[Show abstract][Hide abstract] ABSTRACT: We hypothesized that depression might represent a barrier to reach an ideal cardiovascular health (CVH) as estimated by the 7-item tool proposed by the American Heart Association. Between 2008 and 2012, 9,417 subjects 50–75 years of age were examined in a large health center and enrolled in the Paris Prospective Study III (PPS3). Participants with 0–2, 3–4 and 5–7 health metrics at the ideal level were categorized as having poor, intermediate and ideal CVH, respectively. Participants with a score ≥7 on the 13-item Questionnaire of Depression 2nd version, Abridged or who were on antidepressants were referred as having high level of depressive symptoms (HLDS). The mean age of the 9417 study participants was 59.57 (SD 6.28) years and 61.16% were males. A total of 9.55% had HLDS. Poor, intermediate and ideal CVH was present in 40.38%, 49.52% and 10.10% of the participants. In multivariate polytomous logistic regression analysis, HLDS was inversely associated with ideal CVH (odds ratio = 0.70; 95% CI: 0.55;0.90). This was driven by an association with the behavioural component of the CVH. Participants with HLDS had a substantial reduced chance of reaching an ideal CVH.
[Show abstract][Hide abstract] ABSTRACT: Background:
The clinical use of carotid intima media thickness (cIMT) requires normal values, which may be subject to variation of geographical factors, ethnicity or measurement details. The influence of these factors has rarely been studied. The aim of this study was to determine whether normative cIMT values and their association with event risk are generalizable across populations.
Meta-analysis of individual participant data.
From 22 general population cohorts from Europe, North America and Asia we selected subjects free of cardiovascular disease. Percentiles of cIMT and cIMT progression were assessed separately for every cohort. Cox proportional hazards models for vascular events were used to estimate hazard ratios for cIMT in each cohort. The estimates were pooled across Europe, North America and Asia, with random effects meta-analysis. The influence of geography, ethnicity and ultrasound protocols on cIMT values and on the hazard ratios was examined by meta-regression.
Geographical factors, ethnicity and the ultrasound protocol had influence neither on the percentiles of cIMT and its progression, nor on the hazard ratios of cIMT for vascular events. Heterogeneity for percentiles of cIMT and cIMT progression was too large to create meaningful normative values.
The distribution of cIMT values is too heterogeneous to define universal or regional population reference values. CIMT values vary widely between different studies regardless of ethnicity, geographic location and ultrasound protocol. Prediction of vascular events with cIMT values was more consistent across all cohorts, ethnicities and regions.
Full-text · Article · Jan 2016 · European Journal of Preventive Cardiology
[Show abstract][Hide abstract] ABSTRACT: PURPOSE: Sudden cardiac death (SCD) is a major public health concern, but data regarding epidemiology of this disease in Western European countries are outdated.This study reports the first results from a large registry of SCD.
[Show abstract][Hide abstract] ABSTRACT: AIMS:
Passive smoking is the inhalation of environmental tobacco smoke (ETS) and is a risk factor for coronary heart disease (CHD). We aimed to describe the frequency of passive smoking among patients with CHD and to investigate the association between ETS exposure and smoking cessation.
METHODS AND RESULTS:
The EUROASPIRE III survey was conducted in 2006-07 among CHD patients up to 80 years of age from 22 European regions. Patients were interviewed and examined on average 15 months after hospital admission for CHD. Information was obtained on smoking prior to hospital admission, smoking at interview, and ETS exposure at home, at work, and at other locations. Breath carbon monoxide was measured to validate self-reported non-smoking. Among 8729 patients, 6060 (69.4%) were non-smokers prior to hospital admission, of whom 10.3% reported ETS exposure at home, 7.2% at work, and 13.8% at other locations. Overall, 24.2% of non-smokers were exposed to ETS at any place. Among the 2669 patients who were smoking prior to hospital admission, the likelihood of cessation at interview was lower in those with ETS exposure at home than in those without [25.3 vs. 58.1%; adjusted odds ratio (OR) 0.26, 95% confidence interval (CI) 0.20-0.33]. This finding applied also to ETS exposure at work (32.2 vs. 52.7%; adjusted OR 0.56, 95% CI 0.42-0.76) and at other locations (38.0 vs. 52.8%; adjusted OR 0.63, 95% CI 0.48-0.84).
A noteworthy proportion of non-smokers with CHD are exposed to ETS. Passive smoking may jeopardize smoking cessation among CHD patients.
