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Lockdown measures have obvious psychological impacts, which could, in turn, increase cardiovascular risk. We assessed the association between lockdown-related factors and the worsening of cardiovascular risk, incident anxiety and depression during 12 months’ follow-up. During lockdown (April–May 2020), 534 subjects, aged 50–89 years, were included in the PSYCOV-CV study (NCT04397835) and followed for up to 12 months post-lockdown. We found that participants with symptoms of depression during lockdown were more likely to report increased cardiovascular drug treatment (Odds-Ratio (OR) = 5.08 (1.78–14.5), p = 0.002), decreased physical activity (OR = 1.76 (1.10–2.82), p = 0.019) and weight gain (OR = 1.85 (1.08–3.17), p = 0.024) after lockdown. Moreover, changes in sleep patterns (OR = 2.35 (1.13–4.88), p = 0.022) or living in a rural area during lockdown (OR = 1.70 (0.96–3.03, p = 0.069) were associated with higher incident depression, whereas a better relationship with one’s partner during lockdown was associated with less incident depression (OR = 0.56 (0.29–1.08), p = 0.084). Finally, we found that continuing to work during lockdown in a role requiring in-person contact with the public (such as cashiers, nurses or physicians) was associated with more incident anxiety after lockdown (OR = 3.38 (1.12–10.2), p = 0.031). Interestingly, decreased consumption of alcohol during lockdown was associated with less incident anxiety (OR = 0.30 (0.10–0.90), p = 0.032). Our study, conducted in a representative sample of an age group at increased risk of both cardiovascular disease and severe COVID-19, increases the understanding of modifiable factors associated with the health impacts of lockdown measures.

To estimate trends of in- and out-of-hospital Acute Coronary Events (ACE) mortality rates from 2000 to 2016 and their respective contributions to total ACE mortality in France.All fatal coronary events occurring between January 2000 and December 2016 were recorded for patients age 35-74 in the French MONICA registries. Trends in age-standardized and crude mortality rates were expressed as annual percentage changes (APC).Between 2000 and 2016, 20,822 fatal events were recorded, of which 69.4% were out-of-hospital. Almost 90% of out-of-hospital deaths occurred at home. Decreases in ACE mortality were greater inside than outside the hospital (APC: -4.3% vs. -2.9% in men; -5.0% vs. -3.2% in women), resulting in a higher contribution of out-of-hospital mortality to overall ACE mortality, from 65.3% in 2000 to 71.4% in 2016. This trend was more pronounced for elderly than younger patients.Between 2000 and 2016, ACE mortality declined in France. This trend was more pronounced for in- than for out-of-hospital. These results underline the importance of out-of-hospital mortality in driving ACE mortality rates and the need to further investigate ways to reduce it.

Return to work (RTW) after a coronary event remains a major concern. This systematic review and meta-analysis of prospective studies published between January 1988 and August 2020, aim to evaluate the prevalence of RTW after a coronary event (myocardial infarction, acute coronary syndrome, angina pectoris) and to assess the determinants of RTW (such as follow-up duration, date of recruitment, country, gender, occupational factors, etc.). PRISMA and MOOSE guidelines were followed. Study quality was assessed using the Newcastle–Ottawa Scale. Random-effects models were carried out to determine pooled prevalence estimates and 95% confident interval. A total of 43 prospective studies (34,964 patients) were investigated. RTW overall random effects pooled prevalence was estimated at 81.1% [95% CI 75.8–85.8]. Country, year of implementation or gender did not significantly modify the prevalence estimates. Lower level of education and degraded left ventricular ejection fraction decreased RTW prevalence estimates (respectively, 76.1% vs 85.6% and 65.3% vs 77.8%). RTW prevalence estimates were higher for white-collars (81.2% vs 65.0% for blue-collars) and people with low physical workload (78.3% vs 64.1% for elevated physical workload).Occupational physical constraints seem to have a negative role in RTW while psycho-logical factors at work are insufficiently investigated. A better understanding of the real-life working conditions influencing RTW would be useful to maintain coronary patients in the labor market.

