Higher 1-year mortality on rest days in patients with acute coronary syndromes and decompensated heart failure-A SPUM-ACS sub-study.

BACKGROUND: Acute coronary syndromes (ACS) occurring on rest days have been associated with higher mortality, but the current literature remains inconsistent in this regard. This study included ACS patients presenting with acute decompensated heart failure (ADHF) investigating the relationship between time of coronary catheterization and outcomes. METHODS: Analyses were performed from the prospective, multicentric Special Program University Medicine Acute Coronary Syndromes and Inflammation (SPUM-ACS) Cohort. Patients were divided into two groups according to time of coronary catheterization on either workdays (Monday, 00:00 to Friday, 23:59) or rest days (Saturday, 00:00 to Sunday, 23:59 and public holidays). ADHF was defined by Killip Class III or IV upon presentation. Patients were followed over 1 year. RESULTS: Out of 4787 ACS patients enrolled in the SPUM-ACS Cohort, 207 (4.3%) presented with ADHF. 52 (25.1%) and 155 (74.9%) patients underwent coronary angiography on rest days or workdays, respectively. Baseline characteristics were similar among these groups. ACS patients with ADHF showed increased 1-year mortality on rest days (34.6% vs. 17.4%, p-value = 0.009). After correction for baseline characteristics, including the GRACE 2.0 Score, rest day presentation remained a significant predictor for 1-year mortality (adjusted hazard ratio = 2.42 [95% confidence interval: 1.14-5.17], p-value = 0.022). CONCLUSIONS: One-year all-cause mortality was high in ACS patients with ADHF and doubled for patients admitted on rest days. The present data support the association of a rest day effect and long-term patient survival and indicate a need for further investigations.

[Cardiovascular risk evaluation using the coronary artery calcium score]. / Évaluation du risque cardiovasculaire à l'aide du score calcique coronarien.

The coronary artery calcium score (CAC-score) using imaging is a cardiovascular screening tool that can be used in adults with no known cardiovascular disease and no symptoms suggestive of a cardiovascular pathology. It involves calculating the amount of calcification in the coronary arteries on a low-dose, non-injected chest CT-scan. A positive score above 0 is associated with more cardiovascular events. The CAC-score is currently selectively recommended for certain adults at intermediate cardiovascular risk, when the introduction of lipid-lowering treatment or the intensification of preventive measures remain uncertain.

Le score calcique coronarien (CAC-score) utilisant l'imagerie est un outil de dépistage cardiovasculaire utilisable chez des adultes sans maladie cardiovasculaire connue et symptômes évoquant une pathologie cardiovasculaire. Il s'agit d'un calcul de la quantité de calcifications dans les artères coronaires lors d'un CT-scan thoracique non injecté à faible dose. Un score positif au-dessus de 0 est associé avec plus d'événements cardiovasculaires. Le CAC-score est actuellement recommandé sélectivement chez certains adultes à risque cardiovasculaire intermédiaire, lorsque l'introduction d'un traitement hypolipémiant ou l'intensification des mesures de prévention restent incertaines.

[Epigenetic modifications and cardiovascular diseases : new Eldorado]. / Modifications épigénétiques et maladies cardiovasculaires : nouvel Eldorado.

As the risk of developing cardiovascular disease (CVD) is strongly dependent on the environment, the study of associated epigenetic modifications is a potentially promising axe of research given that they are affected by both the environment and disease development. Importantly, it is possible to identify and characterize specific epigenetic modifications in association with a disease, or risk factors for a disease, to create a so-called "epigenetic signature". Epigenetic signatures thus provide a summary of associated epigenetic changes and have the potential for several clinical applications including diagnosis, prognosis, as well as patient monitoring. However, although epigenetics has been successfully applied in cancer, efforts are still required to make their clinical use in CVD a reality.

Les maladies cardiovasculaires (MCV) dépendant fortement de l'environnement, l'étude des changements épigénétiques associés constitue un axe de recherche prometteur. En effet, ils sont affectés à la fois par l'environnement et par la survenue de maladies. En particulier, des changements épigénétiques spécifiques ou « signatures épigénétiques ¼ permettent de caractériser certains facteurs de risque des MCV. Les signatures épigénétiques ont de nombreuses applications potentielles dans le domaine du diagnostic, du pronostic et du suivi des patients. Cependant, malgré leur potentiel avéré pour le cancer, des efforts restent à faire pour concrétiser leur utilisation clinique dans le cadre des MCV.

