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• Cardioembolic stroke patients exhibit one of the highest 1-month mortality rates. • Stroke etiology predicts early mortality, irrespective of stroke severity. • Atrial fibrillation underdiagnosis and undertreatment show gaps in its management. • Atrial fibrillation predicts early mortality, irrespective of stroke etiology. • Improved targeted prevention could potentially reduce mortality after stroke. First, this registry-based study aimed to comprehensively analyze patients' medical histories and treatments based on ischemic strokes' etiology. We focused on the management of atrial fibrillation among patients diagnosed with cardioembolic stroke. Then, our objective was to identify prognostic factors associated with 28-day mortality. All ischemic strokes occurring in adults between 2014 and 2021 in Lille, France, were categorized using the TOAST classification. Comparative analyses of patients' medical characteristics were conducted across subtypes. Survival rates within 28 days post-stroke were assessed, and factors influencing mortality were identified using a multivariate Cox model. 1912 ischemic strokes were recorded, due to cardioembolism (36%), large-artery atherosclerosis (9%), small-artery occlusion (9%), other determined causes (6%), or undetermined causes (39%). The median NIHSS score after cardioembolic stroke (6, IQR: 3-13) was twice that after small-artery occlusion (3, IQR: 2-5). Among patients with cardioembolic stroke, 26% were diagnosed post-admission with atrial fibrillation. For the 42% diagnosed pre-admission, only 54% had prior prescriptions for oral anticoagulants. Reperfusion therapies were administered in 21% of cases, with significant variations across subtypes. Mortality rates were higher after cardioembolic strokes (17%) than after small-artery occlusions (3%). Prognostic factors included etiology, high NIHSS score, atrial fibrillation, and previous heparin prescription. While atrial fibrillation was underdiagnosed and undertreated, patients with cardioembolic stroke exhibited high severity and elevated mortality rates. Etiology emerged as an independent predictor of early mortality, regardless of NIHSS score upon admission. These findings underscore the importance of targeted prevention to improve patient outcomes after ischemic stroke. [ABSTRACT FROM AUTHOR]

LIPCAR is a long noncoding RNA identified in plasma of patients after myocardial infarction (MI) to be associated with left ventricle remodeling (LVR) and to be a predictor of early death in heart failure (HF) patients. However, the mechanisms involved in LIPCAR expression and secretion into the circulation have not yet been studied. To characterize the extracellular transporter of LIPCAR from heart into the circulation and to determine whether LIPCAR levels in plasma isolated-extracellular vesicles (EVs) could be used as biomarkers of LVR post-MI. Since expression of LIPCAR is restricted to human species and the limitation of availability of cardiac biopsy samples, serum-free conditioned culture media from HeLa cells were first used to characterize the extracellular transporter of LIPCAR before validation in EVs isolated from human cardiac biopsies (non-failing and ischemic HF patients) and plasma samples (patients who develop or not LVR post-MI). Differential centrifugation at 20,000 g and 100,000 g were performed to isolate the large (lEVs) and small EVs (sEVs), respectively. Western blot and nanoparticle tracking (NTA) analysis were used to characterize the isolated EVs. qRT-PCR analysis was used to quantify LIPCAR in all samples. We showed that LIPCAR is present in both lEVs and sEVs isolated from all samples. LIPCAR levels are higher in lEVs compared to sEVs isolated from HeLa culture media and cardiac biopsies. No difference of LIPCAR levels was observed in tissue or EVs isolated from cardiac biopsies obtained from non-failing and ischemic HF patients. Interestingly, LIPCAR levels were increased in lEVs and sEVs isolated from MI patients who develop LVR compared to patients who did not develop and are positively correlated with LVR. Our data showed that lEVs are the main EV transporter of LIPCAR from heart into the circulation in non-failing or HF patients. The levels of LIPCAR in EVs isolated from plasma could be used as biomarkers of LVR in post-MI patients. [ABSTRACT FROM AUTHOR]

After an acute coronary syndrome (ACS), fatal and non-fatal recurrences can occur, especially during the first year following the initial event. Previous studies on this issue were mainly based on hospital series or health insurance databases, and concerned fatal recurrences only. Furthermore, there are few comparative data between women and men on the risk of combined fatal and non-fatal recurrences in population at 1 year after a first ACS. The aim of this study was to compare the 1-year cumulative risk of ACS recurrence between men and women among survivors of a first episode and identify factors associated with this risk in French population-based registries. All patients aged from 35 to 74 living in the Lille urban community, the Bas-Rhin department and the Haute-Garonne county, and who survived a first ACS between 2009 and 2016, were recorded. The primary endpoint was the first fatal or non-fatal recurrent ACS occurring at 1 year (2017 as the date of point). A total of 15,318 patients (23% women) were included. Compared to men, women were older (mean age 59.5 vs. 57.3, p < 0.001), had more atypical symptoms (i.e. absence of chest pain, chest pain during less than 20 minutes, or not precordial, 34.3% vs. 27.2%, p < 0.001), had major complications (i.e. resuscitated cardiac arrest or acute pulmonary edema or cardiogenic shock, 9.7% vs. 7.4%, p < 0.001) and had less angioplasty (67.7% vs. 80.8%, p < 0.001) at the acute phase of the event. During the 1-year follow-up, there were 1022 recurrences (268 women, 26.2%). The overall 1-year cumulative incidence of recurrent ACS [95% CI] was 6.7% [6.3; 7.1] and it was higher in women (7.6% [6.8; 8.6]) than men (6.4% [5.9; 6.8], log rank P = 0.009). In multivariable analysis, age, atypical symptoms, major complications and reperfusion therapies were associated with a higher risk of ACS recurrence at 1 year. In contrast, sex was no longer statistically associated with the risk of recurrence (HR [95% CI]: 1.09 [0.94; 1.27]). In this population-based study, women have a higher risk of ACS recurrence the year following a first ACS episode. This difference could be partly explained by sex-related confounding factors such as an older age, atypical symptoms, major complications or reperfusion disparities at the acute phase of the first episode. [ABSTRACT FROM AUTHOR]

In recent years, contrasted results have been reported in acute coronary syndrome (ACS) hospitalization rates according to sex and ACS subtype. Changes in coronary heart disease epidemiology, but also evolutions in ACS definitions and international classifications of diseases may have affected the trends observed. To investigate changes in ACS hospitalization rates and revascularization procedures according to sex and ACS subtype, based only on troponin dosages and ECG characteristics. All hospitalized ACS occurring between January 2009 and December 2018 were recorded for patients aged 35 to 74 in the three French MONICA registries. Troponin dosage and ECG characteristics were used to classify ACS as ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI) or unstable angina (UA), irrespective of the clinical diagnosis or ICD coding. Trends in age-standardized rates were analysed using Poisson regression models and expressed as annual percentage changes. Between 2009 and 2018, 36,622 hospitalized ACS were analysed. Almost two-thirds were incident (i.e. occurring among patients without a history of coronary heart disease). A total of 33.4% of cases were STEMI, 39.8% were NSTEMI, 13.6% were UA and 13.2% were unclassified ACS. Overall, the rates of ACS did not significantly vary in men and women. When only incident cases were considered, there was a significant increase in rates among women only (+1.2%/year, p < 10–4). Analysis performed by ACS subtype showed a decrease in UA rates in both men (−8.1%/year, p < 10–4) and women (−9.0%/year, p < 10–4). At the same time, an increase in NSTEMI rates was observed in both sexes (+1.5%/year, P = 0.04 in men ; +2.9%/year, p < 10–4 in women). There was a slight increase in STEMI rates, but this was not significant (+0.7%/year for men, P = 0.07; +1.4%/year for women, P = 0.17). With regard to revascularization, the rates of percutaneous coronary interventions increased significantly, by +1.0%/year in men and +2.0%/year in women (p < 10–4 for both sexes), whereas non-significant decreases in rates of coronary artery bypass were reported. Between 2009 and 2018, there was no decline in ACS hospitalization rates in France. While STEMI rates stagnated, NSTEMI rates rose at the expense of UA, probably due to the implementation of high-sensitive troponin from 2010. In women, first-ever events are tending to increase, raising concerns about future trends. [ABSTRACT FROM AUTHOR]

