Blandine Pasquet

Publications (6)37.76 Total impact

• Article: Thiazolidinedione use is not associated with worse cardiovascular outcomes: A study in 28,332 high risk patients with diabetes in routine clinical practice: Brief title: Thiazolidinedione use and mortality.

  Ronan Roussel, Samy Hadjadj, Blandine Pasquet, Peter W F Wilson, Sidney C Smith, Shinya Goto, Florence Tubach, Michel Marre, Avi Porath, Michel Krempf, Deepak L Bhatt, P Gabriel Steg
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  ABSTRACT: OBJECTIVE: Assess the cardiovascular safety of Thiazolidinediones (TZD) in routine clinical practice. BACKGROUND: TZD are insulin-sensitizing antidiabetic drugs commonly used in type 2 diabetes, but their cardiovascular safety has been questioned. We examined the association between TZD use and major cardiovascular outcomes. METHODS: We examined 2-year mortality, non-fatal myocardial infarction (MI), and congestive heart failure (CHF) rates among outpatients with high cardiovascular risk and diabetes according to TZD use in the REACH Registry. Multivariable adjustment and propensity scores were used in the analyses. RESULTS: A total of 4997 out of 28,332 patients took TZDs at baseline. During follow-up, 1532 patients died. The mortality rates (95% confidence interval [CI]) were 6.5% (5.5-7.6) with TZD and 7.2% (6.33-8.06) without; adjusted hazard ratio (HR) was 1.06 (0.89-1.26, P=0.54). The lack of association with mortality was consistent across subgroups regardless of history of atherothrombosis or CHF. Rates of non-fatal MI (HR 1.10, 95% CI 0.83-1.45, P=0.50) and non-fatal CHF (HR 0.90, CI 0.75-1.09, P=0.27) were similar in users and non-users. TZD use was associated with an increased risk of CHF in patients aged >80years (HR 1.59, CI 1.06-2.40, P=0.03). CONCLUSIONS: Use of TZD was not associated with increased incidence of major cardiovascular events in patients with diabetes from this large registry. Older patients experienced an increased risk of CHF over the study interval. Limitations of this study include its observational design, and thus unmeasured confounders cannot be excluded.
  International journal of cardiology 05/2012; · 7.08 Impact Factor
• Article: Carotid plaque and intima-media thickness and the incidence of ischemic events in patients with atherosclerotic vascular disease.

  Hong H Keo, Iris Baumgartner, Alan T Hirsch, Sue Duval, Ph Gabriel Steg, Blandine Pasquet, Deepak L Bhatt, Joachim Roether
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  ABSTRACT: We aimed to evaluate whether carotid intima-media thickness (CIMT) or the presence of plaque can confer additional predictive value of future cardiovascular (CV) ischemic events in patients with pre-existing atherosclerotic vascular disease. We identified 2317 patients enrolled in the REduction of Atherothrombosis for Continued Health (REACH) registry who had atherosclerotic vascular disease and baseline CIMT measurements. The entire range of CIMT was divided into quartiles and the fourth quartile (≥ 1.5 mm) was defined as carotid plaque. Mean ± standard deviation baseline CIMT was 1.31 ± 0.65 mm. Associated CV ischemic events and vascular-related hospitalizations were evaluated over a 2-year follow-up. There was a positive increase in adjusted hazard ratios (HRs) for all-cause mortality (p = 0.04 for trend) and the quadruple endpoint (CV death, myocardial infarction (MI), stroke, hospitalization for CV events) with increasing quartiles of CIMT (p = 0.0008 for trend), which was mainly driven by the fourth quartile (carotid plaque). HRs for all-cause mortality, CV death, CV death/MI/stroke and the quadruple endpoint comparing the highest (carotid plaque) with the lowest CIMT quartile were 2.09 (95% CI, 1.07-4.10; p = 0.03); 2.49 (1.10-5.67; p = 0.03); 1.71 (1.10-2.67; p = 0.02); and 1.73 (1.31-2.27; p = 0.0001). In conclusion, our analyses suggest that the presence of carotid plaque, rather than the thickness of intima-media, appears to be associated with increased risk of CV morbidity and mortality, but confirmation of these findings in other population and prospective studies is required.
  Vascular Medicine 09/2011; 16(5):323-30. · 1.46 Impact Factor
• Article: Two-year vascular event rates in patients with symptomatic cerebrovascular disease: the REACH registry.

