C Mounier-Vehier

CHRU de Strasbourg, Strasburg, Alsace, France

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Publications (161)146.85 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Cardiovascular (CV) diseases are the primary cause of death of women. Since they kill 10 times more than breast cancer, preventive measures should be implemented. According to U.S. recommendations, a woman is either at "CV risk" or at "optimal health status" if she has no risk factors and a perfectly healthy lifestyle. Some risk factors are more deleterious to women (smoking, diabetes, stress, depression, atrial fibrillation); or specific to women (preeclampsia, gestational diabetes, contraception, menopause, headaches). The lifestyle plays a key role for them. The blood pressure measurement is the most frequent opportunity to detect women at risk. CV tests should be performed to all symptomatic women and for those over the age of 45 who want to start practicing sport. The cardiologist can play a key role to improve women's CV health by integrating their hormonal risks. Women can also be a powerful medium of prevention by adopting a healthy lifestyle. From those recommendations concerning women's CV health, there is a great opportunity to initiate a health path for women at high cardiovascular risk. The objectives of the specific path "heart, arteries and women" of University hospital of Lille will be to improve professional practice, awareness of women, educate public authorities and within a few years reduce the epidemic of CVD of French women.
    Annales de cardiologie et d'angeiologie 06/2014; · 0.21 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Cardiovascular (CV) diseases are the primary cause of death of women. Since they kill 10 times more than breast cancer, preventive measures should be implemented. According to U.S. recommendations, a woman is either at “CV risk” or at “optimal health status” if she has no risk factors and a perfectly healthy lifestyle. Some risk factors are more deleterious to women (smoking, diabetes, stress, depression, atrial fibrillation); or specific to women (preeclampsia, gestational diabetes, contraception, menopause, headaches). The lifestyle plays a key role for them. The blood pressure measurement is the most frequent opportunity to detect women at risk. CV tests should be performed to all symptomatic women and for those over the age of 45 swho want to start practicing sport. The cardiologist can play a key role to improve women's CV health by integrating their hormonal risks. Women can also be a powerful medium of prevention by adopting a healthy lifestyle. From those recommendations concerning women's CV health, there is a great opportunity to initiate a health path for women at high cardiovascular risk. The objectives of the specific path “heart, arteries and women” of University hospital of Lille will be to improve professional practice, awareness of women, educate public authorities and within a few years reduce the epidemic of CVD of French women.
    Annales de cardiologie et d'angeiologie 01/2014; · 0.21 Impact Factor
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    ABSTRACT: Therapeutic inertia (TI) is a recent concept still unknown by many physicians. In chronic diseases such as hypertension, it is defined as the tendency of physicians not to increase or change antihypertensive medications when the target blood pressure is not reached. Acting on TI could improve blood pressure control in France. This was a single-center prospective pilot study conducted by hypertension specialist physicians at the University Cardio-Vascular Center in Lille (France). It was conducted between March and June 2011. Data was collected from 161 hypertensive patients (mean age: 61.64±11.18 years; 98 (60.9%) male; 75 secondary prevention patients). Each physician completed a questionnaire on therapeutic inertia. TI was defined as a consultation in which treatment change was indicated (systolic blood pressure [BP]≥140 and/or diastolic BP≥90mmHg in all patients), but did not occur, with absence of an adapted justification of this choice. We considered as an adapted justification: a white coat effect demonstrated by ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring; scheduled reassessment of the BP by ABPM; recent change in antihypertensive treatment (less than 4 weeks); hospitalization needed for complete evaluation of secondary causes of hypertension and a more detailed assessment of potential target organ damage in patients with grade 1 or 2 hypertension. Our study aimed to evaluate rates of TI, to identify factors associated with TI, and to test the TI questionnaire. Therapeutic inertia as defined in this study occurred in 11 consultations (8.3%) of the 133 hypertensive patients having uncontrolled BP above or equal to 140 and/or 90mmHg. Significant factors associated with TI were older age (Z=2.35, P<0.05) and sleep apnea syndrome (χ(2)=8.33, P<0.05). The absence of ambulatory blood pressure monitoring before the consultation (χ(2)=4.28, 0.1>P>0.05) and the number of consultations (Z=1.92, 0.1>P>0.05) exhibited a significant trend to be associated with TI. Although the rate of TI was low in our study conducted in a specialized center, a well-accepted definition of therapeutic inertia would be useful for further study. The feasibility of using the questionnaire tested with this study shows that this measurement tool could help physicians become more aware of TI, both in the hospital and primary care setting. Further multicenter studies are needed for validation.