Summary Background & aims Blood levels of polyunsaturated fatty acids (PUFAs) are under control of endogenous synthesis via Δ5- and Δ6-desaturases, encoded by the FADS1 and FADS2 genes, respectively and of diet. Genome-wide associations studies (GWAS) reported associations between polymorphisms in FADS1–FADS2 and variations in plasma concentrations of PUFAs, HDL- and LDL-cholesterol and triglycerides. However, it is not established whether dietary PUFAs intake modulates these associations. We assessed whether dietary linoleic acid (LA) or α-linolenic acid (ALA) modulate the association between the FADS1 rs174547 polymorphism (a GWAS hit) and lipid and anthropometric phenotypes. Methods Dietary intakes of LA and ALA, FADS1 rs174547 genotypes, lipid and anthropometric variables were determined in three French population-based samples (n = 3069). These samples were stratified according to the median dietary LA (<9.5 and ≥9.5 g/d) and ALA (<0.80 and ≥0.80 g/d) intakes. The meta-analysis was performed using a random-effect. Results Our meta-analysis confirmed the association between rs174547 and plasma lipid levels and revealed an association with waist circumference and body mass index. These associations were not modified by dietary ALA intake (all p-interaction > 0.05). In contrast, the associations with HDL-cholesterol levels, waist circumference and BMI were modulated by the dietary intake of LA (p interaction < 0.05). In high LA consumers only, the rs174547 minor allele was significantly associated with lower HDL-cholesterol levels (β = −0.05 mmol/L, p = 0.0002). Furthermore, each copy of the rs174547 minor allele was associated with a 1.58 cm lower waist circumference (p = 0.0005) and a 0.46 kg m−2 lower BMI (p = 0.01) in the low LA intake group, but not in the high LA intake group. Conclusions The present study suggests that dietary LA intake may modulate the association between the FADS gene variants and HDL-cholesterol concentration, waist circumference and BMI. These gene–nutrient interactions, if confirmed, suggest that subjects carrying the rs174547 minor allele might benefit from low dietary LA intakes. [ABSTRACT FROM AUTHOR]

Background Blood polyunsaturated fatty acid (PUFA) levels are determined by diet and by endogenous synthesis via Δ5- and Δ6-desaturases (encoded by the FADS1 and FADS2 genes, respectively). Genome-wide association studies have reported associations between FADS1-FADS2 polymorphisms and the plasma concentrations of PUFAs, HDL- and LDL-cholesterol, and triglycerides. However, much remains unknown regarding the molecular mechanisms explaining how variants affect the function of FADS1-FADS2 genes. Objective Here, we sought to identify the functional variant(s) within the FADS gene cluster. Methods To address this question, we (1) genotyped individuals (n = 540) for the rs174547 polymorphism to confirm associations with PUFA levels used as surrogate estimates of desaturase activities and (2) examined the functionality of variants in linkage disequilibrium with rs174547 using bioinformatics and luciferase reporter assays. Results The rs174547 minor allele was associated with higher erythrocyte levels of dihomo-γ-linolenic acid and lower levels of arachidonic acid, suggesting a lower Δ5-desaturase activity. In silico analyses suggested that rs174545 and rs174546, in perfect linkage disequilibrium with rs174547, might alter miRNA binding sites in the FADS1 3′UTR. In HuH7 and HepG2 cells transfected with FADS1 3′UTR luciferase vectors, the haplotype constructs bearing the rs174546T minor allele showed 30% less luciferase activity. This relative decrease reached 60% in the presence of miR-149-5p and was partly abolished by cotransfection with an miR-149-5p inhibitor. Conclusion This study identifies FADS1 rs174546 as a functional variant that may explain the associations between FADS1-FADS2 polymorphisms and lipid-related phenotypes. Highlights • The rs174547 polymorphism is associated with n-6 polyunsaturated fatty acid levels in erythrocytes. • Among the 25 polymorphisms of the rs174547 haplotype block, rs174546 is functional. • The rs174546 minor allele triggers FADS1 gene downregulation. • The rs174546 minor allele creates an miR-149-5p binding site in the FADS1 3′UTR. [ABSTRACT FROM AUTHOR]

Background: Age and sex have a major impact on stroke onset.Aims: We aimed to compare the attack, incidence, and 28-day mortality rate for stroke as well as risk factors in men and women aged 35 and over.Methods: Data were obtained between 2008 and 2015 from the stroke population-based registry covering the city of Lille (northern France).Results: A total of 2426 strokes (1917 incident strokes) were recorded. The number of strokes was lower in women than in men when considering individuals under the age of 75 but was twice as high when considering individuals aged 75 or over. Overall, there were 25% more strokes in women than in men. The age-adjusted attack (P = .017) and incident (P = .027) rates of stroke were ~30% lower in women than in men (a ~30% lower risk of ischemic stroke (P = .02) and a ~40% lower risk of intracerebral hemorrhage (ICH) (P = .004)). The age-adjusted mortality rate after ICH was ~35% lower in women than in men (P = .014). With regard to cardiovascular risk factors, women with stroke were older, smoked less, and were more likely to have a history of migraine or atrial fibrillation than the men.Conclusion: The risk of stroke is lower in women than in men under the age of 75 but is similar when comparing women and men after that age. Nevertheless, the age structure of the population (with more elderly women than elderly men) translates into a higher absolute number of strokes in women than in men. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Heart failure (HF) is a primary cause of death worldwide. Three miRNAs, miRNA 21-5p, 23a-3p, and 222-3p, were significantly upregulated in the heart and plasma of HF-rats compared to sham-rats. Extracellular vesicles (EVs) are prominent carriers of diagnostically relevant molecules, such as regulatory proteins and miRNAs. EVs can be categorized as large or small based on their biogenesis. We investigated small EVs in the context of HF due to their prominent role in transporting extracellular miRNAs. Our aim was to develop an efficient and reproducible EV isolation technique and to identify specific markers of cardiac EVs in order to investigate the role of these EVs in transporting miRNAs involved in HF. Four EV isolation techniques were compared to find the most optimal approach to isolate vesicles from rat cardiac tissue. EV total recovery and purification (EVTRAP) followed by LC-MS were performed on rat heart and plasma samples to identify protein markers that are enriched in cardiac EVs. RT-qPCR was used to detect the presence of the three miRNAs in cardiac-derived small EVs. Differential ultracentrifugation (UC) was the most efficient technique for cardiac EV isolation. Surprisingly, classical small EV markers were not detected in cardiac small EVs. LC-MS of cardiac and plasma total EVs isolated by EVTRAP revealed two potential markers enriched in cardiac EVs: Alpha B-Crystallin (CRYAB) and LIM domain biding 3 (LDB3). These proteins were confirmed to be cardiac-specific by comparing their expression in different tissue types by western blot, and their presence was confirmed in cardiac small EVs isolated using UC. Finally, RT-qPCR revealed that the three miRNAs involved in HF are indeed loaded in cardiac-derived small EVs. We found that UC is the most efficient technique for isolating EVs from cardiac tissue, and identified CRYAB and LDB3 as cardiac EV markers. Moreover, we showed that cardiac-derived small EVs transport the three miRNAs known to be increased in the heart and plasma of HF-rats. Going forward, we will compare the quantity of the three miRNAs in cardiac small EVs from HF- and sham-rats to confirm their transport into the circulation via EVs during HF. [ABSTRACT FROM AUTHOR]

