.52; p=0.0359). The EPIDEMCA program contributes to a better understanding of PAD in general African population. It highlights the the high prevalence of PAD on the African continent, describes specifically associated risk factors and underlines the importance of an available, inexpensive marker of atherosclerosis in order to detect risk populations in these countries.Le vieillissement de la population mondiale s’accompagne de l’augmentation de la prévalence des maladies non transmissibles, dont certaines liées à l’athérosclérose. Les études épidémiologiques sur l’artériopathie oblitérante des membres inférieurs (AOMI) ont été majoritairement menées dans les pays occidentaux. Peu d’entre elles sont conduites dans les pays à faible et moyen revenu, comme les pays africains alors que la rapide transition socio-économique de ces pays entraîne une modification épidémiologique importante. Le programme EPIDEMCA (Épidémiologie des Démences en Afrique Centrale), enquête épidémiologique transversale multicentrique en population générale âgée de 65 ans et plus, a été mené en zones rurales et urbaines de deux pays d’Afrique Centrale: la République Centrafricaine (RCA) et la République du Congo (RDC), entre 2011 et 2012. Durant la première phase, l’enquête épidémiologique a permis de déterminer la prévalence de l’AOMI et d’analyser les facteurs de risque associés. L’AOMI a été définie par un Index de Pression Systolique (IPS) ≤ 0,9. Parmi les 1871 participants évalués sur le plan vasculaire, la prévalence de l’AOMI a été de 14,8% et atteignant 22,2% pour les sujets âgés de 80 ans et plus. Une prévalence plus importante de l’AOMI a été retrouvée dans les zones urbaines en RDC (20,7% versus 14,4% dans la zone rurale, p=0,0114). Cette différence n’a pas été retrouvée en RCA (11,5% urbain versus 12,9%, rural p=NS). Après ajustement à tous les possible facteurs confondants, des facteurs de risque associés avec l’AOMI ont été décrits : l’âge (OR: 1,03 ; p=0,0039), l’hypercholestérolémie (OR: 1,88 ; p=0,0034), le tabac (OR: 1,78 ; p=0,0026). Plus particulièrement, cette première étude en population générale ayant analysé spécifiquement le rôle de la dénutrition (Index de Masse Corporelle <18) dans l’AOMI met en évidence une association significative (OR: 2,09; p=0,0009) et ceci autant chez les hommes que chez les femmes (OR: 2,82; p= 0,0038 et respectivement OR: 1,75; p= 0,0492). Lors de la deuxième phase de l’étude, ayant permis la confirmation de l’atteinte cognitive, nous avons analysé l’association entre l’IPS et la présence des troubles cognitifs. La prévalence des troubles cognitifs s’est avérée être de 13,6%, plus importante chez les sujets avec IPS≤0,9 et IPS≥1,4 que chez les sujets avec 0,9<IPS<1,4 (20,1% et 17% versus 12%, p=0,0024). La présence des troubles cognitifs a été significativement associée avec l’âge (OR: 1,09; p<0,0001), le sexe féminin (OR: 2,36; p<0,0001), la consommation de tabac (OR: 1,78; p=0,0026) et l’IPS <0,90 (OR: 1,52; p=0,0359). Ce travail, s’inscrivant dans le cadre du programme EPIDEMCA, contribue à une meilleure connaissance de l’épidémiologie de l’AOMI sur le continent Africain. Il souligne la haute prévalence de cette pathologie, comparable aux pays occidentaux décrit les facteurs de risque spécifiques associés et met en évidence l’importance des outils de diagnostic de l’athérosclérose (IPS), fiables, peu coûteux et d’utilisation facile dans le dépistage des sujets à risque polyvasculaire

Follow-up of patients after revascularisation for peripheral arterial diseases : a consensus document from the European Society of Cardiology Working Group on Aorta and Peripheral Vascular Diseases and the European Society for Vascular Surgery

Peripheral arterial diseases comprise different clinical presentations, from cerebrovascular disease down to lower extremity artery disease, from subclinical to disabling symptoms and events. According to clinical presentation, the patient's general condition, anatomical location and extension of lesions, revascularisation may be needed in addition to best medical treatment. The 2017 European Society of Cardiology guidelines in collaboration with the European Society for Vascular Surgery have addressed the indications for revascularisation. While most cases are amenable to either endovascular or surgical revascularisation, maintaining long-term patency is often challenging. Early and late procedural complications, but also local and remote recurrences frequently lead to revascularisation failure. The rationale for surveillance is to propose the accurate implementation of preventive strategies to avoid other cardiovascular events and disease progression and avoid recurrence of symptoms and the need for redo revascularisation. Combined with vascular history and physical examination, duplex ultrasound scanning is the pivotal imaging technique for identifying revascularisation failures. Other non-invasive examinations (ankle and toe brachial index, computed tomography scan, magnetic resonance imaging) at regular intervals can optimise surveillance in specific settings. Currently, optimal revascularisation surveillance programmes are not well defined and systematic reviews addressing long-term results after revascularisation are lacking. We have systematically reviewed the literature addressing follow-up after revascularisation and we propose this consensus document as a complement to the recent guidelines for optimal surveillance of revascularised patients beyond the perioperative period.Peer reviewe

