Should diastolic and systolic blood pressure be considered for cardiovascular risk evaluation: a study in middle-aged men and women

AbstractOBJECTIVESThe goal of this study was to evaluate the role of diastolic blood pressure (DBP) in cardiovascular mortality for different systolic blood pressure (SBP) levels in middle-aged men and women.BACKGROUNDIn middle-aged subjects it is unclear whether DBP, in addition to SBP, should be considered for risk evaluation.METHODSSubjects (77,023 men; 48,480 women) aged 40 to 70 years old, had no major cardiovascular disease, no antihypertensive treatment and were examined at the Centre d’Investigations Préventives et Cliniques between 1972 and 1988. Mortality was assessed for an 8- to 12-year period.RESULTSIn both genders, cardiovascular mortality increased with the SBP level. In men and women with normal SBP levels, DBP did not influence cardiovascular mortality after adjustment for age and SBP. In men with systolic hypertension, a U-shaped curve relationship between cardiovascular mortality and DBP was observed, with the lowest mortality rates in the group with DBP 90 to 99 mm Hg. Compared with this group, age- and SBP-adjusted cardiovascular mortality was higher by 73% (p < 0.02) in the group with DBP <90 mm Hg and by 65% (p < 0.001) in the group with DBP ≥110 mm Hg. In women with systolic hypertension, however, DBP was positively correlated with cardiovascular mortality.CONCLUSIONSIn middle-aged subjects, classification of cardiovascular risk according to DBP levels should take into account gender, especially when SBP levels are elevated. Men with systolic hypertension are at higher risk when their DBP is “normal” than when they present a mild to moderate increase in DBP. In women of the same age, however, systolic-diastolic hypertension represents a higher risk than isolated systolic hypertension

The metabolic syndrome: similar deleterious impact on all-cause mortality in hypertensive and normotensive subjects

Objectives Few data are available on the impact of the metabolic syndrome on all-cause mortality risk according to the presence of hypertension. Our aim was to evaluate the 5-year impact of the metabolic syndrome, according to blood pressure status, on all-cause mortality risk in a large French population. Methods The study population included 39 998 men and 20 756 women with no personal history of cardiovascular disease, who had a health check-up at the IPC Center (Paris, France) between 1999 and 2002, and who were followed up for 4.7 W 1.2 years. The metabolic syndrome was defined according to the National Cholesterol Educational Program classification (2001). Cox regression models were used to evaluate risk of all-cause mortality after adjustment for age, sex, classical risk factors and socioeconomic categories. Subjects were classified according to blood pressure status: hypertensive subject (systolic blood pressure &gt; -140 mmHg and/or diastolic blood pressure &gt; -90 mmHg or treatment) and normotensive subject. Results The risk of all-cause mortality associated with the metabolic syndrome was 1.50 (1.24-1.82) [hazard ratio (HR) (95% confidence interval)]. The risk of all-cause mortality associated with the presence of hypertension was 1.60 (1.38-1.85). During the 4.7 years of follow-up, the impact of the metabolic syndrome was similar among normotensive and hypertensive subjects [HR: 1.09 (0.68-1.75) and 1.40 (1.13-1.74), respectively, P for interaction U 0.35]. Conclusion The findings from this study show that, in a large middle-aged French population, the metabolic syndrome has the same deleterious impact on all-cause mortality in hypertensive subjects and normotensive subjects

La fréquence cardiaque, facteur pronostique majeur du risque cardiovasculaire

La valeur pronostique de la fréquence cardiaque (FC) de repos dans la population générale et chez les coronariens a été analysée d'après les données de la littérature. Les analyses multivariées de la mortalité totale et cardiovasculaire montrent que la FC élevée constitue un facteur prédictif indépendant. Le comportement de la FC à l'effort a également une valeur pronostique concernant la mortalité subite. L'amélioration du pronostic par une réduction de la FC par les bêtabloquants dans le post-infarctus est bien établie. A l'opposé, les antagonistes calciques qui accélèrent la FC ont un effet défavorable sur la survie. Il est donc important de ne pas méconnaître la FC et de la prendre en compte au même titre que les autres facteurs de risque de la maladie coronaire. Dès lors, la baisse de la FC de repos peut être envisagée comme un objectif thérapeutique dans la prise en charge du coronarien

EVALUATION ECHOCARDIOGRAPHIQUE DE LA STIMULATION BIVENTRICULAIRE

ST QUENTIN EN YVELINES-BU (782972101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Relationship between alcohol intake, health and social status and cardiovascular risk factors in the Urban Paris-Ile-de-France Cohort: is the cardioprotective action of alcohol a myth?