Acute decompensated heart failure (ADHF) is characterized by dyspnea, edema and fatigue, as well as a high morbi-mortality. Recently we observed that Thiamet G (TG) exerts protective effects in a rat model of ADHF. Extracellular vesicles (EV) are known to carry key regulatory molecules from cell-to-cell in both the heart and circulation, however, an effective isolation technique specific to cardiac EVs is yet to be discovered. Our goal is to identify cardiac-specific EV markers and to investigate the role of EVs in mediating improvement of ADHF outcomes upon TG treatment. HF was induced in 10 week-old Wistar rats via coronary ligation. Three months later, acute decompensation was induced via NaCl administration in water (1.8 g/kg), followed by injection of 25 mg/kg TG 12 hours later. Rats were sacrificed 12 hours after TG treatment, and their left ventricles (4 TG-treated, 4 untreated ADHF rats) were used to produce unpurified EVs. These EVs were then captured by EVTRAP before LC-MS analysis, followed by proteomic analysis to identify cardiac-specific EV markers and their expression in EV-subtypes. LC-MS performed on left-ventricular EVs of TG-treated and untreated ADHF rats revealed a total of 2362 proteins. In order to identify a common cardiac marker, the most abundant proteins were investigated for tissue-specificity. αB-crystallin (CRYAB) was identified as a potential marker of cardiac EVs. Furthermore, western blots of cardiac tissue-derived EVs revealed the presence of CRYAB in large and small EVs isolated via differential ultracentrifugation, precipitation, and density gradient ultracentrifugation. TG treatment improves cardiac output in a salt-induced experimental model of ADHF. EVs could be an intercellular signalling pathway involved in this improvement of cardiac function, therefore specific isolation of cardiac EVs is imperative for understanding their role in TG-mediated cardiac recovery. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: We investigated the association between the rs9939609 (T>A) polymorphism in the FTO (fat mass– and obesity-associated) gene and obesity- and type 2 diabetes mellitus–related phenotypes in the French Multinational MONItoring of Trends and Determinants in CArdiovascular Disease (MONICA) Study (n = 3367). In the study, TA or AA subjects had higher body mass index (BMI) (P = .017), waist circumference (P = .017), and hip (P = .01) circumference in an A allele dose-dependent manner. The A allele was also significantly associated with higher plasma insulin levels (P = .05), higher insulin resistance index (homeostasis model assessment) (P = .02), and higher systolic blood pressure (P = .003); but these associations disappeared after adjustment for BMI. In the study, 598 subjects were obese (BMI ≥30 kg/m2); and 2769 subjects were not obese (BMI <30 kg/m2). Subjects bearing the A allele of rs9939609 had a higher risk of obesity (adjusted odds ratio [95% confidence interval] = 1.29 [1.06-1.58], P = .01) compared with TT subjects. Moreover, the homozygous AA genotype of rs9939609 was associated with a higher risk of type 2 diabetes mellitus (odds ratio = 1.45 [1.05-1.99], P = .02, 283 subjects with and 2601 subjects without type 2 diabetes mellitus), independently of BMI. In conclusion, the role of the A allele of the FTO rs9939609 polymorphism on the risk of obesity and type 2 diabetes mellitus was confirmed in the French MONICA Study. [Copyright &y& Elsevier]

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: The plasma level of high-density lipoprotein cholesterol (HDL-C) is known to be inversely associated with cardiovascular risk. However, besides lifestyle, gene polymorphism may influence the HDL-C concentration. The aim of this study was to investigate the possibility of interactions between CETP, PPARA, APOE, and APOAI polymorphisms and HDL-C, apolipoprotein (apo) A-I, lipoprotein (Lp) A-I, and Lp A-I:A-II in a sample selected from the Prospective Epidemiological Study of Myocardial Infarction (PRIME) study population who remained free of cardiovascular events over 5 years of follow-up. Healthy individuals (857) were randomly selected for genotyping the PRIME study subjects. The population was selected so as to provide 25% of subjects in the lowest tertile of HDL-C (≤28 mg/dL) in the whole PRIME study sample, 25% of subjects in the highest tertile of HDL-C (≥73 mg/dL), and 50% of subjects in the medium tertile of HDL-C (28-73 mg/dL). Genotyping was performed by using a polymerase chain reaction system with predeveloped TaqMan allelic discrimination assay. The CETP A373P rare allele c was less frequent in the group of subjects with high HDL-C, apo A-I, Lp A-I, and Lp A-I:A-II concentrations. Apolipoprotein A-I and Lp A-I were also found to be higher in the presence of the ɛ2 allele coding for APOE. The effect of the CETP A373P rare allele c on HDL-C was independent of all tested parameters except triglycerides. The respective effect of these polymorphisms and triglycerides on cardiovascular risk should be evaluated prospectively. [Copyright &y& Elsevier]

Background: Left ventricular remodeling (LVR) is a strong predictor of cardiovascular events after myocardial infarction (MI). Although several factors have been shown to influence LVR, interindividual variability exists. Some studies have suggested that gene polymorphisms may be associated with LVR, but these studies were limited by either a retrospective design or the inclusion of limited patient numbers. The present study was designed to prospectively assess the impact of gene polymorphisms on LVR. Methods: We included 266 patients with inaugural anterior MI. Systematic echocardiographic follow-ups were performed at 3 months and at 1 year after MI. The polymorphisms were selected using a candidate gene approach based on LVR pathophysiology. We analyzed 14 polymorphisms in 3 different systems: the renin-angiotensin-aldosterone system (ACE I/D, RAT1 1166A/C, angiotensinogen M235T, CYP11B2 −344C/T), the adrenergic system (β1AR Ser49Gly, β1AR Gly389Arg, β2AR Gly16Arg, β2AR Gln27Glu, β2AR Thr164Ile, α2cAR Del322-325), and the metalloproteinase (MMP) system (−1607 1G/2G MMP-1, −1306 C/T MMP-2, −1171 5A/6A MMP-3, −1562 C/T MMP-9). Results: Left ventricular remodeling was documented by a progressive increase in end-diastolic volume from 56.5 ± 14.9 mL/m2 at baseline to 62.8 ± 18.8 mL/m2 at 1 year (P < .0001). End-diastolic volume at baseline, 3 months, or 1 year did not differ significantly among genotypes for any polymorphism. The change in end-diastolic volume from baseline to 1 year was also similar among genotypes for all polymorphisms. Conclusions: Left ventricular remodeling after MI is not associated with common polymorphisms in the renin-angiotensin-aldosterone, adrenergic, or MMP systems. [Copyright &y& Elsevier]