Sex differences in clinical presentation, patient care and fatal outcomes after an acute coronary syndrome (ACS) have been reported. However, recent improvements in the care and treatment of ACSs have not been assessed with regard to possible sex differences.To assess sex differences in trends between 2006 and 2016 in the characteristics of ACSs, their management, and the associated mortality.We assessed all men and women (aged 35-74) covered by the MONICA registries in north, east and south-west France and having been hospitalized for an incident (first) ACS during a 12-month period in 2006 or a 6-month period in 2016. We analyzed the patients' clinical, biochemical, electrocardiographic and care-related data, and their vital status 28 days and 12 months after the ACS.In 2006, women were older (0.0001) and had more atypical symptoms than men (p 0.01). These differences were no longer statistically significant in 2016. Medical care improved in both men and women. However, revascularization treatment, prescriptions of platelet aggregation inhibitors, statins, and functional rehabilitation were still more frequently provided to men than to women (p 0.01) in 2016, independently of confounders. The 28-day or 12-month case fatality was not different between men and women in both 2006 and 2016.The results of the present study evidenced an improvement over time in the management of ACS. However, although there were no longer sex differences in the patients' age and clinical presentation, women with ACS were still less likely than men to receive revascularization and pharmacological treatments in 2016.

Background Recurrence is common after an acute coronary syndrome (ACS). In order to better assess the prognosis for patients with ACS, we compared clinical profiles, treatments, and case fatality rates for incident vs. recurrent ACS. Methods We enrolled 1,459 men and women (age: 35–74) living in three geographical areas covered by French MONICA registries and who had been admitted to hospital for an ACS in 2015/2016. We recorded and compared the clinical characteristics and medical care for patients with an incident vs. a recurrent ACS. Results Overall, 431 (30%) had a recurrent ACS. Relative to patients with an incident ACS, patients with recurrence were older (p Conclusion Compared with incident patients, recurrent cases were more likely to have co-morbidities and to have suboptimal treatments prior to hospital stay, reinforcing the need for secondary prevention.

Background Over the past few decades decreases in coronary heart disease morbidity and mortality rates have been observed throughout the western world. We sought to determine whether the acute coronary event rates had decreased between 2006 and 2014 among French adults, and whether there were sex and age-specific differences. Methods We examined the French MONICA population-based registries monitoring the Lille urban area in northern France, the Bas-Rhin county in north-eastern France and the Haute Garonne county in south-western France. All acute coronary events among men and women aged 35–74 were collected. Results Over the study period, the age-standardised attack rates decreased in both men (annual percentage change −1.5%, P = 0.0006) and women (annual percentage change −2.1%, P = 0.002). Also, the age-standardised incidence rates decreased in both men (annual percentage change −0.9%, P = 0.03) and women (annual percentage change −1.8%, P = 0.002) due to decreases in the 65–74 year age group. In men, age-standardised mortality rates decreased by 3.5% per year ( P = 0.0004), especially in the 55–64 and 65–74 year age groups. In women, these rates decreased by 4.3% per year ( P = 0.0009), particularly in the 35–44 and 65–74 year age groups. We also observed significant decreases in case fatality among both men (annual percentage change −1.7%, P Conclusions Downward trends in acute coronary event attack, incidence and mortality rates were observed between 2006 and 2014 in men and women. This effect was age dependent and was primarily due to decreases in the 65–74 year age group. There were no substantial declines in the younger age groups except for mortality in young women. Prevention measures still need to be strengthened, particularly in young adults.

Resume Contexte Avec le vieillissement de la population, la prevalence des maladies chroniques augmente. Ces maladies sont a l’origine de decompensations necessitant des hospitalisations parfois multiples. Force est de constater que les objectifs de prises en soin (curatifs ou palliatifs) ne sont pas toujours en rapport avec l’esperance de vie. La prise de decision, surtout dans un contexte aigu, est souvent delicate, et les outils pronostics en termes de mortalite peuvent aider a une meilleure evaluation. Objectif Cette revue de la litterature a pour objectif de decrire les outils pronostiques de mortalite a moins de 3 mois, 6 et 12 mois d’une hospitalisation en medecine aigue chez les patients de plus de 65 ans. Sources documentaires Les mots cles suivant ont ete recherches dans le titre et le resume des articles en recherche avancee sur PubMed, et par la recherche de Mesh terms : « aged », « aged, 80 and over », « mortality », « prognosis », « hospitalized », « models, statistical », « acute geriatric ward », « frailty », « outcome ». Selection des etudes La recherche s’est limitee aux etudes publiees en anglais entre 1985 et 2015. La derniere recherche a ete menee en juin 2015. Seules les etudes evaluant des scores pronostics, et non des items isoles, etaient inclues. Les etudes concernant des patients des urgences, ou des soins intensifs, ainsi que les etudes selectionnant des patients vivant specifiquement en institution etaient exclues. Resultats Vingt-deux outils pronostiques sont proposes par 17 etudes. Ces outils reprennent des parametres lies a l’autonomie en particulier fonctionnelle du patient, ses comorbidites et son statut cognitif. Certains font appel a la notion de « fragilite ». Les performances de prediction a cours termes (moins de 3 mois a 6 mois) de la majorite de ces outils sont insuffisantes. Seuls certains instruments a 12 mois presentent des performances excellentes. Limites du travail Cette revue de la litterature a comme principale limite de ne pas etre systematique. Conclusion L’utilisation de ces outils en pratique clinique pourrait permettre d’orienter la reflexion concernant la prise en charge de ces patients, et d’initier si necessaire une demarche palliative appropriee.