  Narayanaswamy Venketasubramanian, Joachim Röther, Deepak L Bhatt, Blandine Pasquet, Jean-Louis Mas, Mark J Alberts, Michael D Hill, Franz Aichner, P Gabriel Steg
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  ABSTRACT: Few practice-based studies have reported vascular outcome events among patients with cerebrovascular disease (CeVD). We describe 2-year vascular outcomes among symptomatic CeVD patients from the REduction of Atherothrombosis for Continued Health (REACH) Registry. Vascular events (stroke; myocardial infarction, MI; cardiovascular death, CV death; hospitalization) were studied among symptomatic CeVD patients from a prospective cohort of stable outpatients with established atherothrombosis or ≥3 atherothrombotic risk factors. Of the 69,055 patients in REACH, 18,992 (28%) had symptomatic CeVD, of which outcome data were available for 18,189 patients. At 2 years, the frequency of non-fatal stroke was 5.93% (95% CI 5.22-6.64), non-fatal MI 2.21% (95% CI 1.65-2.76), CV death 4.45% (95% CI 3.66-5.22), combined vascular endpoint 11.48% (95% CI 10.46-12.49), and all deaths 7.39% (95% CI 6.34-8.42). The frequency of stroke, MI, CV death, or hospitalization for atherothrombotic events was 21.05% (95% CI 20.05-22.03). Event rates were lowest among patients with CeVD alone and highest among patients with CeVD, coronary artery disease, and peripheral artery disease. Other predictors of the primary outcome were increasing age, history of diabetes, current smoking, asymptomatic carotid stenosis, and carotid plaque. Outcomes were similar across geographical regions. Symptomatic CeVD patients encounter high vascular event rates despite treatment. Recurrent nonfatal stroke is more common than nonfatal MI.
  Cerebrovascular Diseases 08/2011; 32(3):254-60. · 2.72 Impact Factor
• Source

  Available from: Shinya Goto

  Article: Metformin use and mortality among patients with diabetes and atherothrombosis.

  Ronan Roussel, Florence Travert, Blandine Pasquet, Peter W F Wilson, Sidney C Smith, Shinya Goto, Philippe Ravaud, Michel Marre, Avi Porath, Deepak L Bhatt, P Gabriel Steg
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  ABSTRACT: Metformin is recommended in type 2 diabetes mellitus because it reduced mortality among overweight participants in the United Kingdom Prospective Diabetes Study when used mainly as a means of primary prevention. However, metformin is often not considered in patients with cardiovascular conditions because of concerns about its safety. We assessed whether metformin use was associated with a difference in mortality among patients with atherothrombosis. The study sample comprised 19 691 patients having diabetes with established atherothrombosis participating in the Reduction of Atherothrombosis for Continued Health (REACH) Registry between December 1, 2003, and December 31, 2004, treated with or without metformin. Multivariable adjustment and propensity score were used to account for baseline differences. The main outcome measure was 2-year mortality. The mortality rates were 6.3% (95% confidence interval [CI], 5.2%-7.4%) with metformin and 9.8% 8.4%-11.2%) without metformin; the adjusted hazard ratio (HR) was 0.76 (0.65-0.89; P < .001). Association with lower mortality was consistent among subgroups, noticeably in patients with a history of congestive heart failure (HR, 0.69; 95% CI, 0.54-0.90; P = .006), patients older than 65 years (0.77; 0.62-0.95; P = .02), and patients with an estimated creatinine clearance of 30 to 60 mL/min/1.73 m(2) (0.64; 95% CI, 0.48-0.86; P = .003) (to convert creatinine clearance to mL/s/m(2), multiply by 0.0167). Metformin use may decrease mortality among patients with diabetes when used as a means of secondary prevention, including subsets of patients in whom metformin use is not now recommended. Metformin use should be tested prospectively in this population to confirm its effect on survival.
  Archives of internal medicine 11/2010; 170(21):1892-9. · 11.46 Impact Factor
• Article: Cardiovascular event rates in diabetic and nondiabetic individuals with and without established atherothrombosis (from the REduction of Atherothrombosis for Continued Health [REACH] Registry).

  Michel Krempf, Klaus G Parhofer, Ph Gabriel Steg, Deepak L Bhatt, E Magnus Ohman, Joachim Röther, Shinya Goto, Blandine Pasquet, Peter W F Wilson
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  ABSTRACT: The objective of this study was to determine cardiovascular event rates in diabetic patients and nondiabetic subjects from the REACH Registry with established coronary artery disease, cerebrovascular disease, peripheral arterial disease, or multiple risk factors for atherothrombosis. REACH is an international, prospective, and contemporaneous cohort of patients with > or = 3 atherothrombotic risk factors only or established atherothrombotic disease, of which 30,043 have diabetes. The main outcomes after 1-year follow-up were cardiovascular death, myocardial infarction, stroke, major adverse cardiovascular events (MACEs; cardiovascular death, myocardial infarction, or stroke), and MACEs/hospitalization. The MACE rate at 1 year was positively related to the number of atherothrombotic anatomic sites in diabetic patients and nondiabetic subjects, and the rate was higher in those with (3.8%) than without (3.0%, p <0.001) diabetes. Diabetic patients with risk factors only had a lower MACE rate than nondiabetic subjects or diabetic patients with established atherothrombotic disease (2.2% vs 4.0% or 6.0%, respectively, p <0.001 for the 2 comparisons). These differences persisted after adjusting for gender and age. In conclusion, diabetic patients in the REACH Registry have an increased risk of cardiovascular events compared to nondiabetic subjects related to the number of atherothrombotic sites. Although increasing risk, diabetes may not be truly equivalent to previous atherothrombotic events on new cardiovascular event rates.
  The American journal of cardiology 03/2010; 105(5):667-71. · 3.58 Impact Factor
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  Available from: damedpel.com