    Journal des Maladies Vasculaires 10/2013; · 0.24 Impact Factor
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    ABSTRACT: HTA Vasc offers an approved educational program for hypertensive patients at high cardiovascular risk (CVR). METHOD: A telephone survey (December 2011-July 2012) evaluated the benefits of different workshops "my treatment", "my blood pressure" and "my nutrition", more than 6 months after the end of the program. The follow-up data (TS) were compared to inclusion data (T0) and to final data (TF) in 73 hypertensive patients. RESULTS: The follow-up period was 6 to 31 months. The number of hypertensive controlled patients [blood pressure (BP)<140/90mmHg] increased from 55.4% to 75.4% (P=0.0158) in TF, which remained over time. The practice of physical activity increased from 47.9% (T0) to 79.5% (TS) (P=0.001). The follow-up period of 18 months or more was associated with a tendency to weight gain (P=0.0059) and with a decline in physical activity [89.7% (<18 months) to 67.5% (≥18 months) (P=0.0198)]. The practice of self-measurement BP increased from 41.1% (T0) to 71.2% (TS) (P<0.0001); knowledge of the "rule of three" increased from 6.8% (T0) to 74% (TS) (P<0.0001). CONCLUSION: An educational support contributes to a better long-term BP control. The motivation for lifestyle rules decreases with time. The implementation of a structured motivational follow-up could maintain the lifestyle motivation at these CVR patients.
    Annales de cardiologie et d'angeiologie 04/2013; · 0.21 Impact Factor
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    ABSTRACT: Mid-term and long-term mortality after aortic dissection remain high and due to unknown factors. To determine predicting factors at the acute phase associated with mid- and long-term all-cause mortality, patients with type B aortic dissection including intramural hematoma, treated in one referral university center in an area with a population of 4 million, were analyzed over a period of 12 years (from 1996 to 2008). Based on the total population, 77 patients discharged after type B aortic dissection (including 11 intramural hematoma) were recorded as treated with either medical treatment alone (n = 41) or with additional endovascular therapy (n = 36). The mean follow-up period was 50.8 months, with a survival rate of 78 % (17 deaths). Patient history, symptoms, medical treatment, biological parameters, imaging, and intervention during acute phase (more than 150 parameters) were analyzed to identify any relationship with complications and death. Kaplan-Meier survival curve and Cox proportional hazards analyses identified independent predictors of follow-up mortality from any cause. Factors influencing mortality (P < 0.05) were a low systolic blood pressure (SBP) at admission, a thrombocytopenia in the acute period, chronic bronchitis, diameter of ascending aorta, and renin-angiotensin system inhibitor intake. Independent predictors of mortality were chronic bronchitis (P = 0.0022, hazard ratio (HR) 17.5), early thrombocytopenia (P = 0.042, HR 3.5), and admission SBP <120 mmHg (P = 0.0048, HR 7.928). Treated (medical ± endovascular) type B aortic dissection held a worse long-term prognosis, which can be correlated with predicting factors, especially in-hospital thrombocytopenia, and should require closer follow-up.
    Heart and Vessels 04/2013; · 2.13 Impact Factor
  • Journal des Maladies Vasculaires 03/2013; 38(2):131. · 0.24 Impact Factor
  • T Caudrelier, P Delsart, G Claisse, C Mounier-Vehier
    Journal des Maladies Vasculaires 03/2013; 38(2):140. · 0.24 Impact Factor
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    ABSTRACT: Background Therapeutic inertia (TI) is a recent concept still unknown by many physicians. In chronic diseases such as hypertension, it is defined as the tendency of physicians not to increase or change antihypertensive medications when the target blood pressure is not reached. Acting on TI could improve blood pressure control in France. Method This was a single-center prospective pilot study conducted by hypertension specialist physicians at the University Cardio-Vascular Center in Lille (France). It was conducted between March and June 2011. Data was collected from 161 hypertensive patients (mean age: 61.64 ± 11.18 years; 98 (60.9%) male; 75 secondary prevention patients). Each physician completed a questionnaire on therapeutic inertia. TI was defined as a consultation in which treatment change was indicated (systolic blood pressure [BP] ≥ 140 and/or diastolic BP ≥ 90 mmHg in all patients), but did not occur, with absence of an adapted justification of this choice. We considered as an adapted justification: a white coat effect demonstrated by ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring; scheduled reassessment of the BP by ABPM; recent change in antihypertensive treatment (less than 4 weeks); hospitalization needed for complete evaluation of secondary causes of hypertension and a more detailed assessment of potential target organ damage in patients with grade 1 or 2 hypertension. Our study aimed to evaluate rates of TI, to identify factors associated with TI, and to test the TI questionnaire. Results Therapeutic inertia as defined in this study occurred in 11 consultations (8.3%) of the 133 hypertensive patients having uncontrolled BP above or equal to 140 and/or 90 mmHg. Significant factors associated with TI were older age (Z = 2.35, P < 0.05) and sleep apnea syndrome (χ2 = 8.33, P < 0.05). The absence of ambulatory blood pressure monitoring before the consultation (χ2 = 4.28, 0.1 >P > 0.05) and the number of consultations (Z = 1.92, 0.1 > P > 0.05) exhibited a significant trend to be associated with TI. Conclusions Although the rate of TI was low in our study conducted in a specialized center, a well-accepted definition of therapeutic inertia would be useful for further study. The feasibility of using the questionnaire tested with this study shows that this measurement tool could help physicians become more aware of TI, both in the hospital and primary care setting. Further multicenter studies are needed for validation.