[Identifying and assisting sedentary patients: a practical guide]. / Identifier et accompagner les patient-es sédentaires : un guide pratique.

A sedentary lifestyle is a significant cardiovascular risk factor and increases premature mortality. Engaging in routine physical activity (PA) provides a wide range of health benefits. Accordingly, physical inactivity must be identified and sedentary patients supported systematically to achieve recommended levels of PA. The level of PA can be assessed by taking patients' history and using specific tools. Support begins by assessing PA contraindications and patients' level of motivation to change their lifestyle. Patients are then encouraged to adopt a more active lifestyle through tailored advice, and if necessary, referred to specialists with expertise in exercise medicine. This article details the key aspects of accompanying sedentary patients, to help healthcare professionals integrate them into their practice.

La sédentarité est un facteur de risque cardiovasculaire et de mortalité prématurée important et la pratique d'une activité physique (AP) procure un éventail large de bénéfices pour la santé. Elle doit donc être identifiée et adressée de manière systématique en consultation médicale. Le niveau d'AP peut être évalué par l'anamnèse et des outils spécifiques. L'accompagnement débute par une évaluation des contre-indications à la pratique d'une AP et du niveau de motivation des patient-es à changer leur mode de vie. Ceux-ci sont ensuite encouragé-es à adopter un mode de vie plus actif à travers des conseils adaptés, et si nécessaire, adressé-es à d'autres spécialistes. Cet article détaille les aspects clés de l'accompagnement des patient-es sédentaires afin d'aider les professionnel-les de la santé à les intégrer dans leur pratique.

[Mobile cardiovascular screening and prevention in the population : useful in Switzerland?] / Dépistage et prévention cardiovasculaire mobile dans la population : utile en Suisse ?

Mobile cardiovascular prevention interventions are still uncommon in Switzerland. Mobile clinics improve access to prevention and enable new diagnoses of hypertension or hypercholesterolemia to be identified in a cost-effective way and has shown benefits in health behaviors such as physical activity, smoking cessation and medication compliance. The Unisanté Bus Santé is a mobile clinic run by nurses that offers screening for cardiovascular risk factors, health advice and, if necessary, referral to medical care. Mobile health initiatives such as the Bus Santé could play a more important role in the Swiss healthcare system, bringing personalized preventive care closer to the population.

Les interventions mobiles de promotion de la santé et de prévention sont encore peu fréquentes en Suisse. Elles permettent pourtant, par exemple, l'identification de nouveaux diagnostics d'hypertension ou d'hypercholestérolémie avec un rapport coût-efficacité favorable et ont également montré des bénéfices sur les comportements de santé comme l'activité physique, le sevrage tabagique et l'observance médicamenteuse. Le Bus santé d'Unisanté est une clinique mobile gérée par des infirmières proposant un dépistage des facteurs de risque cardiovasculaire, des conseils de santé et, si nécessaire, une orientation vers des soins médicaux. Ces interventions mobiles pourraient jouer un rôle plus important dans le système de santé suisse en amenant une offre de prévention personnalisée au plus proche de la population.

Smoking Cessation in People With and Without Diabetes After Acute Coronary Syndrome.

INTRODUCTION: People with diabetes smoke at similar rates as those without diabetes, with cardiovascular consequences. Smoking cessation rates were compared between people with and without diabetes 1 year after an acute coronary syndrome (ACS). AIMS AND METHODS: People with ACS who smoked and were part of an observational prospective multicenter study in Switzerland were included from 2007 to 2017 and followed for 12 months. Seven-day point prevalence abstinence was assessed at 12 months follow-up. Association between diabetes and smoking cessation was assessed using multivariable-adjusted logistical regression model. RESULTS: 2457 people with ACS who smoked were included, the mean age of 57 years old, 81.9% were men and 13.3% had diabetes. At 1 year, smoking cessation was 35.1% for people with diabetes and 42.6% for people without diabetes (P-value .01). After adjustment for age, sex, and educational level, people with diabetes who smoked were less likely to quit smoking compared with people without diabetes who smoked (odds ratio [OR] 0.76, 95% confidence interval [CI] 0.59-0.98, P-value = .037). The multivariable-adjusted model, with further adjustments for personal history of previous cardiovascular disease and cardiac rehabilitation attendance, attenuated this association (OR 0.85, 95% CI 0.65-1.12, P-value = .255). Among people with diabetes, cardiac rehabilitation attendance was a positive predictor of smoking cessation, and personal history of cardiovascular disease was a negative predictor of smoking cessation. CONCLUSIONS: People with diabetes who smoke are less likely to quit smoking after an ACS and need tailored secondary prevention programs. In this population, cardiac rehabilitation is associated with increased smoking cessation. IMPLICATIONS: This study provides new information on smoking cessation following ACSs comparing people with and without diabetes. After an ACS, people with diabetes who smoked were less likely to quit smoking than people without diabetes. Our findings highlight the importance of tailoring secondary prevention to people with diabetes.