Full-text · Article · Dec 2013 · European Heart Journal
[Show abstract][Hide abstract] ABSTRACT: AimsCommon carotid artery intima-media thickness (CCIMT) is widely used as a surrogate marker of atherosclerosis, given its predictive association with cardiovascular disease (CVD). The interpretation of CCIMT values has been hampered by the absence of reference values, however. We therefore aimed to establish reference intervals of CCIMT, obtained using the probably most accurate method at present (i.e. echotracking), to help interpretation of these measures.Methods and resultsWe combined CCIMT data obtained by echotracking on 24 871 individuals (53% men; age range 15-101 years) from 24 research centres worldwide. Individuals without CVD, cardiovascular risk factors (CV-RFs), and BP-, lipid-, and/or glucose-lowering medication constituted a healthy sub-population (n = 4234) used to establish sex-specific equations for percentiles of CCIMT across age. With these equations, we generated CCIMT Z-scores in different reference sub-populations, thereby allowing for a standardized comparison between observed and predicted ('normal') values from individuals of the same age and sex. In the sub-population without CVD and treatment (n = 14 609), and in men and women, respectively, CCIMT Z-scores were independently associated with systolic blood pressure [standardized βs 0.19 (95% CI: 0.16-0.22) and 0.18 (0.15-0.21)], smoking [0.25 (0.19-0.31) and 0.11 (0.04-0.18)], diabetes [0.19 (0.05-0.33) and 0.19 (0.02-0.36)], total-to-HDL cholesterol ratio [0.07 (0.04-0.10) and 0.05 (0.02-0.09)], and body mass index [0.14 (0.12-0.17) and 0.07 (0.04-0.10)].Conclusion
We estimated age- and sex-specific percentiles of CCIMT in a healthy population and assessed the association of CV-RFs with CCIMT Z-scores, which enables comparison of IMT values for (patient) groups with different cardiovascular risk profiles, helping interpretation of such measures obtained both in research and clinical settings.
Full-text · Article · Aug 2013 · European Heart Journal
[Show abstract][Hide abstract] ABSTRACT: Atrial fibrillation is a common finding in patients with myocardial infarction, its incidence vanes between 4% and 25% in the acute phase of myocardial infarction. The présence of atrial fibrillation is associated with an increased risk of mortality in patients with a myocardial infarction, even after adjustment for several important atrial fibrillation risk factors and regardless of the timing of onset of atrial fibrillation. This subsequent 40% increase in mortality associated with atrial fibrillation during myocardial infarction suggests that closer attention should be paid to these patients. Further research is needed to identify ways to prevent the occurrence of atrial fibrillation during myocardial infarction and to determine the optimal atrial fibrillation therapeutics strategies to reduce mortality in patients with myocardial infarction.
Preview · Article · Jun 2013 · Archives of Cardiovascular Diseases Supplements
[Show abstract][Hide abstract] ABSTRACT: In heart transplants, the significance of very late rejection (after 7 years post-transplant, VLR) detected by routine endomyocardial biopsies (EMB) remains uncertain. Here, we assessed the prevalence, histopathological and immunological phenotype, and outcome of VLR in clinically stable patients. Between 1985 and 2009, 10 662 protocol EMB were performed at our institution in 398 consecutive heart transplants recipients. Among the 196 patients with >7-year follow-up, 20 (10.2%) presented subclinical ≥3A/2R-ISHLT rejection. The VLR group was compared to a matched control group of patients without rejection. All biopsies were stained for C4d/C3d/CD68 with sera screened for the presence of donor-specific antibodies (DSAs). In addition to cellular infiltrates with myocyte damage, 60% of VLR patients had evidence of intravascular macrophages. C4d and/or C3d-capillary deposition was found in 55% VLR EMB. All cases of VLR associated with microcirculation injury had DSAs (mean DSA(max) -MFI = 1751 ± 583). This entity was absent from the control group (p < 0.0001). Finally, after a similar follow-up postreference EMB of 6.4 ± 1 years, the mean of CAV grade was 0.76 ± 0.18 in the control group compared to 2.06 ± 0.26 in the VLR group respectively, p = 0.001). There was no difference in patient survival between study and control groups. In conclusion, VLR is frequently associated with complement-cascade activation, microvascular injury and DSA, suggesting an antibody-mediated process. VLR is associated with a dramatic progression to severe CAV in long-term follow-up.
Full-text · Article · Jun 2011 · American Journal of Transplantation
[Show abstract][Hide abstract] ABSTRACT: INTRODUCTION AND AIMS: Recently, uridine adenosine tetraphosphate (Up4A) was described as a strong vasoconstrictor released from endothelial cells
after stimulation with mechanical stress. In this study, we isolated and identified Up4A from kidney tissue, and we characterized
the essential varying effects of Up4A on the afferent and efferent arterioles.
METHODS: Porcine and human kidney tissue was fractionated by size-exclusion-chromatography affinity-chromatography, anion-exchange-chromatography,
and reverse phase-chromatography. In fractions purified to homogeneity, Up4A was identified by matrix assisted laser desorption/ionisation
mass-spectrometry (MALDI-TOF-MS), MALDI-LIFT-fragment-massspectrometry (MALDI-TOF-TOF-MS), retention-time comparison, and
enzymatic cleavage analysis. We analysed the release of Up4A from cultivated renal proximal tubule cells after stimulation
of protein kinase C with OAG. Up4A was identified in renal tissue, and the effect of Up4A on the vascular tone of isolated
perfused afferent and efferent arterioles was tested.