2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS) : Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries

Endorsed by: the European Stroke Organization (ESO), The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS)Peer reviewe

Editor's Choice-2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS)

Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries Endorsed by: the European Stroke Organization (ESO) The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS) Authors/Task Force Members (a), Victor Aboyans (*), Jean- Baptiste Ricco (*), Marie- Louise E. L. Bartelink, Martin Bjorck, Marianne Brodmann, Tina Cohnert, Jean-Philippe Collet, Martin Czerny, Marco De Carlo, Sebastian Debus, Christine Espinola-Klein, Thomas Kahan, Serge Kownator, Lucia Mazzolai, A. Ross Naylor, Marco Roffi, Joachim Rother, Muriel Sprynger, Michal Tendera, Gunnar Tepe, Maarit Venermo, Charalambos Vlachopoulos, Ileana Desormais Document Reviewers (b), Petr Widimsky, Philippe Kolh, Stefan Agewall, Hector Bueno, Antonio Coca, Gert J. De Borst, Victoria Delgado, Florian Dick, Cetin Erol, Marc Ferrini, Stavros Kakkos, Hugo A. Katus, Juhani Knuuti, Jes Lindholt, Heinrich Mattle, Piotr Pieniazek, Massimo Francesco Piepoli, Dierk Scheinert, Horst Sievert, Iain Simpson, Jakub Sulzenko, Juan Tamargo, Lale Tokgozoglu, Adam Torbicki, Nikolaos Tsakountakis, Jose Tunon, Melina Vega de Ceniga, Stephan Windecker, Jose Luis ZamoranoPeer reviewe

Wytyczne ESC/ESH dotyczące postępowania w nadciśnieniu tętniczym (2018)

SŁOWA KLUCZOWE: wytyczne, nadciśnienie tętnicze, ciśnienie tętnicze, pomiar ciśnienia tętniczego, progi rozpoznania i cele terapeutyczne leczenia nadciśnienia tętniczego, zależne od nadciśnienia powikłania narządowe, modyfikacje stylu życia, farmakoterapia, terapia złożona, leczenie inwazyjne, wtórne nadciśnienie tętnicz

Peripheral arterial disease in Central Africa : Epidemiology, risk factors, marker prognostic

