M E Safar

Tongji Medical University, Shanghai, Shanghai Shi, China

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Publications (682)2946.63 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: During year 2013, several recommendations for the management of hypertension were published: recommendations of the French and European Societies of Hypertension and two recommendations from the USA, those from the ACC/AHA/CDC groups and those from the JNC 8. The recommendations of the JNC 8 are not, strictly speaking, the recommendations of JNC 8, since they are neither endorsed by their sponsor: the National Heart, Lung and Blood Institute (NHLBI), nor by any other supervisor. They only commit their authors. Just before the publication of the JNC 8, "competing" recommendations, jointly produced by the AHA, ACC and CDC, were jointly published in Hypertension and in the Journal of American College of Cardiology, with different preferred treatment choices and significantly different algorithms. The authors of the JNC 8 have only included in their literature review randomized controlled trials of sufficient power. Randomized controlled trials are clearly the gold standard of comparative trials in medicine, but can they summarize all the knowledge? The authors of the JNC 8 propose in subjects over 60, a therapeutic threshold and target blood pressure of 150/90mmHg. This original threshold is poorly supported by the evidence and possibly increases the risk of physicians' inertia. The issue of experts' conflicts of interest has greatly changed the rules of drafting guidelines for clinical practice. Knowing that the vast majority of clinical trials is promoted by drug industry, could guidelines be strictly without any conflict of interest? Finally, recommendations for practice should have as primary, if not unique, objective to improve the practice.
    Presse medicale (Paris, France : 1983). 09/2014;
  • Michel E Safar, Bernard I Levy
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    ABSTRACT: Patho-physiological and pharmacological studies have consistently noticed that, with the exception of subjects with end-stage renal disease, total intravascular blood volume is not increased in patients with chronic hypertension.
    American journal of hypertension. 09/2014;
  • M E Safar, J Blacher
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    ABSTRACT: In recent years, treatment strategies for hypertension have often focused on combination therapies that include diuretics and renin angiotensin aldosterone system blockers such as angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. However, in clinical practice, a significant number of patients do not respond completely to these combination treatments, and long-term reduction of cardiovascular risk remains insufficient. The particularly high residual cardiovascular risk of hypertensive patients, even when adequately treated with strategies based on renin angiotensin aldosterone system blockers, speaks in favor of new, innovative strategies. Thus, it has become relevant to consider whether it is always necessary to block plasma renin activation and whether other guideline-approved combinations should be considered routinely. Diuretic/calcium channel blocker combinations, which are supported by significant long-term evidence, are put forth as a preferred combination in the main guidelines, but are still underused by physicians who do not yet have easy access to such treatments. Fixed-dose indapamide sustained release/amlodipine is the first such single-pill combination to become available. Complementary mechanisms of action of these two molecules are expected to lead to greater and longer-term reductions in systolic blood pressure and pulse pressure and potentially to the reduction of cardiovascular risk.
    American journal of cardiovascular drugs : drugs, devices, and other interventions. 08/2014;
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    ABSTRACT: Pulse wave analysis is a pivotal tool to estimate central haemodynamic parameters. Available commercial devices use applanation tonometry and have been validated against invasive catheterism. We previously observed differences on a radial second systolic peak (rSPB2) between two commonly used devices: SphygmoCor (AtCor, Australia) and PulsePen (DiaTecne, Italy). The aim of our study was to further quantify differences in radial and carotid signals from the two devices.We measured radial and carotid waveforms in 38 patients with minimal changes between systolic, diastolic blood pressure and heart rate.
    Physiological Measurement 08/2014; 35(9):1837. · 1.50 Impact Factor
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    ABSTRACT: Blood pressure (BP) variability is associated with several cardiovascular (CV) risk factors. Is BP variability measurement of any additive value, in terms of CV risk assessment strategies? To answer this question, we analyzed data from the SU.FOL.OM3 secondary prevention trial that included 2501 patients with background of CV disease history (coronary or cerebrovascular disease). BP was measured every year allowing calculation of variability of BP, expressed as s.d. and coefficient of variability (s.d./mean systolic BP) in 2157 patients. We found that systolic BP variability was associated with several CV risk factors: principally hypertension, age, and diabetes. Furthermore, all antihypertensives were positively associated with variability. Logistic regression analysis revealed that three factors were independent predictors of major CV event: coefficient of variability of systolic BP (OR=1.23 per s.d., 95% CI: 1.04-1.46, P=0.016), current smoking (OR=1.94, 95% CI: 1.03-3.66, P=0.039), and inclusion for cerebrovascular disease (OR=1.92, 95% CI: 1.29-2.87, P=0.001). Finally, when comparing logistic regression models characteristics without, and then with, inclusion of BP variability, there was a modest but statistically significant improvement (P=0.04). In conclusion, age, BP and diabetes were the major determinants of BP variability. Furthermore, BP variability has an independent prognostic value in the prediction of major CV events; but improvement in the prediction model was quite modest. This last finding is more in favor of BP variability acting as an integrator of CV risk than acting as a robust independent CV risk factor in this high-risk population.Journal of Human Hypertension advance online publication, 3 July 2014; doi:10.1038/jhh.2014.44.
    Journal of human hypertension. 07/2014;
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    ABSTRACT: To test the hypothesis that left-ventricular hypertrophy (LVH) is better associated with aortic, than brachial, 24-h average blood pressure (BP) in individuals with hypertension.
    Journal of hypertension. 07/2014;
  • Source
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    ABSTRACT: Aortic stiffness, assessed by carotid-to-femoral pulse wave velocity (PWV), often fails to predict cardiovascular (CV) risk and mortality in the very elderly. This may be due to the non-linear association between PWV and compliance or to blood pressure decrease in the frailest subjects. Total arterial compliance (C T) is the most relevant arterial property regarding CV function, compared to local or regional arterial stiffness. A new method for C T estimation, based on PWV, was recently proposed. We aimed to investigate the value of C T to predict all-cause mortality at the elderly. PWV was estimated in 279 elderly subjects (85.5 ± 7.0 years) who were followed up for a mean period of 12.8 ± 6.3 months. C T was estimated by the formula C T = k × PWV(-2); coefficient k is body-size dependent based on previous in silico simulations. Herein, k was adjusted for body mass index (BMI) with a 10 % change in BMI corresponding to almost 11 % change in k. For a reference BMI = 26.2 kg/m(2), k = 37. Survivors (n = 185) and non-survivors (n = 94) had similar PWV (14.2 ± 3.6 versus 14.9 ± 3.8 m/s, respectively; p = 0.139). In contrast, non-survivors had significantly lower C T than survivors (0.198 ± 0.128 versus 0.221 ± 0.1 mL/mmHg; p = 0.018). C T was a significant predictor of mortality (p = 0.022, odds ratio = 0.326), while PWV was not (p = 0.202), even after adjustment for gender, mean pressure and heart rate. Age was an independent determinant of C T (p = 0.016), but not of PWV. C T, estimated by a novel method, can predict all-cause mortality in the elderly. C T may be more sensitive arterial biomarker than PWV regarding CV risk assessment.
    Age 05/2014; · 6.28 Impact Factor
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    ABSTRACT: Predictive value of arterial stiffness in cardiovascular disease has been recognized for many decades. Carotid-femoral pulse wave velocity (cfPWV), as a noninvasive measurement, has been recommended as a gold standard of arterial stiffness, and we believe that this surrogate of arterial stiffness has been refined to the point that its utility in routine clinical practice need to be recommended. Considering the worldwide aging population and aging itself as a major cause of arterial stiffness, we would focus in this article, from a practical point of view, on cfPWV in the elderly, and review the current knowledge on the effect of arterial aging on cfPWV measurements, as well as the significance of its clinical application in the elderly.
    Journal of Hypertension 04/2014; · 4.22 Impact Factor
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    ABSTRACT: Tropical aortitis is a rare and poorly described aortic disease, sometimes confounded with Takayasu's disease, mainly in people from Africa. In this case report, the panaortic aneurysmal disease in a young woman from Haiti, first diagnosed after a work-up on renovascular hypertension, would appear to approach this particular arterial disease with no clinical, radiological or biological argument for an infectious etiology. The initially suspected diagnosis of Takayasu's disease had to be rethought because of the presence of several saccular aneurysms extending from the aortic arch to the infrarenal aorta, rarely described in Takayasu's aortitis. Expert opinions from vascular surgeons and clinicians tagged this aortic disease as similar to tropical aortitis which remained asymptomatic for more than a decade. Hypertension was managed with successful balloon angioplasty of the left renal artery stenosis and anti-hypertensive combination therapy. Surgical management of the extended aortic aneurysms was not proposed because of the stability and asymptomatic nature of the aneurysmal disease and the high risk of surgical morbidity and mortality. More than ten years after diagnosis, the course was marked with inaugural and sudden-onset chest pain concomitant with contained rupture of the descending thoracic aortic aneurysm. This case report underlines the persistent risk of aneurysmal rupture and the importance of an anatomopathological study for the diagnosis of complex aortic disease.
    Journal des Maladies Vasculaires 03/2014; · 0.24 Impact Factor
  • Michael F O'Rourke, Michel E Safar, Audrey Adji
    Journal of Hypertension 03/2014; 32(3):699. · 4.22 Impact Factor
  • Orson D Go, Michel E Safar, Harold Smulyan
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    ABSTRACT: Aortic stiffness, often measured by the carotid/femoral pulse-wave velocity (PWV) method, has become an attractive predictor for cardiovascular (CV) risk. Although noninvasive, PWV requires additional equipment and training. Aortic diameters measured at transesophageal echocardiography (TEE) provide high spatial resolution images as an alternative to PWV, and permit a more routine assessment of aortic stiffness. The purpose of this study was to measure aortic diameters at TEE, calculate aortic stiffness and compare these data to those of the more established PWV as estimates of CV risk and survival. Systolic and diastolic aortic dimensions were measured retrospectively in 500 consecutive patients who had a clinically indicated TEE. Aortic compliance, distensibility, and stiffness index were calculated using the aortic diameters and corrected brachial cuff blood pressures (BP). Compliance significantly related to age and mean BP (both P < 0.0001) and nearly significantly to chronic renal disease (P = 0.064). The results for distensibility and stiffness index were similar. When analyzed by Kaplan-Meier curves, all stiffness tertiles were significantly predictive of 4.5- to 7.5-year survival. These calculated values behaved similar to those of PWV reported in the literature. This study showed that in patients undergoing routine TEE, aortic stiffness can be readily measured and that the derived values offer relationships comparable to those of PWV, including survival prediction. The method may also find use in assessing aortic stiffness in the TEE evaluation of patients with a bicuspid aortic valve or in preparation for transcatheter aortic valve replacement.
    Echocardiography 02/2014; · 1.26 Impact Factor
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    ABSTRACT: Central blood pressure (cBP) and pulse pressure amplification (PPA) are receiving renewed interest with the increase in the availability of noninvasive techniques that enable its measurement. However, to date, there is no standardized protocol to validate their accuracy. Although invasive comparison seems intellectually ideal, it will soon raise technical and ethical issues with the growing number of devices to be validated. We proposed a modified ESH-IP2010 protocol for electronic brachial devices to validate noninvasively systolic cBP and pulse pressure amplification, and used it to compare the newly commercialized Centron cBP301 device with radial tonometry SphygmoCor. Radial tonometric SphygmoCor measurements were performed four times alternated with three Centron cBP301 measurements. Each Centron recording was compared with the most favourable SphygmoCor recordings performed immediately before or after and calibrated with Centron peripheral systolic and diastolic blood pressure measurements. Following protocol requirements, 33 individuals (21 men and 12 women) were recruited in the low, medium and high peripheral BP range. Systolic cBP varied from 88 to 188 and the difference between the devices was -0.33±3.28 mmHg (m±SD). It fell within the ESH-IP2010 pass requirements for the number of measurements within 5, 10 and 15 mmHg. The PPA varied from 1.13 to 2.09 and the difference between devices was -0.03±0.11, which showed good agreement for the PPA. The Centron cBP301 device was compared with the similarly calibrated SphygmoCor with a modified ESH-IP2010 protocol. It provided accurate measurements of systolic cBP and PPratio.
    Blood pressure monitoring 01/2014; · 1.62 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Tropical aortitis is a rare and poorly described aortic disease, sometimes confounded with Takayasu's disease, mainly in people from Africa. In this case report, the panaortic aneurysmal disease in a young woman from Haiti, first diagnosed after a work-up on renovascular hypertension, would appear to approach this particular arterial disease with no clinical, radiological or biological argument for an infectious etiology. The initially suspected diagnosis of Takayasu's disease had to be rethought because of the presence of several saccular aneurysms extending from the aortic arch to the infrarenal aorta, rarely described in Takayasu's aortitis. Expert opinions from vascular surgeons and clinicians tagged this aortic disease as similar to tropical aortitis which remained asymptomatic for more than a decade. Hypertension was managed with successful balloon angioplasty of the left renal artery stenosis and anti-hypertensive combination therapy. Surgical management of the extended aortic aneurysms was not proposed because of the stability and asymptomatic nature of the aneurysmal disease and the high risk of surgical morbidity and mortality. More than ten years after diagnosis, the course was marked with inaugural and sudden-onset chest pain concomitant with contained rupture of the descending thoracic aortic aneurysm. This case report underlines the persistent risk of aneurysmal rupture and the importance of an anatomopathological study for the diagnosis of complex aortic disease.
    Journal des Maladies Vasculaires 01/2014; · 0.24 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: During year 2013, several recommendations for the management of hypertension were published: recommendations of the French and European Societies of Hypertension and two recommendations from the USA, those from the ACC/AHA/CDC groups and those from the JNC 8. The recommendations of the JNC 8 are not, strictly speaking, the recommendations of JNC 8, since they are neither endorsed by their sponsor: the National Heart, Lung and Blood Institute (NHLBI), nor by any other supervisor. They only commit their authors. Just before the publication of the JNC 8, “competing” recommendations, jointly produced by the AHA, ACC and CDC, were jointly published in Hypertension and in the Journal of American College of Cardiology, with different preferred treatment choices and significantly different algorithms. The authors of the JNC 8 have only included in their literature review randomized controlled trials of sufficient power. Randomized controlled trials are clearly the gold standard of comparative trials in medicine, but can they summarize all the knowledge? The authors of the JNC 8 propose in subjects over 60, a therapeutic threshold and target blood pressure of 150/90 mmHg. This original threshold is poorly supported by the evidence and possibly increases the risk of physicians’ inertia. The issue of experts’ conflicts of interest has greatly changed the rules of drafting guidelines for clinical practice. Knowing that the vast majority of clinical trials is promoted by drug industry, could guidelines be strictly without any conflict of interest? Finally, recommendations for practice should have as primary, if not unique, objective to improve the practice.
    La Presse Médicale. 01/2014;
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    ABSTRACT: Sinoaortic denervated (SAD) and chemically sympathectomized (SNX) rats are characterized by a decrease in arterial distensibility without hypertension and would, thus, be relevant for analyzing arterial wall stiffening independently of blood pressure level. The fibronectin network, which plays a pivotal role in cell-matrix interactions, is a major determinant of arterial stiffness. We hypothesized that in SAD and SNX rats, arterial stiffness is increased, due to alterations of cell-matrix anchoring leading to spatial reorganization of the extracellular matrix. The intrinsic elastic properties of the arterial wall were evaluated in vivo by the relationship between incremental elastic modulus determined by echotracking and circumferential wall stress. The changes of cell-extracellular matrix links in the abdominal aorta were evaluated by studying fibronectin, vascular integrin receptors, and ultrastructural features of the aorta by immunochemistry. In both experimental conditions, wall stiffness increased, associated with different modifications of cell-extracellular matrix adhesion. In SAD rats, increased media cross-sectional area was coupled with an increase of muscle cell attachments to its extracellular matrix via fibronectin and its α5-β1 integrin. In SNX rats, reduced media cross-sectional area was associated with upregulation of αv-β3 integrin and more extensive connections between dense bands and elastic fibers despite the disruption of the elastic lamellae. In aorta of SNX and SAD rats, a similar arterial stiffness is associated to different structural alterations. An increase in αvβ3 or α5β1 integrins together with the already reported increase in the proportion of less distensible (collagen) to more distensible (elastin) components in both models contributes to remodeling and stiffening of the abdominal aorta.
    Journal of Hypertension 12/2013; · 4.22 Impact Factor
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    ABSTRACT: Hypertension is a multifactorial systemic chronic disorder through functional and structural macrovascular and microvascular alterations. Macrovascular alterations are featured by arterial stiffening, disturbed wave reflection and altered central to peripheral pulse pressure amplification. Microvascular alterations, including altered wall-to-lumen ratio of larger arterioles, vasomotor tone abnormalities and network rarefaction, lead to disturbed tissue perfusion and susceptibility to ischemia. Central arterial stiffness and microvascular alterations are common denominators of organ damages. Vascular alterations are intercorrelated, amplifying the haemodynamic load and causing further damage in the arterial network. A plausible precursor role of vascular alterations in incident hypertension provides new insights for preventive and therapeutic strategies targeting macro and microvasculature. Cumulative metabolic burden and oxidative stress lead to chronic endothelial injury, promoting structural and functional vascular alterations, especially in the microvascular network. Pathophysiology of hypertension may then be revisited, based on both macrovascular and microvascular alterations, with a precursor role of endothelial dysfunction for the latter.
    Journal of Hypertension 11/2013; · 4.22 Impact Factor
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    ABSTRACT: Biomarkers derived noninvasively from the aortic blood pressure (BP) waveform provide information regarding cardiovascular (CV) risk independently of brachial BP (bBP). Although body position has significant impact on the assessment of bBP, its effect on aortic hemodynamics remains unknown. This study investigated the changes in both brachial and aortic hemodynamics, between the supine and sitting position. In this randomized cross-over study, the bBP and the aortic pressure waveform were assessed after a 5 min rest (sitting and supine in randomized order); aortic BP, pulse pressure (PP) amplification, augmentation index (AIx) and subendocardial viability index (SEVR) were assessed. Sixty-one subjects were examined (36 males, mean age 50±12 years). Mean BP did not differ between the sitting and supine position (110.8±13.7 vs 110.9±14.9, respectively, P=0.945). However, significant difference between the sitting and supine position in brachial PP (45.9±16.0 vs 52.6±15.6, respectively, P<0.001), aortic PP (36.7±15.2 vs 43.1±13.9, P<0.001), PP amplification (1.28±0.1 vs 1.23±0.1, P<0.001), AIx (26.9±11.9 vs 31.1±10.2, P<0.001) and SEVR (179.6±25.7 vs 161.2±25.8, P<0.001) were found. Review of the literature identified underestimation of the role of body position on aortic hemodynamics. In conclusion, increased PP in both the aorta and brachial artery were found in the supine compared to the sitting position. Reduced PP amplification and SEVR were further observed in the supine position, due to increased pressure wave reflections (AIx).Journal of Human Hypertension advance online publication, 24 October 2013; doi:10.1038/jhh.2013.101.
    Journal of human hypertension 10/2013; · 2.80 Impact Factor
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    ABSTRACT: Although hypertension contributes significantly to worsen cardiovascular risk, blood pressure increment in subjects with heart failure is paradoxically associated with lower risk. The objective was to determine whether pulse pressure and pulse wave velocity (PWV) remain prognostic markers, independent of treatment in heart failure with reduced left ventricular function. The investigation involved 6632 patients of the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study. All subjects had acute myocardial infarction with left ventricular ejection fraction <40% and signs/symptoms of heart failure. Carotid-femoral PWV was measured in a subpopulation of 306 subjects. In the overall population, baseline mean arterial pressure <90 mm Hg was associated with higher all-cause death (hazard ratio, 1.14 [95% confidence interval, 1.00-1.30]; P<0.05), whereas higher left ventricular ejection fraction or pulse pressure was associated with lower rates of all-cause death, cardiovascular death/hospitalization, and cardiovascular death. In the subpopulation, increased baseline PWV was associated with worse outcomes (all-cause death: 1.16 [1.03-1.30]; P<0.05 and cardiovascular deaths: 1.16 [1.03-1.31]; P<0.05), independent of age and left ventricular ejection fraction. Using multiple regression analysis, systolic blood pressure and age were the main independent factors positively associated with pulse pressure or PWV, both in the entire population or in the PWV substudy. In heart failure and low ejection fraction, our results suggest that pulse pressure, being negatively associated with outcome, is more dependent on left ventricular function and thereby no longer a marker of aortic elasticity. In contrast, increased aortic stiffness, assessed by PWV, contributes significantly to cardiovascular death.
    Hypertension 10/2013; · 6.87 Impact Factor
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    ABSTRACT: Arterial stiffness in hypertension is markedly influenced by age, mean arterial pressure (MAP) and heart rate, whereas factors influencing this parameter in diabetes mellitus are not yet fully understood. The aim of our study was to compare central hemodynamics in diabetics (n = 126) versus non-diabetic controls (n = 203), most of whom were hypertensive, and with similar MAP. Anthropometric, laboratory and clinical measurements were collected. Hemodynamic parameters (central blood pressure, aortic pulse wave velocity [PWV], augmentation index [AIx] and pulse pressure amplification [PPA]) were measured using applanation tonometry. PWV and AIx were significantly higher in diabetics, after adjustment for age, gender, MAP, and heart rate. After further adjustment for metabolic syndrome, only the difference in PWV persisted (P < 0.0001). PPA was marginally altered though not significantly. In diabetics, PWV did not correlate with MAP, suggesting that other structural alterations, resulting from insulin resistance, may account for diabetic arterial stiffening to a greater extent than, and independently of, blood pressure. Chronic treatment with insulin was associated with increased PWV, independently of blood pressure, diabetes control and duration, or other common confounding variables. In conclusion, hypertensive diabetics had greater arterial stiffness than hypertensive controls. In diabetes, multiple factors affect arterial stiffening independently of hemodynamic status. Notably, insulin therapy (IT) is associated with more severe arterial stiffness, suggesting a consistent relationship between these parameters. It remains to be determined whether IT should be considered as a marker of diabetes severity that leads to increased arterial stiffness, or whether it has a direct/indirect effect on arterial wall modifications.
    Atherosclerosis 10/2013; 230(2):315-21. · 3.71 Impact Factor
  • Yi Zhang, Michel E Safar
    Future Cardiology 09/2013; 9(5):603-5.

Publication Stats

18k Citations
2,946.63 Total Impact Points

Institutions

  • 2012–2014
    • Tongji Medical University
      • Department of Cardiology
      Shanghai, Shanghai Shi, China
  • 2007–2014
    • Université Paris Descartes
      • Faculté de Médecine
      Lutetia Parisorum, Île-de-France, France
    • Université de Ghardaia
      Larhouat, Laghouat, Algeria
    • Alexandra Regional General Hospital
      Athínai, Attica, Greece
    • Ruijin Hospital North
      Shanghai, Shanghai Shi, China
  • 2006–2014
    • Université René Descartes - Paris 5
      • • Faculté de Médecine
      • • Faculté de Médecine
      Lutetia Parisorum, Île-de-France, France
  • 2004–2014
    • Hôtel-Dieu de Paris – Hôpitaux universitaires Paris Centre
      Lutetia Parisorum, Île-de-France, France
    • Hôpital Européen Georges-Pompidou (Hôpitaux Universitaires Paris-Ouest)
      Lutetia Parisorum, Île-de-France, France
    • University Medical Center – Rizk Hospital
      Beyrouth, Beyrouth, Lebanon
    • University of Naples Federico II
      Napoli, Campania, Italy
    • Centre Hospitalier Universitaire de Grenoble
      Grenoble, Rhône-Alpes, France
  • 2013
    • University of Bologna
      Bolonia, Emilia-Romagna, Italy
    • Hotel Dieu Hospital
      Kingston, Ontario, Canada
  • 2009–2013
    • National and Kapodistrian University of Athens
      • • Faculty of Medicine
      • • Department of Medicine
      Athínai, Attica, Greece
    • Centre hospitalier universitaire de Sherbrooke
      Sherbrooke, Quebec, Canada
    • Jagiellonian University
      • Institute of Cardiology
      Kraków, Lesser Poland Voivodeship, Poland
  • 2002–2013
    • University of New South Wales
      Kensington, New South Wales, Australia
    • Centre D'Investigations Préventives Et Cliniques
      Lutetia Parisorum, Île-de-France, France
    • Institute Mutualiste Montsouris
      Lutetia Parisorum, Île-de-France, France
  • 1989–2013
    • Unité Inserm U1077
      Caen, Lower Normandy, France
  • 2009–2012
    • Assistance Publique – Hôpitaux de Paris
      Lutetia Parisorum, Île-de-France, France
  • 2011
    • Hôpital d'Instruction des Armées Sainte-Anne
      Toulon-sur-Mer, Provence-Alpes-Côte d'Azur, France
  • 2001–2011
    • State University of New York Upstate Medical University
      • • Division of Cardiology
      • • Department of Medicine
      Syracuse, NY, United States
    • Centre Chirurgical Marie Lannelongue
      Plessis-Robinson, Île-de-France, France
    • Ghent University
      Gand, Flanders, Belgium
  • 1998–2011
    • University of Leuven
      • • Division of Hypertension and Cardiovascular
      • • Department of Cardiovascular Sciences
      Louvain, Flanders, Belgium
  • 1989–2011
    • French Institute of Health and Medical Research
      • Paris-Cardiovascular Research Center PARCC
      Lutetia Parisorum, Île-de-France, France
  • 2010
    • Private geriatrics hospital “les Magnolias”
      Île-de-France, France
  • 2008–2010
    • Université Paris 13 Nord
      • Unité de recherche en épidémiologie nutritonnelle - UREN (UMR 557) Inserm - INRA - CNAM
      Île-de-France, France
  • 2003–2009
    • Maastricht University
      • Farmacologie
      Maastricht, Provincie Limburg, Netherlands
    • Centre Hospitalier Sainte Anne
      Lutetia Parisorum, Île-de-France, France
    • Université de Sherbrooke
      • Sherbrooke Institute of Pharmacology
      Sherbrooke, Quebec, Canada
  • 1999–2009
    • Νοσοκομείο Σωτηρία
      Athínai, Attica, Greece
  • 2005–2007
    • Centre Hospitalier Universitaire de Bordeaux
      Burdeos, Aquitaine, France
    • University of Texas at Austin
      • Department of Kinesiology and Health Education
      Texas City, TX, United States
    • Hôpital Paris Saint Joseph
      Lutetia Parisorum, Île-de-France, France
  • 2004–2007
    • Centre Hospitalier Universitaire de Montpellier
      Montpelhièr, Languedoc-Roussillon, France
  • 1997
    • State University of New York
      New York City, New York, United States
  • 1991
    • Institut de France
      Lutetia Parisorum, Île-de-France, France
  • 1988
    • American Hospital of Paris
      Lutetia Parisorum, Île-de-France, France
  • 1987
    • University of Vienna
      Wien, Vienna, Austria
  • 1979–1982
    • University of Lyon
      Lyons, Rhône-Alpes, France