RESULTS: Stimulation of tubule cells with OAG increased the release-rate of Up4A from tubule cells about ten fold. Up4A acts as a
strong vasoconstrictive mediator on afferent arterioles, but has no significant effect on the tone of efferent arterioles,
suggesting a functional role of Up4A a an autocrine hormone for glomerular perfusion. Because of the predominant effect of
the Up4A on afferent arterioles, we assume that Up4A may decrease glomerular perfusion, intraglomerula pressure, and hence
glomerular filtration rate. The release of Up4A from renal tubular cells may be an additional mechanism whereby tubular cells
could affect renal perfusion. Up4A release may further contribute to renal vascular autoregulation mechanisms.
CONCLUSIONS: As Up4A occurs in renal tissue and has marked effects on afferent but not efferen arterioles, Up4A may play a role in renal
hemodynamics and blood pressure regulation.
No preview · Article · Jun 2011 · CKJ: Clinical Kidney Journal
[Show abstract][Hide abstract] ABSTRACT: INTRODUCTION AND AIMS: The renin-angiotensin-aldosterone system (RAS) plays critical roles in the progression of chronic kidney disease. Aldosterone,
which is secreted from adrenal cortex by the stimulation of angiotensin II, promotes kidney injury. Patients with primary
aldosteronism are frequenrly accompanied with chronic kidney disease. (Pro)renin receptor ((P)RR), a specific receptor for
renin and prorenin, has recently been identified. When bound to prorenin, (P)RR activates the angiotensin I-generating activity
of prorenin in the absence of cleavage of the prosegment, and directly stimulates the MAPK pathway independently from the
RAS. (P)RR expressed in the adrenal may be related to the progression of chronic kidney disease. The aim of the present study
is therefore to clarify the expression of (P)RR in kidneys, adrenal glands and aldoterone-secreting adenomas.
METHODS: The present study was approved by the Ethics Committee of the Tohoku Univ. Grad. School of Medicine. Aldosterone-secreting
adrenal adenomas and non-neoplastic portion of adrenal glands were obtained at surgery from patients undergoing adrenalectomy
for the treatment of primary aldosteronism. As positive control, the kidney tissues were obtained at autopsy from patients
with and without diabetic nephropathy (n=5 without diabetes mellitus; and n=8 with diabetic nephropathy). Immunocytochemistry
was performed by the ABC method using paraffin-embedded sections. The antiserum against (P)RR was raised in a rabbit by injecting
the peptide fragment of human (P)RR corresponding to 224-237 a.a. The identity of the (P)RR immunoreactivity was confirmed
by Western blot analysis.
RESULTS: In non-neoplastic portion of adrenal gland, the adrenal medulla was positively immunostained with (P)RR, whereas the adremal
cortex was very weakly or was not immunostained with (P)RR. By contrast, the tumor tissues of aldosterone-secreting adrenal
adenomas were more clearly immunostained with (P)RR. Adipocytes in the adipose tissue around the adrenal glands were positively
immunostained with (P)RR. In the kidney, (P)RR was mainly expressed in the tubular cells and collecting duct cells of the
kidney both with and without diabetic nephropathy. (P)RR immunostaining in the tubular cells and collecting duct cells was
clearly and frequently more strongly observed in the kidney with diabetic nephropathy up to the end stage renal disease.
CONCLUSIONS: (P)RR expressed in the adrenal adenomas may promote angiotensin II generation from angiotensinogen, and increase aldosterone
secretion from the adrenal tumors. Increased aldosterone secretion may, in turn, promote the progression of chronic kidney
disease in patients with primary aldosteronism.
No preview · Article · Jun 2011 · CKJ: Clinical Kidney Journal
[Show abstract][Hide abstract] ABSTRACT: We aimed to develop and validate a simple coronary heart disease (CHD) risk algorithm applicable to asymptomatic men and women in France, and to compare its accuracy with that of the last published version of the Framingham risk function for cardiovascular disease.
A pooled analysis of four French prospective general-population studies.
The baseline and follow-up data from D.E.S.I.R., PRIME, Three City, and SU.VI.MAX studies were used. The 10-year CHD risk was estimated by the Cox proportional hazards model with candidate variables including age, gender, body mass index, waist circumference, family history of coronary heart disease, smoking status, diabetes status, systolic blood pressure, and total and high-density lipoprotein (HDL) cholesterol.
The study population included 22,256 subjects (61.4% men) aged (SD) 56.0 years (8.3) without a personal history of CHD at baseline. After a mean follow-up of 8.0 years (2.3), 788 first CHD events occurred, 726 in men and 62 in women. The final model included age, gender, age × gender interaction, current smoking status, diabetes status, systolic blood pressure, total and HDL cholesterol. Using this model, the number of predicted coronary events fitted that given by the 10-year Kaplan-Meier survival estimates within each decile of estimated risk (calibration). This model had fair discrimination: Harrell C-index, 0.7831 (95% CI: 0.7704-0.7957). For comparison, the recalibrated Framingham risk function had equivalent performances compared to the French risk equation.
Our 10-year French CHD risk equation based on traditional risk factors performed at least as well as the recalibrated Framingham cardiovascular disease risk function.
No preview · Article · Apr 2011 · European journal of cardiovascular prevention and rehabilitation: official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology