[Show abstract][Hide abstract] ABSTRACT: Purpose:
This study investigated the effects of an exercise program at the intensity corresponding to the crossover point of substrate utilization (COP) on anthropometric measures, health-related quality of life (HRQoL) and cardiorespiratory fitness (i.e., peak oxygen uptake: VO2peak and peak power output: Ppeak) in women with metabolic syndrome (MetS).
Nineteen obese and post-menopausal women with MetS (age: 54.8 ± 8.1 y, body mass: 89.0 ± 12.2 kg, body mass index: 34.5 ± 4.0 kg.m-2) followed a 12-week program consisting of three 45-min sessions per week of cycle ergometer exercise. The imposed exercise intensity corresponded to COP. Before and after the program, HRQoL, VO2peak and Ppeak were measured and then compared.
Body mass (89.0 ± 12.2 vs 86.2 ± 11.0 kg), body mass index (34.5 ± 4.0 vs 33.4 ± 3.6 kg.m-2), waist (106 ± 10 vs 100 ± 9 cm) and hip (117 ± 11 vs 114 ± 11 cm) circumferences, waist-to-hip ratio (0.91 ± 0.07 vs 0.88 ± 0.07), fat mass (43.3 ± 4.6 vs 41.9 ± 4.6%), fat-free mass (56.7 ± 4.6 vs 58.2 ± 4.6%), VO2peak (16.6 ± 3.4 vs 18.1 ± 4.1 mL.min-1.kg-1) and Ppeak (102 ± 22 vs 125 ± 27 W) were significantly improved after the exercise program (P < 0.05), but HRQoL showed no significant improvement on any subscale (i.e., physical functioning: performance limitation for physical activities including bathing and dressing, role physical: problems with work or other daily activities, bodily pain, general health, vitality, social functioning, role emotional and mental health; P > 0.05).
Although a 12-week exercise program at COP improved anthropometric measures and cardiorespiratory fitness in women with MetS, self-perceived HRQoL did not significantly improve. This finding may be linked to a significant but nevertheless insufficient reduction in body mass, probably because COP is too weak exercise intensity to induce important energy expenditure.
The Journal of sports medicine and physical fitness 09/2015; · 0.97 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective: The association between a structural anomaly of the aortic wall and uncontrolled hypertension are the main causing factors of aortic dissection. Follow-up management is based on an optimal blood pressure control. The data on blood pressure control and on medical therapy prescription at discharge after an acute surgery in this population are scares. Design and method: We retrospectively analyzed the data of 74 patients hospitalized from 2005 to 2010 for an emergency surgical type A aortic dissection. All patients benefited of a 24-hour blood pressure monitoring at discharge, medical prescription before admission and at discharge were collected. Statistical analyses were made with non parametric tests. Results: 67% of the population was male, median age of 53 years, 9.5 % with a prior history of ascending aorta aneurysm, 6.7 % with an elastic aortic wall disease. 50% take an antihypertensive therapy before admission, 8% of patients received 3 or more drugs, 4 % of diabetes mellitus, 31 % of former smoker and median Body Mass Index was of 26.4 Kg/m2. We note 23 % of left ventricular hypertrophy on electrocardiogram. The median systolic and diastolic blood pressure on the 24 h monitoring were respectively 125/71 mmHg. The results on medical therapy prescription are summarized in the Table. Copyright
Journal of Hypertension 06/2015; 33:e311-e312. DOI:10.1097/01.hjh.0000468329.68545.92 · 4.72 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Various toxic or drug agents can induce arterial hypertension, aggravate or limit the efficiency of anti-hypertensive drugs. Iatrogenic and drug-induced hypertension should be well known by the clinicians and the pharmacists, given the impact for driving the management of patients. In the food, an excessive alcohol consumption (more than 30 g per day) and more rarely glycerizine (active ingredient of the licorice) should be systematically looked for in front of a recent hypertension or do not respond to usual treatment. In the list of offending medicines, we must remember ethinyl estradiol contained in the contraception (oral, vaginal ring or transcutaneous patch), non steroidal anti-inflammatory drugs, immunosuppressants (cyclosporine, tacrolimus), vascular endothelial growth factor and its receptor R2 (avastin, inhibitors of receptor tyrosine kinases), recombinant human erythropoietin, sympathomimetics (nasal decongestants), anabolic steroids, bromocriptine (inhibitor of lactation), psychotropes (tricyclics antidepressants, monoamine oxydase inhibitors). The diagnosis of iatrogenic hypertensions should be systematically suspected in front of a suggestive clinical context with a meticulous food questioning because these hypertensions are partially or fully reversible after exposure stops.
[Show abstract][Hide abstract] ABSTRACT: Obstructive sleep apnea (OSA) is the most common factor involved in uncontrolled blood pressure (BP). Management of OSA is part of cardiologist work. We have few data on BP control in a population of OSA followed by cardiologists.
We evaluated the prevalence of effective BP control using ambulatory measurement in a population of patients followed in cardiology.
Data from 69 OSA patients treated for more than 6 months by continuous positive airway pressure (CPAP) were collected prospectively from March 2012 until December 2012. These patients were divided into 2 groups according to the results of 24-h ambulatory BP monitoring (ABPM). Controlled BP was defined as a 24 h BP <130/80 mmHg.