ObjectivesThe individual peripheral vascular disease risk factors are well documented, but the role of work conditions remains equivocal. This systematic review aims to assess relationships between lower limb peripheral venous diseases (lower limb varicose veins (LLVV), venous thromboembolism (VTE) comprising deep vein thrombosis and pulmonary embolism), peripheral arterial disease (intermittent claudication, aortic dissection, aortic aneurysm) and occupational constraints among working adults.MethodsSeveral databases were systematically searched until February 2019 for observational studies and clinical trials. Preferred Reporting Items for Systematic Reviews and Meta-Analyses method was used for article selection. Quality assessment and risk of bias were evaluated using Strengthening the Reporting of Observational Studies in Epidemiology and Newcastle-Ottawa scales.ResultsAmong the 720 screened articles, 37 remained after full-text evaluation. Among the 21 studies on LLVV, prolonged standing was significantly associated to a higher risk of varicose veins with a threshold probably around >3 to 4 hours/day but exposure duration in years was not sufficiently considered. Seated immobility was often observed in workers, with no sufficient evidence to prove that prolonged sitting at work is related to VTE. Carrying heavy loads, stress at work and exposure to high temperatures have emerged more recently notably in relation to varicose veins but need to be better explored. Only three studies discussed the potential role of work on peripheral arterial disease development.ConclusionsAlthough some observational studies showed that prolonged standing can be related to varicose veins and that seated immobility at work could be linked to VTE, very little is known about peripheral arterial disease and occupational constraints. Clinical trials to determine preventive strategies at work are needed.PROSPERO registration numberCRD42019127652.

Introduction Selon la litterature, les troubles du sommeil constituent une veritable epidemie. Certains facteurs professionnels contribuent totalement ou partiellement a la genese de ces troubles du sommeil. De plus, certaines conditions de travail augmenteraient le risque de mortalite, notamment cardiovasculaire. Objectif Analyser le role du sommeil dans les relations entre facteurs professionnels et mortalite. Methode Apres avoir realise une revue de la litterature, nous avons utilise la base de donnees VISAT-EVE, une etude longitudinale prospective. Les participants ont repondu a un auto-questionnaire, comportant notamment des questions sur l’exposition a des risques professionnels et des questions permettant de caracteriser des troubles du sommeil. Des scores de Nottingham Health Profile ont ete calcules selon trois methodes. Les donnees de mortalite ont ete obtenues pour une periode de 20 ans. Des regressions logistiques ont permis de decrire les relations entre facteurs professionnels et troubles du sommeil, entre troubles du sommeil et mortalite et entre facteurs professionnels et mortalite totale. Des analyses de mediation ont ete effectuees pour estimer l’effet mediateur des troubles du sommeil entre les facteurs professionnels et la mortalite, en mesurant: Les effets totaux, directs et indirects. Resultats Les donnees de 3135 personnes ont ete analysees. Les personnes exposees au port de charges lourdes, aux nuisances sonores intenses, au travail poste, au nombre de d’heures de travail hebdomadaire superieure a 48 h et celles ayant commence a travailler avant 18 ans ont un risque plus important de presenter au moins un symptome de troubles du sommeil, ainsi qu’un risque de mortalite plus eleve que les personnes non exposees. Les analyses de mediation retiennent un effet significatif pour les effets totaux et directs pour les facteurs professionnels sur la mortalite mais les effets indirects des troubles du sommeil dans ces relations sont non significatifs. Conclusion Des relations entre certains facteurs professionnels et le risque de mortalite ont ete mises en evidence. Cependant, les troubles du sommeil ne semblent pas jouer le role de mediateur dans ces relations.