Background: Previous studies have demonstrated that the adenosine monophosphate deaminase 1 (AMPD1) C34T polymorphism may be associated with survival in cardiac populations with a protective effect of the T allele. However, these studies included limited number of patients with few cardiovascular events. Methods: We prospectively analyzed the impact of the C34T polymorphism of the AMPD1 gene in 686 unrelated white patients with stable congestive heart failure related to left ventricular systolic dysfunction. Patients underwent echocardiography, radionuclide angiography, and a cardiopulmonary exercise test. Blood samples were drawn for standard and hormonal determinations and for genetic analysis. Results: There were 517 (75%) CC homozygotes, 155 (23%) CT heterozygotes, and 14 (2%) TT mutated homozygotes. We did not demonstrate any impact of this polymorphism on clinical, biologic, echocardiographic, radionuclide, and exercise parameters in the whole population and in ischemic and nonischemic subgroups of patients. During a median follow-up period of 3 years, there were 145 cardiac-related deaths and 6 urgent transplantations. There was no impact of this polymorphism on survival. Conclusions: In our population, we did not demonstrate any effect of the C34T polymorphism of the AMPD1 gene on major congestive heart failure parameters and on survival. [Copyright &y& Elsevier]

The aim of the OSCAR observatory was to describe the medical management of patients hospitalised for acute coronary syndrome (ACS). Demographic characteristics, risk factors, history of cardiovascular events, diagnostic and therapeutic procedures on admission and during the stay in hospital were recorded. From september 2000 to february 2001, 869 patients with acute coronary syndrome were enrolled in this survey. This sample of patients is quite similar to the one usually described in such studies with a male/female ratio of 2.7 and a mean age of 66. The initial diagnosis at entry was: 23.6% patients with unstable angina, 34.4% patients with myocardial infarction with ST elevation, and 42,0% of patients with myocardial infarction without ST-elevation. Troponins were used in 65% patients for troponin I, 13% for troponin T and should be more widely used. Whatever the inclusion diagnosis, planned procedures or biological data, only 25% of hospitalized patients for acute coronary syndrome were treated with anti-GPIIb/IIIa. This rate of treatment was lower than expected by the guidelines published by Societies of cardiology. [Copyright &y& Elsevier]

The aim of this investigation was to assess the relationship between smoking status and nutrient intakes using a meta-analysis. Publications in English were sought through a Medline search using the following key words: food habits, eating, feeding behavior, diet, food, nutrition, nutritional status or assessment, tobacco use disorder, tobacco, nicotine and smoking. Scanning relevant reference lists of articles and hand searching completed the data collection. No attempt was made to search for unpublished results. Paper selection was based on nutritional surveys including comparisons of smokers with nonsmokers. Fifty-one published nutritional surveys from 15 different countries with 47,250 nonsmokers and 35,870 smokers were used in the analysis. The estimates of size effects were calculated with the mean and variance values of each nutrient intake and the size of the sample. Smokers declared significantly (all P < 10(-5)) higher intakes of energy (+4.9%), total fat (+3.5%), saturated fat (+8.9%), cholesterol (+10.8%) and alcohol (+77.5%) and lower intakes of polyunsaturated fat (-6.5%), fiber (-12.4%), vitamin C (-16.5%), vitamin E (-10.8%) and beta-carotene (-11.8%) than nonsmokers. Protein and carbohydrate intakes did not differ between smokers and nonsmokers. There was no evidence of heterogeneity among studies. In conclusion, the nutrient intakes of smokers differ substantially from those of nonsmokers. Some of these differences may exacerbate the deleterious effects of smoke components on cancer and coronary heart disease risk. [ABSTRACT FROM AUTHOR]

Introduction In the past decades, decreasing trends in coronary heart disease (CHD) morbidity and mortality rates have been observed in all of the western world, including France. Objective We aimed to assess whether gender- and age-specific trends were still favourable between 2006 and 2014 in France. Method We analysed data from the three geographical areas covered by the French MONICA population registers (inhabitants aged 35–74 years from the Urban Community of Lille in the north of France, the district of Bas-Rhin in the north-east and the district of Haute Garonne in the south-west. Registered events were all hospitalised/non-hospitalised fatal/non-fatal acute coronary events. Log-linear Poisson regression models were used to analyse trends. Results There was still a decrease in standardized event rates of CHD from 2006 to 2014 in the 35–74 age-group (annual decrease of 1.6% in average in men (P = 0.0003) and of 1.8% in women (P = 0.003)). This decrease was significant in women only in the 65–74 age-group (-3.9%, P = 0.0005) and in men in the 55–64 and 65–74 age-groups (-0.8%, P = 0.002 and -2.2%, P = 0.006, respectively). No significant decrease could be observed in the younger individuals. Standardized mortality rates followed the same pattern. Conclusion A clear decline in CHD event rates and CHD mortality rates was observed between 2006 and 2014, especially among subjects above 54 years, but not in younger subjects, particularly in women. Primary and secondary prevention still need to be strengthened, in particular in the youngest. [ABSTRACT FROM AUTHOR]

Myocardial infarction (MI) is the most common cause for heart failure (HF) which is a main cause of mortality worldwide The aim is to identify subtypes of patients, who suffered from MI, with distinct clinical profiles, based on expression levels of biomarkers, able to predict HF and long-term survival. REVE-1 and REVE-2 studies included respectively 215 and 246 patients with a first anterior MI. Patients have been clinically monitored with serial echography during 1 year following MI and were followed-up respectively 12 and 10 years for hospitalization for HF or cardiovascular death. Plasma samples were collected during hospitalization for both studies, allowing the measurement of 5284 proteins using modified aptamers (Somalogic). Univariate survival analysis was used as a selection using Bonferroni correction and patient's subtypes were identified using an unsupervised clustering method (k-means). Survival models were built using Cox regression model. As more events were observed in REVE-1, this cohort was used as derivation cohort and REVE-2 as validation cohort. A clinical model (age, heart rate, diabetes and ejection fraction) showed a C-index of 0.76 on REVE-1 and 0.77 on REVE-2. 50 proteins were selected because significantly associated with long term survival. Clustering was performed on these proteins and 2 subtypes of patients with distinct clinical characteristics were identified. The proteomic variables based clustering showed respectively a C-index of 0.84 and 0.82 on REVE-1 and REVE-2. Hazard ratio associated to the clustering is 4.88 [3.05;7.81] (P < 0.001) and 2.55 [1.58;4.77] (P < 0.001) when added to clinical variables. Proteins measurements allowed us to identify subtypes of patients sharing common clinical characteristics and to build a prediction model for HF and death with higher efficacy than with clinical variables. System biology analysis of the proteins should bring us new insights on HF. [ABSTRACT FROM AUTHOR]