Smoking cessation and depression after acute coronary syndrome.

Smoking and depression are risk factors for acute coronary syndrome (ACS) that often co-exist. We investigated the evolution of depression according to smoking cessation one-year after ACS. Data from 1822 ACS patients of the Swiss multicenter SPUM-ACS cohort study were analyzed over a one-year follow-up. Participants were classified in three groups based on smoking status one-year post-ACS - continuous smokers, smokers who quit within the year, and non-smokers. Depression status at baseline and one-year was assessed with the Center for Epidemiologic Studies Depression scale (CES-D) and antidepressant drug use. A CES-D score ≥ 16 defined depression. A multivariate-adjusted logistic regression model was used to calculate odds ratios (OR) between groups. The study sample mean age was 62.4 years and females represented 20.8%. At baseline, 22.6% were depressed, 40.9% were smokers, and 47.5% of these quit smoking over the year post-ACS. In comparison to depressed continuous smokers, depressed smokers who quit had an adjusted OR 2.59 (95% confidence interval (CI) 1.27-5.25) of going below a CES-D score of 16 or not using antidepressants. New depression at one-year was found in 24.4% of non-depressed smokers who quit, and in 27.1% of non-depressed continuous smokers, with an adjusted OR 0.85 (95% CI 0.55-1.29) of moving to a CES-D score of ≥16 or using antidepressants. In conclusion, smokers with depression at time of ACS who quit smoking improved their depression more frequently compared to continuous smokers. The incidence of new depression among smokers who quit after ACS was similar compared to continuous smokers.

[European guidelines 2021 for the cardiovascular prevention: new concepts]. / Recommandations européennes 2021 pour la prévention cardiovasculaire : nouveautés.

The latest European guidelines for cardiovascular prevention were published in 2021. As compared to the previous 2016 edition, these guidelines include some new concepts. First, the estimation of cardiovascular risk in apparently healthy persons now encompasses for the first time both fatal and nonfatal events, including myocardial infarction and stroke, using the new SCORE2 and SCORE2-OP. Second, the cardiovascular risk thresholds estimated with the scores are now stratified by age. Medical comorbidities play a more important role in risk estimation and preventive treatment. Finally, in the interest of a more personalized management, a step-by-step attitude is proposed to reach therapeutic goals adapted to the patient.

Les dernières recommandations européennes pour la prévention cardiovasculaire ont été publiées en 2021. Elles innovent, avec quelques nouveaux concepts par rapport aux précédentes recommandations de 2016. Premièrement, l'estimation du risque cardiovasculaire à 10 ans chez les patients apparemment en bonne santé englobe pour la première fois les événements mortels et non mortels, incluant l'infarctus et l'AVC, avec les nouveaux SCORE2 (Systemic Coronary Risk Estimation 2) et SCORE2-OP (Older Persons). Deuxièmement, les seuils de risque cardiovasculaire estimés avec les scores sont maintenant stratifiés selon l'âge. Les comorbidités médicales jouent également un rôle plus important dans la décision du traitement préventif. Enfin, dans le souci d'une prise en charge plus personnalisée, une attitude par paliers est proposée pour atteindre des buts thérapeutiques adaptés au patient.

[High-dose Omega-3 for cardiovascular prevention, a bad idea?] / Oméga-3 fortement dosés pour la prévention cardiovasculaire : une fausse bonne idée ?