International audienceBACKGROUND/OBJECTIVES: Observational studies document the inverse relationship between cardiovascular disease (CVD) and moderate alcohol intake. However, the causal role for alcohol in cardioprotection remains uncertain as such protection may be caused by confounders and misclassification. The aim of our study was to evaluate potential confounders, which may contribute to putative cardioprotection by alcohol. SUBJECTS/METHODS: We evaluated clinical and biological characteristics, including cardiovascular (CV) risk factors and health status, of 149,773 subjects undergoing examination at our Center for CVD Prevention (The Urban Paris-Ile-de-France Cohort). The subjects were divided into four groups according to alcohol consumption: never, low (30 g/day); former drinkers were analyzed as a separate group. RESULTS: After adjustment for age, moderate male drinkers were more likely to display clinical and biological characteristics associated with lower CV risk, including low body mass index, heart rate, pulse pressure, fasting triglycerides, fasting glucose, stress and depression scores together with superior subjective health status, respiratory function, social status and physical activity. Moderate female drinkers equally displayed low waist circumference, blood pressure and fasting triglycerides and low-density lipoprotein-cholesterol. Alcohol intake was strongly associated with plasma high-density lipoprotein-cholesterol in both sexes. Multivariate analysis confirmed that moderate and low drinkers displayed better health status than did never drinkers. Importantly, few factors were causally related to alcohol intake. CONCLUSIONS: Moderate alcohol drinkers display a more favorable clinical and biological profile, consistent with lower CV risk as compared with nondrinkers and heavy drinkers. Therefore, moderate alcohol consumption may represent a marker of higher social level, superior health status and lower CV risk

Absence of CTX-M Enzymes but High Prevalence of Clones, Including Clone ST131, among Fecal Escherichia coli Isolates from Healthy Subjects Living in the Area of Paris, France▿

Quinolone-resistant and CTX-M-15-producing Escherichia coli isolates belonging to clone ST131 have been reported in the community. This study was designed to identify these E. coli isolates in the stools of 332 independent healthy subjects living in the area of Paris, France. Stools were plated on media without antibiotics, in order to obtain the dominant (Dm) fecal E. coli strain, and with nalidixic acid (NAL) and cefotaxime. Quinolone susceptibility, phylogenetic groups, and molecular profiles, including multilocus sequence types (ST), were determined for all NAL-resistant (NAL-R) isolates. Groups were also determined for the Dm strains from participants with NAL-R isolates and from a subgroup without NAL-R isolates. All B2 isolates were typed; pulsed-field gel electrophoresis was performed for the ST131 isolates, and the results were compared with those for intercontinental clone ST131. Two participants (0.6%) had extended-spectrum β-lactamase-producing (SHV-2, TEM-52) fecal E. coli isolates, and 51 (15%) had NAL-R isolates; 51% of NAL-R isolates belonged to phylogenetic group A, 31% to group D, 16% to group B2, and 2% to group B1. The Dm strain was NAL-R in 3.3% of the 332 subjects. Forty-nine percent of the NAL-R isolates belonged to clones: ST10 and ST606 for group A isolates, ST117 and ST393 for group D isolates. Of all B2 isolates studied from 100 subjects (8 NAL-R strains; 19 NAL-susceptible dominant strains), 52% belonged to three clones: ST131 (n = 7), ST95 (n = 4), and ST141 (n = 3). This is the first study to show the presence of fecal E. coli isolates of clone ST131 in 7% of independent healthy subjects not colonized by CTX-M-15-producing isolates

1031–34 Differential Effect of Bisoprolol on Heart Rate Variability According to Heart Rate in Patients with Heart Failure

Patients with congestive heart failure (CHF) have reduced heart rate variability (HRV). Beta-blockers (BB) therapy could improve HRV in CHF. However, HRV is influenced by heart rate. The aim of our study was to assess the effect of BB on heart rate adjusted-HRV in 52 patients from the randomized, double-blind, placebo-controlled CIBIS trial (Cardiac Insufficiency Bisoprolol Study). After progressive increase, Bisoprolol was 5 mg once a day. Holter tapes were recorded at baseline and after 2 months of therapy. To assess HRV at given heart rates, we developed a geometrical analysis of scatterplots (SCP). SCP display beat-ta-beat HRV by plotting each RR against the preceding RR interval. SCP heigth, a measure of short term HRV, was measured at the 10th, 25th, 50th, 75th and 90th percentiles of the total RR dispersion (figure). The 10th percentile represents the fastest hearts rates, whereas the 90th represents the slowest heart rates. There was no significant difference in baseline SCP measurements. Results of BB therapy on SCP heights are as follow (mean±SD):PlaceboBisoprololp10th perc (ms)58±1864±30NS25th perc (ms)95±35101±35NS50th perc (ms)133±43152±370.0275th perc (ms)134±53171±530.00490th perc (ms)120±12139±460.05In conclusion, HRV is not improved at higher heart rates. On the contrary, these results indicate that low dose Bisoprolol improves short term HRV at lower heart rates in CHF