Heart failure (HF) remains a main cause of mortality worldwide. The most common cause of HF is coronary artery disease and particularly myocardial infarction (MI). Left ventricular remodelling (LVR) is a progressive dilatation of the left ventricle that occurs in response to MI and is difficult to predict in clinical practice based on infarct size, infarct location or LV ejection fraction. Several studies have identified LVR as a powerful indicator of a high risk of HF or death after MI. The aim is to identify plasmatic proteins that could predict the occurrence and severity of LVR in order to prevent HF. The REVE and REVE-2 studies have included respectively, 215 and 246 patients with a first anterior MI. The patients have been followed-up with serial echocardiography during one year to quantify LVR. Plasma samples have been collected during hospitalization for both studies, and at 1, 3 and 12 months after MI for REVE-2, allowing to measure 5284 proteins thanks to a high throughput proteomic approach (SOMASCAN). Due to the high dimension of data (more variables than individuals), we used statistical methods performing variable selection to build a proteomic signature of LVR. We showed that REVE and REVE-2 studies share common statistical characteristics (distributions, correlations) allowing us to perform analysis on REVE-2 and use REVE for validation. We confirmed the difficulty to predict LVR using only clinical data, with prediction models explaining at the best 11% of LVR (R2 = 0.106). Using the proteomic data we explained 30% of LVR (R2 = 0.297) using a 22-proteins based score built with nested models. We confirmed that LVR is complex to predict even with a huge number of potential biomarkers to explore. Still, we enhanced the predictability of LVR and we intend to find a protein profile of LVR during the year after MI by studying data collected during this period. [ABSTRACT FROM AUTHOR]

Gender differences in the management of Acute Coronary Syndromes (ACS) have been described regarding delays before reperfusion and treatment procedures. To compare medical care between genders in patients hospitalized for a first episode of ACS in the 3 French MONICA Registries. The French MONICA registries based in three administrative regions were used to establish a cohort of 1,156 patients aged 35–74 hospitalized for a first episode of ACS between October 1st of 2015 and March 31st of 2016, and without history of previous coronary heart disease. In this cohort, 25.7% of patients were women (N = 297). They were significantly older than men, with a median age of 61 versus 59 (P = 0.02). No gender differences were observed in delays from symptoms onset until first medical aid or hospitalization. In most cases, both men and women were addressed directly to the hospital (37.9% and 43.4% respectively). When a pre-hospital medical aid was requested, women were more often referred to an Emergency Department (54.9% vs. 40.2%), while a higher proportion of men were addressed to an Intensive Care Unit (27.5% vs. 18.9%) or to an operating room (27.7% vs. 21.3%, P = 0.01). Coronarography was performed in 93.3% cases of women versus 98.0% of men (P < 0.001). As compared with women, men suffered from more severe coronary lesions, resulting in a higher proportion of revascularization procedures (83.6% vs. 65.2%, P < 0.001). Basic drug prescription did not differ between genders. At discharge, women were less frequently scheduled for cardiac rehabilitation (32.7% vs. 43.0%, P < 0.01) or a complementary revascularization (9.2% vs. 15.3%, P = 0.01). Care trajectories differed between men and women, even though this did not seem to lengthen delays of care. Differences were also observed for diagnostic management and prescription of cardiovascular rehabilitation. The age profile of women may partially explain this differential care. [ABSTRACT FROM AUTHOR]

Genomic triplication of the α-synuclein gene (SNCA) has been reported to cause hereditary early-onset parkinsonism with dementia. These findings prompted us to screen for multiplication of the SNCA locus in nine families in whom parkinsonism segregates as an autosomal dominant trait. One kindred was identified with SNCA duplication by semiquantitative PCR and confirmed by fluorescent in-situ hybridisation analysis in peripheral leucocytes. By contrast with SNCA triplication families, the clinical phenotype of SNCA duplication closely resembles idiopathic Parkinson''s disease, which has a late age-of-onset, progresses slowly, and in which neither cognitive decline nor dementia are prominent. These findings suggest a direct relation between SNCA gene dosage and disease progression. [Copyright &y& Elsevier]

Background Risk stratification in systolic chronic heart failure (HF) is critical to identify the patients who may benefit the most from advanced HF therapies. We aimed identifying new biomarkers to improve prognosis evaluation and help to better understand HF physiopathology. Methods Proteomic analysis of plasma from a case/control population of 198 patients with chronic systolic HF (ejection fraction < 45%): 99 patients who died from cardiovascular cause within 3 years and 99 patients alive at 3 years (matched on age, sex and HF etiology), identified 3 apolipoproteins (Apo) associated with cardiovascular death. Apo screening (panel of 15 Apo: Apo-A1, -A2, -A4, -B100, -C1, -C2, -C3, -C4, -D, -E, -F, -H, -J, -L1 and -M) was then targeted using LC-MRM-MS in order to quantify their circulating levels. Results In the final statistical model, 4 Apo remained independently associated with the occurrence of cardiovascular death. The Apo-B100 was negatively associated (OR = 0.50). The Apo-C1, -J and -M were positively associated (OR = 2.22, OR = 2.25 and OR = 4.30, respectively). Net reclassification improvement and integrated discrimination improvement indexes demonstrated that Apo-B100, -C1, -J and -M significantly improved the prediction of cardiovascular death. There was no interaction between patients with and those without ischemic HF. Conclusions Our results showed that a screening of Apo using LC-MRM-MS might be useful in clinical practice for risk stratification of patients with chronic systolic HF. Further research is needed to better understand the role of these Apo in left ventricle remodeling and HF physiopathology. [ABSTRACT FROM AUTHOR]

Background In clinical trials, lowering cardiovascular risk factors (RF) reduce cardiovascular (CV) morbidity and mortality. Nonetheless, few data exist on general population. Purpose We assessed theimpact of the control of RF at baseline on long-term all-cause and CV mortality in French general population. Methods Analysis was based on the participants aged 35-64 of the Third French MONICA population-based survey on RF (1995-1996). Vital status was obtained 18 years after inclusion. Statistical analysis was based on multivariable Cox modelling. We assessed the impact of the control (according to the threshold recommended in the guidelines currently used at the time of recruitment) of high blood pressure, high LDL-cholesterol, diabetes and smoking. Results In our study, 3402 subjects were included. Half were men and 2.5% had history of Coronary Heart Disease. Moreover 569(17%) subjects had 2 or more non-controlled RF, 1194(35%) had 1 non-controlled RF, 770(23%) had all RF controlled under treatment (or were former smokers) and 869(25%) had none RF. During the follow-up, 389 deaths occurred (76 due to a CV cause). Considering all-cause mortality, after adjustment for centre, age, gender, educational level, proxies of alcohol consumption plus medical history of chronic disease, the hazard ratio(HR) for subjects presented 1 non-controlled RF and for subjects presented 2 or more non-controlled RF was 1.38[1.03-1.83](p=0.029) and 1.80[1.33-2.43](p<0.001), respectively, as compared to subjects presented all RF controlled. For subjects presented none RF, adjusted HR was 0.66[0.44-0.98] (p=0.042). Considering CV mortality, adjusted HR for subjects presented 1 non-controlled RF and for subjects presented 2 or more non-controlled RF was 1.70[0.84-3.42](p=0.138) and 3.67[1.85-7.29](p<0.001), respectively, as compared to subjects presented all RF controlled or none RF. Conclusions Failing to control RF increases significantly long-term all-cause and cardiovascular mortality. [ABSTRACT FROM AUTHOR]