Hypertriglyceridemia is a cardiovascular risk factor independent of LDL cholesterol. Omega-3 reduce triglycerides levels, but without proven benefit to reduce cardiovascular risk. Recently, two studies on high-dose omega-3 derivatives have shown contradictory results on the risk of cardiovascular events: REDUCE-IT (4 g/day of icosapent ethyl) showed a 25 % reduction; STRENGTH (4 g/day of a mixture of eicosapentaenoic acid and docosahexaenoic acid) showed no effect. An increased risk of atrial fibrillation was observed in both studies. The European 2021 cardiovascular prevention guidelines propose to consider high-dose ethyl icosapent on a case-by-case basis in patients with hypertriglyceridemia.

L'hypertriglycéridémie est un facteur de risque cardiovasculaire indépendant du taux de LDL-cholestérol. Les oméga-3 diminuent le taux de triglycérides, mais sans effet probant sur la baisse du risque cardiovasculaire. Dernièrement, deux essais cliniques sur des oméga-3 fortement dosés sont arrivés à des résultats con tradictoires: REDUCE-IT (4 g/jour d'icosapent éthyl) a montré une diminution de 25 % des événements cardiovasculaires; STRENGTH (4 g/jour d'un mélange d'acide eicosapentaénoïque et d'acide docosahexaénoïque) n'a pas montré de bénéfice cardiovasculaire. Une augmentation du risque de fibrillation auriculaire a été observée dans les deux études. Les recommandations européennes 2021 de prévention cardiovasculaire proposent de considérer au cas par cas l'icosapent éthyl fortement dosé chez les patients avec hypertriglycéridémie.

[Cascade genetic testing of familial hypercholesterolemia A new opportunity for prevention]. / Dépistage génétique en cascade de l'hypercholestérolémie familiale - Une nouvelle opportunité pour la prévention cardiovasculaire.

Familial hypercholesterolemia (FH) is a genetic disorder associated with an increased risk of early-onset cardiovascular events. Because lifestyle interventions and lipid-lowering drugs can strongly reduce cardiovascular risk, the early diagnosis of FH is important. Indeed, given the autosomal dominant transmission of the pathogenic variant, a genetic cascade screening program of first-degree relatives from an index case could identify patients at high cardiovascular risk. In Switzerland, genetic testing for FH is rarely used, because it is not reimbursed by health insurance companies. To test the usefulness of cascade genetic testing for FH, the CATCH study is currently ongoing in all linguistic part of Switzerland.

L'hypercholestérolémie familiale (HF) est une maladie génétique associée à un risque augmenté d'événements cardiovasculaires précoces. Étant donné que les adaptations du style de vie et les traitements hypolipémiants peuvent réduire fortement le risque cardiovasculaire, le diagnostic précoce de l'HF est important. À cette fin, en raison de la transmission autosomique dominante du variant pathogène, un dépistage génétique en cascade des apparentés du premier degré organisé autour du cas index permettrait d'identifier précocement les patients à risque cardiovasculaire élevé. Cependant, le test génétique est très peu utilisé en Suisse, car il n'est pas remboursé par les caisses-maladie. Afin de tester l'utilité du dépistage génétique en cascade de l'HF, l'étude CATCH est en cours actuellement dans les trois régions linguistiques de Suisse.

Older People's Health-Related Behaviors: Evidence from Three Cohorts of the Lc65+ Study.

Baby-boomers might be more health-conscious than earlier birth cohorts, but limited evidence has been produced so far. To investigate such changes, this study compared health-related behaviors at age 65 to 70 among three successive five-year birth cohorts (pre-war: born 1934-1938; war: born 1939-1943 and baby-boom: born 1944-1948) representative of the community-dwelling population. Information about alcohol use, smoking, physical activity, and nutrition was compared across the three cohorts (n = 4,270 participants) using Chi-squared test. Alcohol and the mean nutritional intake score did not vary across cohorts, whereas the consumption of nonalcoholic drinks increased significantly from pre-war to war and to baby-boom cohort (p<.001). Other differences across cohorts were observed only in women: the proportion of women who never or rarely engaged in sports decreased from 52.9% in the pre-war cohort to around 43% in subsequent cohorts (p<.001), while the proportion of women who had never smoked was higher in the pre-war cohort (56.1%) than in the war and the baby-boom cohorts (49.8% and 46.8%, respectively, p<.001). Overall, these results show some positive changes in older persons' health behaviors over time. Nevertheless, considerable room remains for improving lifestyles through public health interventions.

[Healthy eating counseling : Clinical and community perspectives]. / Conseils pour une alimentation saine : perspectives cliniques et communautaires.

