Apport diagnostique et pronostique additionnel des examens non-invasifs à la prédiction du risque de premier événement coronarien

L'objectif général du travail était d'étudier l'apport respectif de trois tests non-invasifs courants - l'examen clinique, l'épreuve d'effort et l'écho-doppler artériel - à la prédiction du risque d'événement coronaire en prévention primaire. Nous avons utilisé le jeu de données constitué par la cohorte prospective EVADEC (EVAluation du DEpistage de la Coronaropathie). Cette cohorte a suivi pendant une médiane de 6 ans 3034 sujets asymptomatiques et sans antécédent cardiovasculaire entre 1995 et 2004. Les analyses ont donné lieu à quatre travaux originaux. 1) Une épreuve d'effort électriquement positive était associée à la survenue d'événements coronaires chez les sujets à plus haut risque, y compris après ajustement sur les facteurs de risque. 2) Dans une approche diagnostique transversale, la présence d'un souffle fémoral apportait une information significative, au-delà des facteurs de risque traditionnels, à la fois sur la présence d'AOMI asymptomatique, définie par un IPS<0,9 et sur la présence de plaque fémorale. 3) Alors que 40% des sujets étaient porteurs de plaques, de sténoses ou d'AOMI asymptomatiques, une épaisseur intima-média (EIM) modérément augmentée ou la présence de plaques carotidiennes ou fémorales était associées au pronostic, après ajustement sur le risque de Framingham. 4) L'introduction successive dans le modèle des facteurs de risque, de l'épreuve d'effort, l'EIM, puis des plaques fémorales permettait une augmentation incrémentale de l'aire sous la courbe ROC et d'une augmentation de 50% de la valeur prédictive positive sans effet délétère sur la valeur prédictive négativeThe aim of this work was to assess the information provided by three widely used non-invasive tests (physical examination, exercise testing and arterial ultrasound) for the prediction of coronary events in primary prevention. To do so, we used the data from the EVADEC prospective cohort study. Participants were 3034 adults free of any past history of coronary disease. The mean follow-up time was 6 years. 1) An electrically positive exercise test was associated with the onset of coronary events among subjects at higher pre-test risk, after adjustment for major risk factors. 2) In a diagnostic cross-sectional approach, a femoral bruit provided a significant information on both the presence of asymptomatic peripheral arterial disease (PAD, defined by an ABI>0.9) and on the presence of a femoral plaque. 3) With 40% of ours sample having plaques, stenosis or asymptomatic PAD, a moderate increase in intima-media thickness (IMT) or the presence of carotid or femoral plaque were associated with the prognosis, after adjustment on Framingham risk. 4) The consecutive introduction in the model of traditional risk factors, exercise testing, IMT then femoral plaques resulted in an incremental increase in the area under ROC curves and an increase of 50% in the positive predictive value without negative effect on the negative predictive value. Patients with at least three clinical or paraclinical abnormalities had an observed risk equivalent to coronary patient

Ménopause et facteurs de risque cardiovasculaire

TOULOUSE3-BU Santé-Centrale (315552105) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Apport diagnostique et pronostique additionnel des examens non-invasifs à la prédiction du risque de premier événement coronarien

TOULOUSE3-BU Sciences (315552104) / SudocSudocFranceF

Association between Fluorescent Advanced Glycation End-Products and Vascular Complications in Type 2 Diabetic Patients

Objectives. Diabetes is a major health problem associated with hyperglycemia and chronically increased oxidative stress and enhanced formation of advanced glycation end-products (AGEs). The aim of this study was to determine whether oxidative plasma biomarkers in diabetic patients could be evidenced and associated with vascular complications. Methods. Oxidative stress biomarkers such as thiols, ischemia-modified albumin (IMA), glycated albumin (GA), fructosamine, and AGEs were measured in 75 patients with poorly controlled type 2 diabetes (HbA1c > 7.5%) with (44) or without (31) vascular disease and in 31 nondiabetic controls. Results. Most biomarkers of oxidation and glycation were significantly increased in diabetic patients in comparison with nondiabetics. Fructosamines, GA, IMA, and AGEs were positively correlated and levels of fluorescent AGEs were significantly increased in the plasma from patients presenting vascular complication. Conclusions. These results bring new evidence for the potential interest of glycated albumin, oxidative stress, and glycoxidation parameters in the monitoring of type 2 diabetic patients. Furthermore, it emphasizes fluorescent AGEs as a putative indicator for vascular event prediction in diabetic patients

Prevalence, treatment and control of hypertension in La Réunion: the RÉDIA population-based cohort study