Le vieillissement de la population mondiale s’accompagne de l’augmentation de la prévalence des maladies non transmissibles, dont certaines liées à l’athérosclérose. Les études épidémiologiques sur l’artériopathie oblitérante des membres inférieurs (AOMI) ont été majoritairement menées dans les pays occidentaux. Peu d’entre elles sont conduites dans les pays à faible et moyen revenu, comme les pays africains alors que la rapide transition socio-économique de ces pays entraîne une modification épidémiologique importante. Le programme EPIDEMCA (Épidémiologie des Démences en Afrique Centrale), enquête épidémiologique transversale multicentrique en population générale âgée de 65 ans et plus, a été mené en zones rurales et urbaines de deux pays d’Afrique Centrale: la République Centrafricaine (RCA) et la République du Congo (RDC), entre 2011 et 2012. Durant la première phase, l’enquête épidémiologique a permis de déterminer la prévalence de l’AOMI et d’analyser les facteurs de risque associés. L’AOMI a été définie par un Index de Pression Systolique (IPS) ≤ 0,9. Parmi les 1871 participants évalués sur le plan vasculaire, la prévalence de l’AOMI a été de 14,8% et atteignant 22,2% pour les sujets âgés de 80 ans et plus. Une prévalence plus importante de l’AOMI a été retrouvée dans les zones urbaines en RDC (20,7% versus 14,4% dans la zone rurale, p=0,0114). Cette différence n’a pas été retrouvée en RCA (11,5% urbain versus 12,9%, rural p=NS). Après ajustement à tous les possible facteurs confondants, des facteurs de risque associés avec l’AOMI ont été décrits : l’âge (OR: 1,03 ; p=0,0039), l’hypercholestérolémie (OR: 1,88 ; p=0,0034), le tabac (OR: 1,78 ; p=0,0026). Plus particulièrement, cette première étude en population générale ayant analysé spécifiquement le rôle de la dénutrition (Index de Masse Corporelle <18) dans l’AOMI met en évidence une association significative (OR: 2,09; p=0,0009) et ceci autant chez les hommes que chez les femmes (OR: 2,82; p= 0,0038 et respectivement OR: 1,75; p= 0,0492). Lors de la deuxième phase de l’étude, ayant permis la confirmation de l’atteinte cognitive, nous avons analysé l’association entre l’IPS et la présence des troubles cognitifs. La prévalence des troubles cognitifs s’est avérée être de 13,6%, plus importante chez les sujets avec IPS≤0,9 et IPS≥1,4 que chez les sujets avec 0,9<IPS<1,4 (20,1% et 17% versus 12%, p=0,0024). La présence des troubles cognitifs a été significativement associée avec l’âge (OR: 1,09; p<0,0001), le sexe féminin (OR: 2,36; p<0,0001), la consommation de tabac (OR: 1,78; p=0,0026) et l’IPS <0,90 (OR: 1,52; p=0,0359). Ce travail, s’inscrivant dans le cadre du programme EPIDEMCA, contribue à une meilleure connaissance de l’épidémiologie de l’AOMI sur le continent Africain. Il souligne la haute prévalence de cette pathologie, comparable aux pays occidentaux décrit les facteurs de risque spécifiques associés et met en évidence l’importance des outils de diagnostic de l’athérosclérose (IPS), fiables, peu coûteux et d’utilisation facile dans le dépistage des sujets à risque polyvasculaire.With the aging of the global population, the prevalence of non-communicable, including cardiovascular, diseases is increasing. While epidemiological studies on peripheral artery disease (PAD) have been mainly conducted in high-income countries, a few have been carried out in low-and middle-income countries, including in Africa. EPIDEMCA (Epidemiology of Dementia in Central Africa) is a cross-sectional population-based study in rural and urban areas of two countries of Central Africa: Central African Republic (CAR) and the Republic of Congo (ROC). Overall, its aim was to investigate the health status in aging population in Central Africa, with a special focus on cognitive disorders, PAD (Ankle-Brachial Index (ABI) ≤0.90). and cardiovascular risk factors as well as their inter-relationship. The EPIDEMCA program was carried out, among people aged 65 years and over, between 2011 and 2012. Among 2002 subjects who agreed to participate, reliable demographic and vascular data were available in 1871 subjects.Overall, the prevalence of PAD was 14.8% reachting 22.2% after the age of 80. The prevalence was higher in ROC than in CAR (17.4% vs. 12.2%, p=0.0071) and in females than males (16.6% vs. 11.9%, p=0.0122). Higher rates of PAD were found in urban area in ROC (20.7% vs. 14.4% in rural area, p=0.0114), not in CAR (11.5% vs. 12.9%, p=ns). In the multivariate analysis, PAD significantly associated factors were described: age (OR: 1.03; p=0.0039), dyslipidemia (OR: 1.88; p=0.0034), smoking (OR: 1.78; p=0.0026), and more specifically undernutrition (OR: 2.09, p=0.0009). Undernutrition was still significantly associated with PAD after adjustment to all potential confounding factors in males as well as in females (OR: 2.82, p= 0.0038 respectively OR: 1.75, p= 0.0492). As epidemiological research on the implication of atherosclerosis in the development of cognitive impairment in general population is lacking in Africa, we focused on the role of ABI as an available marker of atherosclerosis, providing independent and incremental information on subjects’ susceptibility to present cognitive disorders.The prevalence of cognitive impairment among the study participants was 13.6%, higher in subjects with ABI≤0.9 and ABI≥1.4 than those with 0.9<ABI<1.4 (20.1% and 17% vs. 12%, p=0.0024). Cognitive impairment was significantly associated with age (OR: 1.09; p<0.0001), female gender (OR: 2.36; p<0.0001), smoking (OR: 1.78; p=0.0026) and low (≤0.90) ABI (OR: 1.52; p=0.0359). The EPIDEMCA program contributes to a better understanding of PAD in general African population. It highlights the the high prevalence of PAD on the African continent, describes specifically associated risk factors and underlines the importance of an available, inexpensive marker of atherosclerosis in order to detect risk populations in these countries

Etude prospective de la paraoxonase, facteur de morbimortalité des patients agés insuffisants rénaux chroniques terminaux

LIMOGES-BU Médecine pharmacie (870852108) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Hypertension and associated factors in HIV-infected patients receiving antiretroviral treatment in Burundi: a cross-sectional study