Contexte L’hypertension arterielle est une maladie chronique. La litterature recente evoque le potentiel role des contraintes professionnelles sur l’hypertension arterielle. Cependant compte tenu de la multitude et des possibles co-expositions, le role des expositions professionnelles sur les changements de la pression arterielle n’est pas clairement etabli. Objectif Evaluer le lien entre le changement de la pression arterielle et l’incidence de l’hypertension arterielle sur cinq ans et differents types d’expositions professionnelles. Methode Au total, 1156 participants issus de la cohorte francaise VISAT ont ete examines par des medecins du travail et ont repondu a des auto-questionnaires lors des visites medicales annuelles obligatoires en 2001 et 2006. Quatre categories d’expositions professionnelles ont ete explorees : les contraintes physiques, organisationnelles, psychosociales et celles liees a l’emploi. Le changement de pression arterielle a ete explore de deux maniere : selon la difference de pression arterielle systolique entre 2001 (T1) et 2006 (T2), ainsi qu’en considerant la survenue d’une hypertension a T2 chez les participants qui en etaient indemnes a T1. Des analyses multivariees par regressions lineaires et logistiques, ajustees ou non sur les facteurs de risque cardiovasculaire classiques, ont ete menees afin d’evaluer le lien entre pression arterielle et expositions professionnelles. Ce lien a ete etudie en incluant separement chaque exposition dans plusieurs modeles mais aussi en les combinant dans un meme modele. Resultats En l’absence d’ajustement et parmi les participants ayant une pression arterielle 48 heures par semaine, etre actif ou tendu au travail (modele de Karasek) tend a augmenter la pression arterielle cinq ans plus tard, tandis que la reconnaissance au travail la diminue. Apres ajustement, seules les associations entre une augmentation de la pression arterielle et les contraintes psychologiques et la reconnaissance au travail persistent. Aucune association avec la survenue d’hypertension en cinq ans n’a ete observee. Conclusion Certaines contraintes professionnelles ont un role sur la pression sanguine arterielle notamment lorsque que celle-ci est consideree dans des valeurs normales, initialement. Ce role est principalement explique par des facteurs de risque cardiovasculaires classiques, renforcant la necessite d’une surveillance medicale accrue chez les travailleurs exposes a ces contraintes.

As population grow older, chronic diseases are more prevalent. It leads to an increase of hospitalization for acute decompensation, sometimes iterative. Management of these patients is not always clear, and care provided is not always proportional to life expectancy. Making decisions in acute situations is not easy.This review aims to list and describe mortality scores within a year following hospitalization of patients of 65 years or older.Following keywords were searched in title and abstract of articles via an advanced search in PudMed, and by searching Mesh terms: "aged", "aged, 80 and over", "mortality", "prognosis", "hospitalized", "models, statistical", "acute geriatric ward", "frailty", "outcome".Studies published in English between 1985 and 2015 were selected. Last article was published in June 2015. Articles that described prognostic factors of mortality without a scoring system were excluded. Articles that focus either on patients in the Emergency Department and in Intensive Care Unit, or living in institution were excluded.Twenty-two scores are described in 17 articles. These scores use items that refer to functional status, comorbidities, cognitive status and frailty. Scores of mortality 3 or 6 months after hospitalization are not discriminative. Few of the 1-year mortality prognostic score are discriminative with AUC≥0.7.This review is not systematic.Practical use of these scores might help management of these patients, in order to initiate appropriate reflexion and palliative care if necessary.