Arthroscopic repair of the long head of the biceps (LHB) is performed to treat various biceps pathologies yet the choice between tenotomy or tenodesis remains controversial. Although tenotomy is simpler and quicker, tenodesis results in fewer complications, and there are several techniques available using various fixation devices and sites. This Technical Note describes an all-arthroscopic, suprapectoral tenodesis technique using a bioresorbable interference screw, without motorized devices to create the humeral tunnel in the bicipital groove. The LHB tendon is detached from its glenoid insertion using an arthroscopic cutting instrument or electrocautery. Two portals are created 50 mm distal to the acromioclavicular joint and at 15 mm on either side of the bicipital groove. The arthroscope is introduced through the distal lateral portal till it makes contact with the humerus. The LHB is fastened within its groove using a grasper, reinforced, and then fixed in the humeral tunnel using an interference screw. The present technique is safe, simple, and reproducible. It requires 2 portals in addition to the standard posterior portal and the intra-articular working portal. It minimizes iatrogenic intra-articular damage and thereby limits possible complications. It also limits the intra-articular operative time compared with SLAP repairs. [ABSTRACT FROM AUTHOR]

Purpose: The beneficial effect of lipid-lowering drugs on cardiovascular mortality is well established, but long term safety data remain scarce. The aim of this study was to assess 10-year risk of cancer mortality according to blood lipid levels and lipid-lowering drug exposure, in the French general population. Methods: Our analysis was based on the Third French MONICA Cross-sectional survey on cardiovascular risk factors (1995-1996). Participants aged 35-64 years were randomly recruited from French polling lists. Subjects with a history of cancer at baseline were excluded from the analysis. Vital status and cause of mortality were obtained 10 years after inclusion. Results: There were 3262 participants and 177 deaths were recorded (78 due to cancer). The sample was mainly composed of subjects in primary cardiovascular prevention (96%) and comprised 64% of normolipidemic, 25% of untreated dyslipidemic (total cholesterol ≥ 6.5mmol/L or triglycerides ≥ 3.5mmol/L) and 11% of dyslipidemic subjects treated with a lipid-lowering drug (4% statin, 6% fibrate). After adjustment for centre, age, smoking, gamma-glutamyl transpeptidase and mean corpuscular volume, which were all significantly associated with cancer mortality, the hazard ratio (HR) for cancer mortality in subjects with non HDL-cholesterol < 3.5mmol/L was 2.83 [95% confidence interval: 1.73-4.62]. The adjusted HR in subjects with HDL-cholesterol < 0.9mmol/L was 2.87 [1.63-5.06]. The adjusted HR in subjects on lipid-lowering drug as compared to untreated subjects was 0.31 [0.11-0.85]. Conclusion: In this cohort mainly composed of primary prevention subjects, low HDL- and low non HDL-cholesterol levels were associated with increased cancer mortality, whereas risk of cancer death was reduced in users of lipid-lowering drugs. This suggests that the impact of low cholesterol on cancer risk may be different in subjects with spontaneously low levels and in those for whom cholesterol is lowered by lipid-lowering drugs. [Copyright &y& Elsevier]

Little is known about sex difference of middle-term mortality rates in patients surviving an ACS and about comparison with mortality rates in the corresponding healthy population. Our aims were: 1/to review the sex difference mortality at short-term (28 day) in ACS patients, 2/to describe short-term mortality in relation with middle-term mortality (4 years), 3/to compare sex difference of middle-term mortality in patients surviving an ACS with the corresponding population. 6022 patients hospitalized for a first ACS registered in the Strasbourg (BR), Lille and Toulouse (HG) MONICA registries, between 2009 and 2011 were included. ACS were defined as STEMI, NSTEMI, or unstable angina (UA). Mean follow-up was 50.3 months. 3025 patients (50.2%) were STEMI, 1571 (26.1%) NSTEMI and 1426 (23.6%) UA. Short-term mortality was 6.7% in men vs 9.0% in women for STEMI (p=0.05), 4.7% vs 4.2% for NSTEMI (p=0.67) and 5.2% vs 6.6% for UA (p=0.29). Middle-term mortality was 7.4% in men and 8.5% in women for STEMI (p=0.39), 11.5% vs 11.9% for NSTEMI (p=0.82) and 8.6% vs 10.9% for UA (p=0.20). The small higher short-term and middle-term mortality in women was removed after adjustment for age and center. In men the middle-term risk of death for STEMI compared with the corresponding population was 3.05 [2.32-4.02] in HG, 2.88 [2.25-3.68] in BR and 2.34 [1.83-2.99] in Lille. In women the risk of death was 6.80 [4.03-11.5], 5.04 [3.04-8.37] and 6.40 [4.28-9.58] in HG, BR and Lille respectively. Considering males and females together, middle-term mortality of STEMI for HG was in relation to the regional population 3.26 [2.56-4.15] and to the French population 4.17 [3.27-5.32], for BR 3.53 [2.83-4.41] vs 3.74 [6.00-4.67] and for Lille 4.40 [3.57-5.43] vs 3.42 [2.78-4.22]. Short-term and middle-term mortality were similar in men and women. In patients surviving an ACS, middle-term mortality was, comparatively to the corresponding population, from 2 to 3 times higher in women than in men. [ABSTRACT FROM AUTHOR]

Introduction The impact of dairy fats on cardiovascular risk has been debated. Circulating Pentadecanoic (15:0) and heptadecanoic (17:0) saturated fatty acids are good biomarkers of dairy product consumption as they are mainly provided by dairy fats. We described the prevalence of cardiovascular risk factors according to erythrocyte membrane phospholipid content in 15:0 and 17:0 fatty acids. Methods 402 women and men aged 45-64 were randomly selected in 2005-2007, from the general population of three French areas. Nutritional data were collected through a 3-day food record. Fatty acid content was measured in erythrocyte membrane phospholipids. Results Erythrocyte membrane contents in 15:0 and 17:0 fatty acids significantly increased with the consumption of dairy products collected during the 3-day food record. Prevalence of hypertension significantly decreased from the lowest to the highest quartile of 15:0 erythrocyte content (48.1%; 33.3%; 29.9%; 25.5%; p=0.005). A similar trend was observed for metabolic syndrome prevalence (39.4%; 28.1%; 25.2%; 21.3%; p=0.029). Prevalence of hypertension, hypertriglyceridaemia, overweight and metabolic syndrome significantly decreased from the lowest to the highest quartile of 17:0 erythrocyte content (44.1%; 36.5%; 28.1%; 25.6%; p=0.020 for hypertension; 30.3%; 15.4%; 16.9%; 16.7%; p=0.017 for hypertriglyceridaemia; 68.1%; 58.7%; 46.6%; 44.4%; p=0.002 for overweight; and 43.2%; 26.9%; 22.5%; 17.8%; p<0.001 for metabolic syndrome). All these relationships remained significant after adjustment for age and gender. The link did not reach significance level for diabetes. Conclusion Elevated erythrocyte membrane phospholipid contents in 15:0 and 17:0 saturated fatty acids are associated with a lower prevalence of the metabolic syndrome and several of its components. These results suggest that saturated fat intake should not be systematically associated with high cardiovascular risk and can be considered as part of a balanced diet. [ABSTRACT FROM AUTHOR]