Abstract Currently, the life expectancy of people living with the human immunodeficiency virus (HIV) and the general population are similar. Hypertension is a major public health issue in Africa and is largely underdiagnosed. Most HIV-infected individuals, especially those on Anti-Retroviral Therapy (ART) have hypertension. Our project aims to determine the prevalence of hypertension and associated factors amongst HIV-infected adults treated by ART in Burundi. A cross-sectional study was conducted among HIV-infected subjects over the age of 20, managed in five healthcare centers for people living with HIV (PLWH). The World Health Organization STEPWISE survey and anthropometric measurements were employed. Blood pressure was measured according to the ESC 2018 recommendations. 1 250 HIV-infected patients aged between 35.4 and 50.2 years were included (18.4% men). The prevalence of hypertension was 17.4% (95% CI 13.2–22.1). Approximately 47.25% of HIV patients with hypertension were previously undiagnosed. Other factors were associated with HTN, such as being overweight (OR 2.88; 95% CI 1.46–5.62), obesity (OR 2.65; 95% CI 1.27–5.55), longer duration of HIV infection: ≥ 10 years (OR 1.04; 95% CI 1.14–3.20), diabetes (OR 2.1; 95% CI 1.37–3.32) and age (OR 1.13; 95% CI 1.09–1.14). Despite their young age, almost 20% of HIV-ART treated patients had hypertension, 50% of these were undiagnosed. Blood pressure monitoring is crucial in these patients, especially those identified as high-risk, with prompt life and disability-saving interventions

Hypertension and associated factors in HIV-infected patients receiving antiretroviral treatment in Burundi: a cross-sectional study

International audienceAbstract Currently, the life expectancy of people living with the human immunodeficiency virus (HIV) and the general population are similar. Hypertension is a major public health issue in Africa and is largely underdiagnosed. Most HIV-infected individuals, especially those on Anti-Retroviral Therapy (ART) have hypertension. Our project aims to determine the prevalence of hypertension and associated factors amongst HIV-infected adults treated by ART in Burundi. A cross-sectional study was conducted among HIV-infected subjects over the age of 20, managed in five healthcare centers for people living with HIV (PLWH). The World Health Organization STEPWISE survey and anthropometric measurements were employed. Blood pressure was measured according to the ESC 2018 recommendations. 1 250 HIV-infected patients aged between 35.4 and 50.2 years were included (18.4% men). The prevalence of hypertension was 17.4% (95% CI 13.2–22.1). Approximately 47.25% of HIV patients with hypertension were previously undiagnosed. Other factors were associated with HTN, such as being overweight (OR 2.88; 95% CI 1.46–5.62), obesity (OR 2.65; 95% CI 1.27–5.55), longer duration of HIV infection: ≥ 10 years (OR 1.04; 95% CI 1.14–3.20), diabetes (OR 2.1; 95% CI 1.37–3.32) and age (OR 1.13; 95% CI 1.09–1.14). Despite their young age, almost 20% of HIV-ART treated patients had hypertension, 50% of these were undiagnosed. Blood pressure monitoring is crucial in these patients, especially those identified as high-risk, with prompt life and disability-saving interventions

Accuracy and Reliability of the Ankle Brachial Index Measurement Using a Multicuff Oscillometric Device Versus the Doppler Method

International audienceObjective: Ankle brachial index (ABI) is widely used for the diagnosis of lower extremity artery disease (LEAD). The purpose of this prospective study was to validate the diagnostic ability and reproducibility of a four cuff automated oscillometric device vs. the Doppler method. Methods: Patients with suspected LEAD or asymptomatic individuals at risk because of the presence two or more cardiovascular risk factors were enrolled. For each patient, Doppler and oscillometric ABI measurements were repeated by two observers to address intra- and interobserver reproducibility. Results: In total, 118 patients were evaluated. The prevalence of Doppler ABI (Dop-ABI) ≤ 0.90 was 45.8%. Taking the Dop-ABI as the reference, the sensitivity, specificity, accuracy, positive and negative predictive values of oscillometric ABI (Osc-ABI) during the first measurement by the first observer were 89.1%, 94.4%, 94.1%, 91.8%, and 92.4%, respectively. The concordance for diagnosing ABI ≤0.90 between methods was excellent (kappa coefficients ranging from 0.80 to 0.88 with different observers). Intra-observer reproducibility assessed by intraclass correlation coefficient (ICC) between methods were 0.94 for observer 1 and 0.96 for observer 2. The intra-observer reproducibility using the same method was also excellent (ICC 0.94, 95% confidence interval [CI] 0.91-0.95) for Dop-ABI and 0.95 (95% CI 0.93-0.97) for Osc-ABI). The ICC for interobserver reproducibility using the same method was 0.95 (95% CI 0.92-0.96) for Dop-ABI and 0.96 (95% CI 0.94-0.97) for Osc-ABI. Conclusion: This study validates the excellent diagnostic performances of a four cuff oscillometric device specifically designed for screening for LEAD. The simple measurement method could therefore be advocated in primary care where fast, easy, and reliable methods are suitable