A better knowledge of prevalence, management and determinants of hypertension is needed in regions in epidemiological transition to adapt the strategies of public health screening and prevention, and to reduce the burden of cardiovascular diseases. We conducted a prospective cohort study including 4610 participants aged between 18 and 69 years and representative of the general population of La Réunion, a French overseas island located in the western Indian Ocean. The median time between inclusion and follow-up was 7.4 years. Blood pressure data at baseline and follow-up of 3087 participants were analyzed. We found a high prevalence of hypertension, especially in women (36.7% [34.5–39.0]) and in men (40.3% [37.6–43.0]) and in the under 30s (17.1% [14.0–20.5]), with an increase of 10% at follow-up. Treatment rates were very low in men (19.5% versus 39.1% in women) as was awareness of their condition (25.7% versus 44.6%). Blood pressure control rates were similar (18% at baseline and 34% at follow-up for both sexes). Diagnosis of hypertension at follow-up among subjects normotensive at baseline was independently associated with obesity at baseline (relative risk (RR) = 1.40 [1.12–1.75] for BMI between 27 and 30 kg/m2 and 1.72 [1.33–2.25] for BMI ≥30 kg/m2 as compared with BMI <27 kg/m2) and HbA1C (RR =1.12 [1.05–1.19] per %), suggesting a prominent role of insulin resistance in our population. Our study provides original data that cannot be assimilated to any existing model and should guide the implementation of original community-based programs in such countries

Ceramide production associated with retinal apoptosis after retinal detachment.

International audienceBACKGROUND: During retinal detachment, premature apoptosis of photoreceptors and a loss of optimally corrected visual acuity occur. We hypothesized that retinal cell death and generation of ceramide, a pro-apoptotic lipid, would progress as a function of time following experimental retinal detachment, and undertook to define the appropriate temporal window. METHODS: Unilateral retinal detachment was induced in white New Zealand rabbits by subretinal injection of sodium hyaluronate. In experimental animals, we injected sphingosine-1-P into the vitreous 2 hours before retinal detachment. Both eyes were removed on days 1, 3 and 6 for histological and biochemical examination. The number of photoreceptors was counted in section, the level of apoptosis was assessed using the TUNEL assay, and the production of ceramide was analyzed in situ with immunohistochemistry. The concentration of ceramide was also determined on retinal homogenates using a diacylglycerol kinase assay. RESULTS: We confirmed that the average number of live photoreceptors decreased gradually after retinal detachment. In eyes pre-treated with sphingosine-1-P the number of apoptotic photoreceptors was significantly lower. The proportion of apoptotic photoreceptors (14%) remained constant as a function of time in the window studied. As compared to controls, the detached retina showed intense ceramide immunostaining that was prominent in the photoreceptors, but also present to a lesser extent in other retinal layers. The total concentration of intra-retinal ceramide increased by 40% on the first day and continued augmenting through the sixth day after retinal detachment. CONCLUSIONS: Retinal apoptosis during experimental retinal detachment is associated with in vivo production of ceramide

Relationship between lipoprotein concentrations and short-term and 1-year mortality in intensive care unit septic patients: results from the HIGHSEPS study

International audienceBackground High-density lipoproteins (HDLs), particles characterized by their reverse cholesterol transport function, display pleiotropic properties, including anti-inflammatory and antioxidant functions. Moreover, all lipoproteins (HDLs but also low-density lipoproteins (LDLs)) neutralize lipopolysaccharides, leading to increased bacterial clearance. These two lipoproteins decrease during sepsis, and an association between low lipoprotein levels and poor outcome was reported. The goals of this study were to characterize the lipid profile of septic patients hospitalized in our intensive care unit (ICU) and to determine the relationship with the outcome. Methods A prospective observational study was conducted in a university hospital ICU. All consecutive patients admitted for septic shock or sepsis were included. Total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglyceride levels were assessed at admission (day 1), at day 3, and at ICU discharge. When available, a prehospitalization lipid profile collected prior to the patient’s hospitalization was compiled. Short-term and 1-year prognostic outcomes were prospectively assessed. Results A total of 205 patients were included. We found a decrease in HDL-C concentration between previous values and those at admission, followed by an additional decrease at day 3. At ICU discharge, the concentration was higher than that at day 3 but did not reach the concentration measured prior to hospitalization (prior HDL-C = 1.22 (1.04–1.57) mmol/l; day 1 HDL-C = 0.44 (0.29–0.70) mmol/l; day 3 HDL-C = 0.30 (0.25–0.48) mmol/l; and HDL-C at discharge = 0.65 (0.42–0.82) mmol/l). A similar trend was found for LDL-C (prior LDL-C = 2.7 (1.91–3.33) mmol/l; day 1 LDL-C = 1.0 (0.58–1.50) mmol/l; day 3 LDL-C = 1.04 (0.64–1.54) mmol/l; and LDL-C at discharge = 1.69 (1.26–2.21) mmol/l). Mixed models for repeated measures of lipoprotein concentrations showed a significant difference in HDL-C and LDL-C concentrations over time between survivors and nonsurvivors at day 28. An HDL-C concentration at admission of less than 0.4 mmol/l was associated with increased mortality at day 28 (log-rank test, p = 0.034) but not at 1 year (log-rank test, p = 0.24). An LDL-C concentration at admission of less than 0.72 mmol/l was associated with increased mortality at day 28 and at 1 year (log-rank test, p < 0.001 and p = 0.007, respectively). No link was found between prior lipid profile and mortality. Conclusions We showed no relationship between the prehospitalization lipid profile and patient outcome, but low lipoprotein levels in the ICU were strongly associated with short-term mortality