Background Multiple proteinchip arrays have been developed to selectively bind proteins with diverse physical and chemical properties before the profiling step with SELDI-TOF-MS. However, the additional value of each array is poorly described. Methods A proteomic analysis has been performed in plasma of 198 patients with chronic heart failure with a left ventricular ejection fraction <45%. Plasma samples were profiled with CM10 (Weak Cation Exchanger) and H50 (Hydrophobic) proteinchip arrays in a PBS 4000 SELDI-TOF-MS (BioRad Laboratories). To ensure sufficient coverage of the entire mass range, the acquisition settings for low-mass (LM, 2500-30000 Da) and high-mass (HM, >20000 Da) m/z peaks were optimized separately. Correlation between peaks was analysed face to face by the test of Pearson. Results We detected 203m/z peaks: 109 (52 LM and 42 HM) peaks with the CM10 array and 94 (69 LM and 40 HM) peaks with the H50 array. Among the peaks detected on the H50 array, 28 LM and 8 HM peaks were also present on the CM10 array. In the mass range 20000-30000 Da, peaks can be detected with both, LM and HM acquisition settings. We found 6 of the 13 HM peaks on the CM10 array and 7 of the 15 HM peaks on the H50 array also detected with LM settings. 093We then analysed the correlation among the 203m/z peaks detected with both types of arrays. We found that 56 (27.5%) peaks were highly correlated with at least one other peak with a correlation coefficient r>0.9. Altogether, 30 out of these 56 peaks were correlated with 1 other peak, 14 with 2 other peaks, 7 with 3, 3 with 4, 1 with 5 and 1 with 6 other peaks. These highly correlated peaks may correspond to a unique protein. Conclusion Profiling with multiple proteinchip arrays provides data with high redundancy and colinearity. This finding may be useful for chosen the SELDITOF- MS peaks to be purified and identified. In addition, a unique array (CM10) may be sufficient to obtain a relevant profiling of plasma proteins. [ABSTRACT FROM AUTHOR]

Purpose The assessment of cardiovascular risk is uniformly recommended as a decision-support for therapies aimed at preventing cardiovascular diseases. The aim of this study was to assess the predictive accuracy of the ESC SCORE in French general population. Methods Our analysis was based on the Third French MONICA Cross-sectional population-based survey (from South-Western(SW), North-Eastern(NE) and Northern(N) France), on cardiovascular risk factors (1995-1996) and on subjects consecutively referred for cardiovascular check-up to a Department of Preventive Cardiology (DPC) in a SW French University Hospital since 1995. Vital status was obtained 10 years after inclusion. The 10-year predicted risk of cardiovascular (CV) death was calculated using the SCORE equation for low-risk countries and was compared to the 10-year incidence of CV death. Results SCORE equation was applied in 6915 participants aged 35-64 (56% were men) and 56 CV deaths occurred. The CV death rate was 0.67% [95% confidence interval: 0.39-1.13] in DPC and 0.81%[0.42-1.56], 1.10%[0.61-1.98] and 2.00%[1.31-3.05] in SW, NE and N MONICA sample, respectively. The median risk SCORE was 0.97% and was not significantly different to the 10-year incidence of CV death (1.05%[0.81-1.37]). The C-statistic of the SCORE equation in our sample was 79%[73-85]. The median risk SCORE according to sex, age, educational level, family history of premature CV disease, physical activity, impaired fasting glucose, smoking, systolic blood pressure, total cholesterol, LDL-cholesterol, HDL-cholesterol and risk SCORE was not different to the 10-year incidence of CV death. According to the cut-point of 5%, 6440 participants(93%) were correctly classified using the SCORE equation (i.e. subjects with risk SCORE ?65; 5% deceased during the 10-year period or subjects with risk SCORE<5% non-deceased during the 10-year period). Conclusions In French general population aged 35-64, the SCORE equation adequately predicts CV death. [ABSTRACT FROM AUTHOR]

Background Risk stratification of patients with stable chronic heart failure (CHF) is critical to better identify those who may benefit the most from invasive strategies such as heart transplantation. Methods To improve cardiovascular (CV) death prediction in CHF, we performed a proteomic analysis using high throughput surface enhanced laser desorption ionization – time of fight – mass spectrometry (SELDI-TOF-MS). Plasma samples were pre-treated to access the deep proteome. The proteomic analysis was first performed in a case (CV death within 3 years) /control (survivors at 3 years) study including 198 patients with a left ventricular ejection fraction (LVEF) <45%. A proteomic score was developed in this derivation population using the support vector machine (SVM) method. The score was then validated in an independent cohort of 309 consecutive patients (CV death at 3 years) with CHF. Results Altogether, 203 ion m/z peaks were detected. Among them, 42 peaks were significantly differentially expressed between cases and controls after Bonferroni correction (P value at 0.00025). Then, the SVM method was applied to develop a proteomic score. In the derivation population, the score level was higher in cases as compared to controls: 0.7 vs. 0.25 (P=5.10 -29 ). The ROC curve showed an AUC of 0.87 to predict CV mortality. In the validation population, the score level was still higher in patients who experienced a CV death as compared to survivors: 0.53 vs. 0.39 (P=0.0002). The ROC curve showed an AUC of 0.68. After adjustment on confounders (NYHA class, LVEF, BNP, creatinine, Peak VO 2 ), the score was still significantly associated with CV death (HR=15.1, P=0.007) and it allowed a significant improvement of CHF patient reclassification. The net reclassification index (NRI) and the integrated discrimination improvement (IDI) reach both significant p values. Conclusion Proteomic analysis of low abundance plasma proteins is highly promising to improve CV death risk prediction in CHF. [ABSTRACT FROM AUTHOR]

Guidelines recommend lowering LDL-cholesterol (LDL-c) according to level of cardiovascular risk. We aimed at exploring, in the French general population, the proportion of subjects above the recommended goal, and to assess among these people, how much LDL-c should be further decreased to reach the goal. Methods We analyzed data from a multicenter cross-sectional study conducted in 2006-2007 in Lille, Strasbourg and Toulouse areas. Participants were selected from the general population by drawing on polling lists. Results The sample comprised 4609 subjects aged 35-74 (49.9% of women), among whom 35.0% had no cardiovascular risk factor (age < 50 for men, 60 for women; no family history of premature coronary heart disease; no hypertension; no diabetes, HDL-c ≥ 0.40 g/L; and no current or recent smoking). The sample was further composed of 27.1%, 16.5%, and 3.9% of subjects with 1, 2 and 3 risk factors, respectively, and 17.5% of people at high cardiovascular risk. The percentage of people not reaching LDL-c goal increased from subjects with 0 to those with 3 risk factors (1.2%; 9.7%; 28.0%; and 56.9%), and 82.2% of high risk subjects presented with LDL-c above 1 g/L. These latter people had either a documented cardiovascular disease (68.8% had LDL-c ≥ 1 g/L), or an elevated 10-year absolute risk of cardiovascular disease (86.7% ≥ 1 g/L). In high risk people above the goal, mean LDL-c was 1.49 g/L (±0.32). An average 31.2% (±13.3) decrease in LDL-c was requested to reach the goal. The average decrease requested for people with 0 to 3 risk factors who were above the goal, was 9.7% (±8.6), 8.8% (±7.8), 12.6% (±9.6), and 15.1% (±10.1), respectively. A similar analysis was conducted considering ESC instead of French guidelines. Conclusion By estimating the average decrease in LDL-c needed to reach recommended goal in different risk categories, this study provides helpful information that may guide health agencies to conceive recommendations for management strategies. [ABSTRACT FROM AUTHOR]