All patients were hypertensive. 44 patients (63 %) had uncontrolled hypertension (HTN). The onset of OSA (p = 0.01) and persistent daytime sleepiness appeared as predictors of uncontrolled BP. Systolic BP (SBP) during consultation and all the ABPM variables were higher in uncontrolled BP patients. Uncontrolled BP was associated with greater left ventricular mass (p = 0.02) and greater diameter of the ascending aorta (p = 0.04).
Control of HTN should be evaluated in all OSA patients, using ABPM. The onset of OSA and high SBP during consultation are both factors associated with uncontrolled BP in this population. Repeating ABPM should be of interest for the follow up of these patients.
High Blood Pressure & Cardiovascular Prevention 04/2015; 22(2). DOI:10.1007/s40292-015-0088-1
[Show abstract][Hide abstract] ABSTRACT: Based on theoretical evidence, intensity at the crossover point (COP) of substrate utilization could be considered as potential exercise intensity for metabolic syndrome (MetS). This study aimed to examine the effects of a training program at COP on exercise capacity parameters in women with MetS and to compare two metabolic indices (COP and the maximal fat oxidation rate point LIPOXmax®) with ventilatory threshold (VT).
Nineteen women with MetS volunteered to perform a 12-week training program on cycle ergometer, with an intensity corresponding to COP. Pre- and post-training values of anthropometric and exercise capacity parameters were compared in order to determine the effects of exercise training. The pre-post training change of COP, LIPOXmax® and VT were also investigated.
After training, anthropometric parameters were significantly modified, with a reduction of body mass (3.0 ± 3.0%, p<0.001), fat mass (3.3 ± 3.4%, p<0.001) and body mass index (3.2 ± 3.4%, p<0.001). Exercise capacity was improved after the training program, with significant increase of maximal power output (25.0 ± 18.4%, p<0.001) and maximal oxygen uptake (VO2max = 9.0 ± 11.2%, p<0.01). Lastly, when expressed in terms of power output, COP, LIPOXmax® and VT occurred at a similar exercise intensity but the occurrence of these three indices is different when expressed in terms of oxygen uptake, heart rate or rating of perceived exertion.
This study highlights the effectiveness of 12-week training program at COP to improve physical fitness in women with MetS. The relationships between metabolic indices and VT in terms of power output highlight the determination of VT from a shorter maximal exercise as a useful method for the determination of metabolic indices in MetS.
Medicine and science in sports and exercise 03/2015; DOI:10.1249/MSS.0000000000000674 · 3.98 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: L’hypertension artérielle masquée (HTAm), définie par une pression artérielle (PA) normale en consultation mais élevée en ambulatoire, est caractérisée par une prévalence élevée dans la population générale et un mauvais pronostic cardiovasculaire. Cette étude a cherché à évaluer l’intérêt d’un dépistage systématique de l’HTAm par monitoring de PA des 24 h chez les patients ayant une artériopathie oblitérante des membres inférieurs (AOMI).
[Show abstract][Hide abstract] ABSTRACT: The present study examined the effects of a training program at a special exercise intensity—the crossover point of substrate utilization (COP)—on the metabolic abnormalities and cardiovascular risk factors in obese women with metabolic syndrome (MetS). Eighteen postmenopausal obese women with MetS (age, 54.8 ± 8.4 years; height, 160 ± 6 cm) followed a 12-week training program consisting of three 45-minute sessions/wk on a cycle ergometer. The intensity imposed during the training sessions corresponded to COP. Before and after the training program, anthropometric, biological, and blood pressure data were collected and compared. After the training program, body mass (88.4 ± 12.3 kg vs. 85.7 ± 11.1 kg), fat mass (43.2 ± 4.8% vs. 41.8 ± 4.8% body mass), body mass index (34.3 ± 3.9 kg/m2 vs. 33.2 ± 3.6 kg/m2), and waist circumference (105 ± 10 cm vs. 100 ± 9 cm) were significantly lower (p < 0.01). Moreover, fasting plasma glucose was significantly lower after the training program (114 ± 20 mg/dL vs. 107 ± 15 mg/dL; p = 0.02) and the quantitative insulin-sensitivity check index was significantly higher (0.58 ± 0.08 vs. 0.61 ± 0.05; p = 0.05). A significant reduction in systolic blood pressure was also observed (141 ± 15 mmHg vs. 129 ± 11 mmHg; p = 0.02). After the program, the number of patients with fasting plasma hyperglycemia and arterial hypertension was significantly decreased by 54.4% and 44.4%, respectively, and the number of patients with MetS was nonsignificantly reduced by 22.2% (p = 0.10). The present study shows that a training program at COP is an efficient means to treat MetS.
Journal of exercise science and fitness (JESF) 11/2014; 12(2). DOI:10.1016/j.jesf.2014.09.002 · 0.33 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 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; 63(3). DOI:10.1016/j.ancard.2014.05.001 · 0.30 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; · 0.30 Impact Factor
[Show abstract][Hide abstract] 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.
[Show abstract][Hide abstract] 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; 62(3). DOI:10.1016/j.ancard.2013.04.004 · 0.30 Impact Factor
[Show abstract][Hide abstract] 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; 29(2). DOI:10.1007/s00380-013-0354-x · 2.07 Impact Factor