    Journal des Maladies Vasculaires 01/2013; · 0.24 Impact Factor
  • Archives des Maladies du Coeur et des Vaisseaux - Pratique 01/2013; 2013(221):28–32.
  • C. Mounier-Vehier
    Archives des Maladies du Coeur et des Vaisseaux - Pratique 01/2013; 2013(221):7–8.
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    ABSTRACT: Biological diagnostic criteria for diagnosing aldosterone-producing adenoma (APA) are not well-established. The aim of the study was to establish the best biological predictors of APA. A prospective register was implemented in 17 secondary or tertiary hypertension centres. The inclusion criterion was one of the following: onset of hypertension before 40 years of age; history of hypokalaemia; drug-resistant hypertension (resistant to three drugs); or spironolactone efficiency on BP. Among the 338 collected cases, 192 patients had two aldosterone-to-renin ratio (ARR) determinations (after 1hour supine and at least 1hour upright) on the same occasion. Twenty-five patients (8.2%) had biological hyperaldosteronism and an adrenal adenoma identified by computed tomography. APA was histologically confirmed in all 12 patients who underwent surgery. Histologically proven APAs were used as the 'gold standard' in receiver operating characteristic (ROC) curve analysis. ARRs were computed with a minimum renin value set at 5ng/L to avoid misclassification of so-called 'low-renin hypertension'. To predict an APA, the ARR area under the ROC curve was 0.93. A supine ARR cut-off value of 32ng/ng provided the highest sum of sensitivity (92%) plus specificity (92%). On the basis of an ARR≥32ng/ng in the supine and/or upright position, sensitivity reached 100%. The proposed cut-off value of 32ng/ng for ARR (minimum renin value set at 5ng/L) in one of two determinations had 100% sensitivity and 72% specificity with 20% positive and 100% negative predictive values for diagnosing APA.
    Archives of cardiovascular diseases 12/2012; 105(12):623-30. · 0.66 Impact Factor
  • Claire Mounier-Vehier
    La Presse Médicale. 11/2012; 41(11):1090–1091.
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    ABSTRACT: OBJECTIVES:: To evaluate the modalities of subclinical target organ damage (TOD) assessment in France, 2-3 years after publication of the European Society of Hypertension (ESH)/European Society of Cardiology (ESC) 2007 guidelines. METHODS:: Two parallel, large, cross-sectional surveys were performed in representative samples of 516 private practice cardiologists, and 943 general practitioners (GPs), in hypertensive patients (952 and 1778, respectively) without established cardiovascular or renal disease. RESULTS:: At least one TOD search was performed in 97.6% of cardiologists' patients, performed or ongoing in 96.1% of GPs' patients, with a median number of three TOD searches in both surveys. Only 8.6% of cardiologists' patients and 6.3% of GPs' patients had a full set of TOD analyses [i.e. the five categories investigated: left ventricular hypertrophy (LVH), vascular, renal, retinopathy and cerebrovascular]. When considering the three priority categories of subclinical TOD search recommended by the ESH/ESC guidelines (i.e. LVH, vascular and renal), 63.2% of cardiologists' patients and 49.5% of GPs' patients had this triple assessment completed. The new TOD assessment modalities, namely pulse wave velocity, ankle brachial index and microalbuminuria, were rarely used. Only 3.3% of GPs' patients and 15.4% of cardiologists' patients were reclassified with an upgraded cardiovascular risk. CONCLUSION:: Subclinical TOD modalities are commonly assessed in French hypertensive patients without established cardiovascular or renal diseases, although 55% still do not benefit from combined triple LVH, macrovascular and renal assessment. The new modalities of TOD assessment are rarely implemented. Moreover, TOD assessment displayed poor effectiveness in upgrading cardiovascular risk classification.