Purpose Death rate of acute coronary syndromes has decreased for more than 50 years. Out-of-hospital mortality remains high despite improvements in acute coronary syndrome's care. Aims To evaluate the importance of out-of-hospital mortality and the main determinants of in-hospital and one-year mortality in France. Methods Analyses were based on data from the French MONICA population-based registry including exhaustively all acute coronary syndromes occurring in people aged 35-74 during the year 2006 in 3 geographic areas. First we evaluated out-of-hospital mortality. Then analyses were performed through Cox models on incident ACS reaching the hospital alive in order to determine main factors explaining the one-year mortality. Number of attributable deaths was assessed for variables of interest. Results After a one-year follow-up, case-fatality was 29.3% for incident events (n=2547) with 70.3% of out-of-hospital deaths and 21.1% occurring in the 28 days following the event. The number of attributable deaths related to 3 situations with a strong impact identified from multivariate analyses (out-of-hospital life-and-death emergency, hospitalization before ACS occurrence, and lack of coronary angiography) was 130 (59% of deaths occurring after reaching the hospital) during the one-year follow-up. These sub-groups were corresponding to patients with an important initial state of severity and not benefiting from traditionally recommended treatments. Conclusion The major part of deaths after ACS occurs in the out-of-hospital phase. Moreover, the major part of one-year mortality is associated with a very poor prognosis before medicalization. This underlines the importance of cardiovascular prevention, population education and better out-of-hospital emergency management. [ABSTRACT FROM AUTHOR]

Purpose Statins have demonstrated their efficacy in many situations to prevent cardiovascular risk. In this work we investigated the link between chronic use of statins, type of subsequent acute coronary syndrome (ACS), namely ST-elevation myocardial infarction (STEMI) or unstable angina/non ST-elevation myocardial infarction (UA/NSTEMI), early complications and their impact on one-year mortality in real life conditions. Methods Our study was based on 2006 data from the French MONICA population-based registry which collects all cases of ACS occurring in people aged 35-74 in 3 French areas. The sample consisted of 1951 hospitalized incident ACS (72 were excluded because of missing data). Relationship between chronic use of statins and type of ACS or early complications (resuscitated cardiac arrests and shocks) were analyzed through logistic regression. Impact on one-year mortality was evaluated through Cox models. Analyses were adjusted for patients' characteristics (living area, age, gender and previous cardiovascular treatments). Results Before index event, the rate of statins treated patients was 18%. The percentage of UA/NSTEMI among all hospitalized ACS was 45%; 54.5% in patients with previous statins treatment and 42.9% in those without (p<0.0001). The adjusted odds ratio (OR) for UA/NSTEMI was 1.29 (p=0.049) for subjects with versus those without statins. There was a significant association between statins and early complications (adjusted OR 0.58; p=0.030). Statins treatment prior to event was associated with a significant decrease in one-year mortality with an adjusted HR equal to 0.62 (p=0.017). Conclusions In our registry, people already treated with statins before an incident ACS had a lower rate of one-year mortality. This may result from a lower probability to develop STEMI, or early complications. However it remains difficult to assess from these observational data what is related to the treatment and what is related to potential confounding bias. [ABSTRACT FROM AUTHOR]

Purpose Cardiovascular rehabilitation after an acute coronary syndrome (ACS) has become more prescribed; differences still remain in prescription rates. The aim of this work was to assess the prognostic influence of rehabilitation after ACS in the current medical practice. Methods Our study was based on 2006 data from the French MONICA population-based registry which collects all cases of ACS occurring in people aged 35-74 in 3 French areas. The population consisted of 1838 incident hospitalized ACS after exclusion of those who died in the first 28 days of follow-up. The relationship between prescription of rehabilitation and composite outcome (ACS-recurrence or death) was analyzed using Cox models adjusted for living area, age, number of diseased vessels, diabetes, cardiovascular treatments and delays between symptoms and the first medical care. Results There were 171 ACS-recurrences or deaths during a median follow-up of 18.1 months and 23.6% of women. The rate of rehabilitation was higher in men than in women (36 vs. 26%, p<0.0001) and decreased with age. After multivariate adjustment the risk of composite outcome occurrence was identical in men and women for STEMI but higher in women for UA/NSTEMI [adjusted HR 1.75, 95% confidence interval (1.10-2.77)]. Rehabilitation was associated with a decrease of composite outcome whatever the type of ACS [adjusted HR 0.48, (0.32-0.73)]. However a significant interaction between rehabilitation and gender has been found in UA/NSTEMI (p=0.04) but not in STEMI. A stratified analysis for gender in UA/NSTEMI showed a significant benefit of rehabilitation in women [adjusted HR 0.06, (0.01-0.44)] but not in men [adjusted HR 0.82, (0.39-1.72)]. Conclusions Whatever the definition of ACS, rehabilitation was associated with a reduction of ACS-recurrence and death in both sexes. However it seems to be more beneficial in women presenting UA/NSTEMI in whom it is less prescribed and in whom the rate of recurrence and death is higher. [ABSTRACT FROM AUTHOR]

Background: In 2008, the results of the JUPITER trial were published, showing lower rates of mortality and cardiovascular morbidity in the rosuvastatin group compared to placebo. Beyond these results, a major question often arose among health practitioners and agencies: How many “JUPITER eligible” people can we find in the real world? The aim of the present analysis was to estimate the proportion of French subjects matching the JUPITER inclusion criteria. Methods: We used data from a cross-sectional study on the prevalence of cardiovascular risk factors in the French general population aged 35–75. The study was conducted in 2006–2007 in Lille, Strasbourg and Toulouse areas. Participants were selected by drawing on polling lists and a fasting blood sample was obtained. A direct standardization on age and gender was applied to percentages, using the 2006 French population as reference. Results: The sample was restricted to 1527 men and women aged 50–75 and 60–75, respectively, without lipid-lowering therapy, as younger people and treated dyslipidemic patients were not included in the JUPITER trial. Among them, 6.8% [95% confidence interval: 5.5% – 8.1%] fulfilled the JUPITER inclusion criteria (mainly CRP 2mg/l, LDL-cholesterol < 3.4mmol/l, triglycerides < 5.6mmol/l, no diabetes or cardiovascular disease). Median body mass index, LDL-cholesterol, and CRP in these JUPITER eligible patients were 28.0kg/m2, 3.02mmol/l and 4.2mg/l, respectively. Sixty percent had hypertension, 12% had HDL-cholesterol < 1mmol/l, 18% were current smokers, 33% had a metabolic syndrome and 4% a family history of premature coronary heart disease. The median Framingham ten-year risk score reached 12%. Conclusion: Among people aged 50–75, without lipid lowering therapy, 6.8% could match the JUPITER trial inclusion criteria. These data bring valuable information to estimate the number of eligible patients if the marketing authorization of rosuvastatin were extended. [Copyright &y& Elsevier]