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Background After an acute coronary syndrome (ACS), pharmacologic therapy and lifestyle intervention (optimal medical therapy, OMT) are efficient in reducing cardiovascular (CV) events. However, even if recommended secondary prevention goals are reached, a subset of patients still present CV events. Aim To identify biological or cardiovascular markers predicting the residual risk of CV events in post-ACS patients receiving OMT. Patients and methods 990 patients benefited from an evaluation of risk factors and atherosclerosis lesions, and optimization of long-term treatment and education. Traditional CV risk factors and atheroma disease markers (intima-media thickness (IMT), carotid atheroma, Ankle Brachial Index (ABI) and number of coronary arteries with >50% stenosis) were evaluated 3 months after ACS. CV events were recorded at follow-up (CV death, ACS, stroke, heart failure, revascularization). Results At a median follow-up of 20 months, more than 80% of the patients reached recommended prevention goals. 116 total CV events were recorded. Diabetes was the only CV risk factor significantly associated with CV events in multivariate analysis (including age, sex, hypertension, LDL cholesterol, smoking, diabetes and hsCRP); HR 1,61 (1,09–2,39), p = 0,017. In multivariate analysis including CV risk factors and atheroma disease markers (peripheral vascular disease (PVD) defined as ABI 50%, IMT >0,7 mm, 3-vessel and/or left main coronary disease), only PVD remained significantly associated with CV events; HR 1,83 (1,02–3,31), p = 0,04. The number of vascular beds involved was associated with poorer prognosis: HR for 3 vascular-beds disease 3,85 (1,72–8,63) p = 0,001, given 1 vascular-bed disease as a reference group. Conclusion In post-ACS patients with OMT, PVD and atheroma burden represent powerful prognostic markers of CV events, while diabetes remains the only independent marker of CV events among traditional CV risk factors.

Background Patients with acute coronary syndrome (ACS) have a high prevalence of previously unknown diabetes mellitus (DM) and impaired glucose tolerance (IGT). Both conditions represent strong risk factors for future cardiovascular events after ACS. Aim To evaluate, in non-diabetic patients in post-ACS, the effect of an early diagnosis and management of glucose metabolism abnormalities, on their persistence at 3-month. Patients and methods 271 consecutive patients were admitted for an ACS. OGTT was performed at day 2-4, and risk factors were recorded. Patients were classified following OGTT. All subjects received 3 educational courses for lifestyle modification (diet, smoking, and physical activity). Glucometabolic state was again assessed three months after the ACS. Results DM was known or diagnosed in 29.5% of the patients at admission for ACS. Patients with normal fasting glucose but classified as New Diabetes (ND, 16,7%) on OGTT shared the same risk factor profile and atheroma burden as DM patients. IGT patients (28,3%) displayed risk values in-between NGT and ND patients. Lifestyle modifications after 3 months were effective. Food records found that energy intake and fat intake decreased significantly through 3 months, with a significant increase in mono and poly unsaturated fat and a significant decrease in saturated fat. Triglycerides and metabolic syndrome were reduced, HDL cholesterol increased. As shown by OGTT results at 3 months, 70% of IGT patients at 3 days were classified as NGT at 3 months. More than 50% of the ND group at 3 days was re-classified as IGT or NGT at 3 months. Conclusion An OGTT performed after an ACS, associated with lifestyle modification and diet intervention significantly improved the short-term evolution of the glucometabolic state.

Background The French guidelines recommend dual antiplatelet therapy after acute myocardial infarction (MI). Purpose To estimate persistence of dual antiplatelet therapy after MI. Methods A cohort study was conducted using data from the main French health insurance reimbursement database of the Aquitaine region (southwest France). Patients who have been hospitalized for MI in 2008 were first identified. Then, we looked for their reimbursement form of dual antiplatelet therapy (aspirin+clopidogrel) treatment for the following 12 months. Adherence was assessed by using two parameters: proportion of days covered by the treatment (medication availability) and persistence. The treatment persistence was the percentage of patients still treated at the end of the period. Discontinuation was defined as a minimum gap of 30 days between the theoretical end date of prescription reimbursed (based on a days’ supply) and the starting date of the next one. Results Among the 634 patients identified, 40 had no reimbursement of dual antiplatelet therapy immediately after discharge. At three month, 15.2% of the remaining patients did not buy at least one of the two treatments. They were 48.2% at 12 months although the medication availability was 90%. Conclusion Theses results suggest that while the patients have good medication availability, the treatment is often stopped before one year. At three months after MI, 20.6% of the patients were no longer treated with dual antiplatelet therapy. The results presented are likely to be an underestimation of adherence since some patients who buy their treatment, may not take it. This could explain some “resistance” described to antipletelet therapy.

BackgroundInflammation plays an important role in the initiation and progression of atherosclerosis and in the pathogenesis of acute cardiovascular (CV) events. Recent studies focused on the measurement of high sensitivity C-reactive protein (hsCRP) as predictors of CV events. hsCRP has been reported to have prognostic value immediately after ACS and to be associated with CV risk in patients with stable and unstable angina pectoris.AimTo evaluate the association of hsCRP levels with recurrent cardiovascular events in a large prospective study of stable post-ACS patients.MethodsPatients with an ACS were enrolled in our department between 2002 and 2007. HsCRP was measured at three month after the ACS together with a global evaluation of atherosclerosis burden and risk factors. Optimal medical treatment, a therapeutic and dietary education program was started during the acute phase and adjusted at 3 months.Results1202 patients with hsCRP < 15 mg/l were included and the first 795 patients were followed for an average of 22 months. 94% and 75% of the patients received a combination of b–blocker, anti- aggregates and cholesterol-lowering drugs respectively at 3 and 22 months. LDL-cholesterol, HbA1c, waist circumference, systolic blood pressure, metabolic syndrome, tobacco consumption, and atherosclerosis burden were higher in the 2nd and 3th tertile of hsCRP (p

BackgroundAfter an ischemic stroke, the risk of cardiovascular (CV) event is high. The effect of optimal control of risk factors on this high morbi-mortality has not been established in these patients.AimTo evaluate the effect of optimized secondary prevention including dietetic and therapeutic education, on CV risk factor control and CV events occurrence.Patients and method95 selected consecutive patients at high CV risk profile (>3 CVRF) benefited from a 2 days hospitalization 3 months after a stroke focused on evaluating risk factors and atherosclerosis lesions, and on optimizing treatment and education.ResultsIn this high risk population (mean age 60.4±8), we found respectively 24% and 23% of the patients with previously unknown peripheral vascular disease or coronaropathy, and 31% with left ventricular hypertrophy. At follow-up (median 684 days), 81% of the patients still received a combination of antiagregant + blood pressure drugs + statin. In term of secondary prevention goals, 73% of the patients had a normal blood pressure, 72% had a LDL