    Journal of Hypertension 10/2012; · 4.22 Impact Factor
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    Médecine des Maladies Métaboliques 09/2012; 6(4):347–349.
  • Claire Mounier-Vehier
    La Presse Médicale 08/2012; · 0.87 Impact Factor
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    ABSTRACT: Several studies have shown gender differences in the management of cardiovascular risk factors and diseases. Whether the management of hypertension by cardiologists in France differs according to patient gender has not been fully investigated. The main objective of this cross-sectional, multicentre study was to examine the management according to gender of hypertensive patients by office-based cardiologists in France. Cardiologists were asked to include consecutively two men and two women attending a routine consultation for essential hypertension. Therapeutic management was evaluated by comparing cardiovascular investigations in the preceding 6 months and hypertension control according to gender and the patients' global cardiovascular risk. Overall, data from 3440 adult patients (53% men) referred to 654 cardiologists were analysed. Hypertension was uncontrolled in 76% of both men and women and 69% were at high global cardiovascular risk (75% of men, 62% of women; P<0.001). Significantly fewer cardiovascular investigations had been performed in the preceding 6 months in women (22.6% vs 44.2% in men; P<0.001). The treatment regimen was changed by the cardiologist in approximately 50% of patients regardless of gender or global cardiovascular risk. The PARITE study shows that in French office-based cardiology practice, the antihypertensive regimen is adjusted as often in female as in male patients. However, the results suggest that there is room for improvement in the investigation of cardiovascular disease in women. Healthcare providers could be encouraged to implement established guidelines on the prevention of cardiovascular disease in women.
    Archives of cardiovascular diseases 05/2012; 105(5):271-80. · 0.66 Impact Factor
  • Journal des Maladies Vasculaires 03/2012; 37(2):78–79. · 0.24 Impact Factor
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    ABSTRACT: This clinical case illustrates the management difficulties encountered during gestational hypertension and its impact on maternal and foetal outcome. Typically, preeclampsia occurs at the end of the second trimester. If blood pressure remains high early during pregnancy, a secondary cause of hypertension such as renal artery fibromuscular dysplasia should be explored. A renal vascular etiology can be safely ruled out with a duplex ultrasound. In this particular case of renal vascular hypertension in a patient with a single kidney, angioplasty appeared to be the sole solution and was efficient.
    Journal des Maladies Vasculaires 02/2012; 37(1):26–29. · 0.24 Impact Factor
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    ABSTRACT: This clinical case illustrates the management difficulties encountered during gestational hypertension and its impact on maternal and foetal outcome. Typically, preeclampsia occurs at the end of the second trimester. If blood pressure remains high early during pregnancy, a secondary cause of hypertension such as renal artery fibromuscular dysplasia should be explored. A renal vascular etiology can be safely ruled out with a duplex ultrasound. In this particular case of renal vascular hypertension in a patient with a single kidney, angioplasty appeared to be the sole solution and was efficient.
    Journal des Maladies Vasculaires 02/2012; 37(1):26-9. · 0.24 Impact Factor
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    ABSTRACT: The chronic management of post-acute aortic dissection (AD) of the descending aorta (Type B) is based on optimal control of blood pressure (BP), with a target BP < 135/80 mmHg. The aim of our study was to determine and verify effective blood pressure control with an objective measurement method and to identify predicting factors. We collected data from 26 patients hospitalized in the acute phase of a Type B AD between 2006 and 2009. Two groups were defined according to 24 hour BP monitoring results at follow-up. Group 1 consisted of patients with a controlled BP (<130/80 mmHg), and Group 2 consisted of patients with an uncontrolled BP. Thirty four percent of patients showed an uncontrolled BP at checkup. Vascular history before AD (P = 0.06), high baseline BP trend (P = 0.01 for systolic and P = 0.08 for diastolic), and greater diameter of the descending aorta (P = 0.02) were associated with poor BP control. Prognosis after AD is associated with BP control. Therefore, 24 hour BP monitoring can be made.
    Vascular Health and Risk Management 01/2012; 8:23-30.

Publication Stats

492 Citations
146.85 Total Impact Points

Institutions

  • 1999–2014
    • CHRU de Strasbourg
      • Pôle Gynécologie-obstétrique
      Strasburg, Alsace, France
  • 1998–2013
    • Centre Hospitalier Régional Universitaire de Lille
      Lille, Nord-Pas-de-Calais, France
  • 2011
    • University of Lille Nord de France
      Lille, Nord-Pas-de-Calais, France
  • 2009
    • Université du Droit et de la Santé Lille 2
      Lille, Nord-Pas-de-Calais, France