Given the significant impact of diet on human health and its role in the primary and secondary prevention of many diseases, interventions aimed at modifying dietary behavior are increasingly considered as medical interventions. In this context, clinicians need more education and training on the appropriateness and use of these interventions, including the prescription of therapeutic meals. Both in-office counselling, for example with a dietician, and structural public health measures improve dietary behaviours. These coordinated clinical and community actions are important to reverse the unbalanced dietary trends observed in national surveys in Switzerland.

Vu l'impact important de l'alimentation sur la santé humaine et son rôle dans la prévention primaire et secondaire de nombreuses maladies, les interventions visant à modifier le comportement alimentaire tendent de plus en plus à être considérées comme des interventions médicales. Dans ce contexte, les cliniciens ont besoin de plus d'éducation et de formation sur la pertinence et l'utilisation de ces interventions, notamment pour la prescription de repas thérapeutiques. Autant le conseil au cabinet, par exemple en interprofessionnalité avec un·e diététicien·ne, que les mesures structurelles de santé publique améliorent les comportements alimentaires. Ces actions coordonnées cliniques et communautaires sont importantes pour faire évoluer les tendances alimentaires non équilibrées, observées lors d'enquêtes nationales en Suisse.

[Three approaches to doctor-patient communication and prevention : Which model for which situation ?] / Trois approches de communication médecin-patient et prévention : quel modèle pour quelle situation ?

Doctors learn different communication approaches for use during prevention consultations to promote healthy habits, so as to set up a partnership and to promote patient autonomy. Three of these approaches are shared decision making, when there is more than one reasonable choice, motivational interviewing, principally for behaviour change and therapeutic education, a pedagogical approach helping patients develop skills so that they may have a better management of their chronic illness. This article presents an overview of the commonalities and the differences between these approaches, often considered separately, nevertheless they are complementary and in practice, using elements of all three during a consultation could improve preventative care.

Les médecins apprennent différentes approches de communication utilisées lors des consultations de prévention afin de promouvoir des comportements sains, créer un partenariat avec le patient et favoriser son autonomie. Trois des approches les plus courantes sont : la décision partagée lorsqu'il y a plus d'un choix raisonnable, l'entretien motivationnel pour le changement de comportement et l'éducation thérapeutique, une approche pédagogique visant le développement de compétence des patients pour une gestion optimale des maladies chroniques. Nous présentons ici une vision d'ensemble des similarités et des différences entre ces approches, car, souvent considérées en silos, elles sont néanmoins complémentaires et, en pratique, utiliser des éléments tirés des trois durant une consultation pourrait améliorer la prise en charge.

Optimal Timing of Invasive Coronary Angiography following NSTEMI.

OBJECTIVE: To obtain a real-world perspective of the optimal timing of angiography performed within 24 hours of admission with non-ST elevation myocardial infarction (NSTEMI). BACKGROUND: Current guidelines recommend angiography within 24 hours of hospitalisation with NSTEMI. The recent VERDICT trial found that angiography within 12 hours of admission with NSTEMI was associated with improved cardiovascular outcomes among high-risk patients. We compared the outcomes of real-world NSTEMI patients undergoing angiography within 12 hours of admission with those of patients undergoing angiography 12 to 24 hours after admission. METHODS: NSTEMI patients without life-threatening features who received angiography within 24 hours of admission were obtained from the SPUM-ACS registry, a cohort of consecutive patients admitted with acute coronary syndromes to four university hospitals in Switzerland. Cox models assessed for an association between door-to-catheter time and one-year major adverse cardiovascular events (MACE: cardiovascular mortality, myocardial infarction, and stroke). RESULTS: Of 2672 NSTEMI patients, 1832 met the inclusion criteria. Among them, 1464 patients underwent angiography within 12 hours (12 h group) compared with 368 patients between 12 and 24 hours (12-24 h group). Multiple logistic regression identified out-of-hours admission as the only factor associated with delayed angiography. After 2 : 1 propensity score matching, 736 patients from the 12 h group and 368 patients from the 12-24 h group demonstrated no significant difference in rates of one-year MACE (7.7% vs. 7.3%, HR: 1.050, 95% CI 0.637-1.733, p=0.847). Stratification by GRACE score (>140 vs. ≤140) found no significant reduction in MACE among high-risk patients in the 12 h group (p=0.847). Stratification by GRACE score (>140 vs. ≤140) found no significant reduction in MACE among high-risk patients in the 12 h group (. CONCLUSIONS: In an unselected real-world cohort of NSTEMI patients, angiography within 12 hours of admission was not associated with improved one-year cardiovascular outcomes when compared with angiography 12 and 24 hours after admission, even among high-risk patients.