Background Occupational environment is often suspected to be involved in increased Blood Pressure (BP), but asserting its causality remains uncertain. Purpose To assess the impact of a large panel of occupational factors exposures on changes of BP over a 5-year follow-up period. Methods 790 participants were recruited during 2001-2006 in a French cohort study. Four categories of occupational factors were investigated: physical constraints, organizational and psychosocial factors and employment-related characteristics, allowing nearly exploring 30 occupational determinants. Changes in Systolic BP (SBP) and Diastolic BP (DBP) between the two surveys were dichotomized into increased BP versus decreased or unchanged BP. Logistic regressions were performed to explain how each occupational factor interacts with changes in BP, after adjustment for several classical confounding factors. Receiver Operating Characteristic (ROC) curves were used to determine whether occupational factors could improve the prediction of BP changes. Results No physical constraint was significantly associated with changes in BP. Among organizational factors, only particular working hour schedule had a protective effect on SBP (OR=0.72). The main effect on BP changes was obtained by psychosocial factors. Taking on several tasks at the same time, not being able to interrupt work or being exposed to an active job strain significantly predicted a high risk of an increased SBP (OR≈1.50). In contrast, occupational recognition and consideration of expressed employee opinion, tended to be associated with a protective effect (OR≈0.70). Comparing areas under the ROC curves revealed that occupational factors significantly improved the prediction of SBP changes, compared to taking into account only the classic cardiovascular risks. Conclusion Psychosocial factors appear as the major determinants of changes of BP over time with a dual effect, whereas biomechanical occupational factors play a minor role.

IntroductionThe 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.Methods402 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.ResultsErythrocyte 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

International audience; BACKGROUND: Fat content of dairy foods is diverse, potentially leading to varying effects on cardiovascular risk. We studied relationships of low- and high-fat dairy products with lipids and level of cardiovascular risk (assessed by the SCORE equation), in a cross-sectional population survey conducted in three French areas. SUBJECTS AND METHODS: A sample of 3078 participants aged 35-64 years underwent a standardized cardiovascular risk assessment. Subjects were asked to record the types and amounts of foods and beverages they consumed over a three-consecutive-day period. Dairy products were separated into two groups: the low-fat group comprised milk (including milk in desserts and beverages), yogurts and cottage cheese, whereas other cheeses formed the high-fat group. RESULTS: After adjustment (including physical activity and a diet quality score), the probability of an increased cardiovascular mortality score (\textgreater/=1%) decreased from the lowest to the highest quartile (Q) of low-fat dairy intake: odds ratio (OR) ORQ1 = 1; ORQ2 = 0.89 (95% confidence interval: 0.73-1.10), ORQ3 = 0.78 (0.63-0.97) and ORQ4 = 0.68 (0.55-0.85) for the first, second, third and fourth quartile, respectively. Results were notably different for high-fat dairy intake: ORQ2 = 1.02 (0.82-1.25); ORQ3 = 0.90 (0.73-1.11); ORQ4 = 1.07 (0.86-1.32). Intake of low-fat dairy products was inversely associated with low-density lipoprotein cholesterol (LDL-C), but no significant independent relationship was found with high-density lipoprotein cholesterol (HDL-C) or triglycerides. None of the lipid parameters was significantly associated with the consumption of high-fat dairy products. CONCLUSION: Participants with the highest intake of low-fat dairy products had the lowest mortality risk score and exhibited the best LDL-C profile. Such favourable associations were not observed with cheese consumption.

Background Identification of the coronary origin of a thoracic pain by the emergency physician in charge of telephone triage at the pre-hospital emergency service is a key element of prognosis. Purpose To build a gender-specific telephone score for predicting ACS for patients calling for non-traumatic thoracic pain. Method Observational multicenter prospective study. Patients ≥18 years old calling the telephone triage center for a non-traumatic chest pain were included. The outcome was ACS diagnosis estimated by two independent experts. Separate models were built for men and women. Multivariable analyses were carried out to identify predictive items of ACS using a stepwise logistic regression. Models performances were assessed (c-statistic). Data were randomly divided into a derivation and a validation sample. Results In three medical centers, 3727 patients were included (2097 men, 1630 women). ACS were diagnosed in 24.2% of men and 8.5% of women. Among men, variables independently associated with ACS were age, smoking, pain intensity, persistence of pain, retrosternal pain, lack of increased intensity with inspiration, pain irradiations, pain association to other signs. The area under the receiver operator characteristic (ROC) curve (AUC) was 0.76 (95% confidence interval (CI) 0.73-0.79). A 48 point score was built. The AUC of the score applied to the validation sample was 0.77 (95% CI 0.73-0.80). Among women, variables independently associated with ACS were age, previous coronary artery disease, lack of increased pain intensity with inspiration, pain irradiations. The AUC was 0.79 (0.75-0.83). A 23 point score was built. The AUC of the score applied to the validation sample was 0.67 (95% CI 0.60-0.74). Conclusion Predictive characteristics of ACS in patients who call medical dispatch centre for chest pain are different for women and men. The predictive accuracy of the models we developed was better among men than women.