  Article: Metformin Use and Mortality Among Patients With Diabetes and AtherothrombosisMetformin Use With Diabetes and Atherothrombosis

  Ronan Roussel, Florence Travert, Blandine Pasquet, Peter W. F. Wilson, Sidney C. Smith, Shinya Goto, Philippe Ravaud, Michel Marre, Avi Porath, Deepak L. Bhatt, P. Gabriel Steg
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  ABSTRACT: Background Metformin is recommended in type 2 diabetes mellitus because it reduced mortality among overweight participants in the United Kingdom Prospective Diabetes Study when used mainly as a means of primary prevention. However, metformin is often not considered in patients with cardiovascular conditions because of concerns about its safety.Methods We assessed whether metformin use was associated with a difference in mortality among patients with atherothrombosis. The study sample comprised 19 691 patients having diabetes with established atherothrombosis participating in the Reduction of Atherothrombosis for Continued Health (REACH) Registry between December 1, 2003, and December 31, 2004, treated with or without metformin. Multivariable adjustment and propensity score were used to account for baseline differences. The main outcome measure was 2-year mortality.Results The mortality rates were 6.3% (95% confidence interval [CI], 5.2%-7.4%) with metformin and 9.8% 8.4%-11.2%) without metformin; the adjusted hazard ratio (HR) was 0.76 (0.65-0.89; P < .001). Association with lower mortality was consistent among subgroups, noticeably in patients with a history of congestive heart failure (HR, 0.69; 95% CI, 0.54-0.90; P = .006), patients older than 65 years (0.77; 0.62-0.95; P = .02), and patients with an estimated creatinine clearance of 30 to 60 mL/min/1.73 m2 (0.64; 95% CI, 0.48-0.86; P = .003) (to convert creatinine clearance to mL/s/m2, multiply by 0.0167).Conclusions Metformin use may decrease mortality among patients with diabetes when used as a means of secondary prevention, including subsets of patients in whom metformin use is not now recommended. Metformin use should be tested prospectively in this population to confirm its effect on survival. Figures in this Article Cardiovascular diseases are frequent in patients with type 2 diabetes mellitus and are the most common cause of death. Notable progress has been made in preventive care among the population with diabetes, but the excess of deaths associated with diabetes remains important.1 Recently, large-scale trials failed to demonstrate a clear benefit of intensive glycemic control in patients with type 2 diabetes mellitus at high risk of cardiovascular outcomes or with established diabetic complications.2 In the United Kingdom Prospective Diabetes Study,3 metformin was the first-line therapeutic agent among newly diagnosed overweight patients with diabetes, and the regimen reduced mortality at 11 years and at long-term follow-up. Therefore, it is now believed that metformin can bring some benefit in primary prevention of cardiovascular complications.4 Metformin has been on the market for decades in Europe but only since 1995 in the United States because of concern about metformin-associated lactic acidosis. This concern led to conservative recommendations for the use of metformin in patients with chronic conditions, such as cardiac diseases or renal failure, that predispose them to lactic acidosis.5 These limitations drastically reduced the number of patients who could be treated with and who may benefit from metformin.6 Findings from previous studies5,7 suggest that metformin therapy may be associated with a better prognosis in older patients with diabetes discharged after hospitalization for heart failure, which was a contraindication to the use of metformin in the international recommendations5,8 until 2009. Evaluation of the potential risks and benefits associated with metformin use as a secondary means of prevention of cardiovascular disorders has not yet been performed, to our knowledge. Herein, we studied the baseline characteristics and 2-year outcomes of 19 691 patients with diabetes undergoing a secondary prevention strategy in the international Reduction of Atherothrombosis for Continued Health (REACH) Registry. Our aim was to assess whether metformin use was associated with a difference in mortality after adjustment for baseline differences and for the propensity to receive metformin among patients with established coronary artery disease, cerebrovascular disease, or peripheral arterial disease.
  Archives of Internal Medicine 170(21):1892-1899. · 11.46 Impact Factor