Trimethyllysine, a trimethylamine N-oxide precursor, provides near- and long-term prognostic value in patients presenting with acute coronary syndromes.

AIMS: Trimethyllysine (TML) serves as a nutrient precursor of the gut microbiota-derived metabolite trimethylamine N-oxide (TMAO) and is associated with incident cardiovascular (CV) events in stable subjects. We examined the relationship between plasma TML levels and incident CV events in patients presenting with acute coronary syndromes (ACS). METHODS AND RESULTS: Plasma levels of TML were quantified in two independent cohorts using mass spectrometry, and its relationship with CV events was investigated. In a Cleveland Cohort (N = 530), comprised of patients presenting to the emergency department with chest pain and suspected ACS, TML was associated with major adverse cardiac events (MACE, myocardial infarction, stroke, need for revascularization, or all-cause mortality) over both 30 days [3rd tertile (T3), adjusted odds ratio (OR) 1.77, 95% confidence interval (CI) 1.04-3.01; P < 0.05] and 6 months (T3, adjusted OR 1.95, 95% CI 1.15-3.32; P < 0.05) of follow-up independent of traditional CV risk factors and indices of renal function. Elevated TML levels were also associated with incident long-term (7-year) all-cause mortality [T3, adjusted hazard ratio (HR) 2.52, 95% CI 1.50-4.24; P < 0.001], and MACE even amongst patients persistently negative for cardiac Troponin T at presentation (e.g. 30-day MACE, T3, adjusted OR 4.49, 95% CI 2.06-9.79; P < 0.001). Trimethyllysine in combination with TMAO showed additive significance for near- and long-term CV events, including patients with 'negative' high-sensitivity Troponin T levels. In a multicentre Swiss Cohort (N = 1683) comprised of ACS patients, similar associations between TML and incident 1-year adverse cardiac risks were observed (e.g. mortality, adjusted T3 HR 2.74, 95% CI 1.28-5.85; P < 0.05; and MACE, adjusted T3 HR 1.55, 95% CI 1.04-2.31; P < 0.05). CONCLUSION: Plasma TML levels, alone and together with TMAO, are associated with both near- and long-term CV events in patients with chest pain and ACS.

[New European and American guidelines on the management of blood cholesterol†: similarities and differences]. / Nouvelles recommandations européennes et américaines pour les dyslipidémies†: similitudes et différences.

Experts' guidelines for the management of dyslipidemias differ from country to country, with important differences between medical societies of Europe and the United States. Recently, new American and European guidelines have been established. These guidelines mainly differ for cardiovascular risk stratification in secondary prevention, and for LDL-cholesterol (LDL-c) goals to achieve. Similitudes between guidelines include the global strategy to initiate lipid-lowering drugs, which is based first on the global cardiovascular risk, then on the LDL-c level. We are here presenting a comparison and an interpretation of these guidelines.

Les recommandations d'experts pour la prise en charge des dyslipidémies varient d'un pays à l'autre, avec des différences importantes entre les sociétés médicales d'Europe et des États-Unis. Récemment, de nouvelles recommandations américaines et européennes ont été établies. Elles diffèrent principalement dans la stratification du risque cardiovasculaire en prévention secondaire, ainsi que dans les cibles de LDL-cholestérol (LDL-c) à atteindre. Le point commun reste que l'indication au traitement hypolipémiant se base en premier sur le risque cardiovasculaire global, puis sur le taux de LDL-c. Nous présentons une comparaison et une interprétation de ces recommandations.

[Controversies concerning screening and treatment of primary dyslipidemias in 2020]. / Controverses sur le dépistage et la prise en charge des dyslipidémies familiales en 2020.

Familial dyslipidemia is rare compared to polygenetic causes. Nevertheless, it is important not to miss this diagnosis, as it is more strongly associated with an increased risk of early cardiovascular disease and scores for calculating cardiovascular risk are not valid in this population. Early detection and management based on lifestyle optimization and treatment of cardiovascular risk factors can delay the onset of cardiovascular complications and thus improve patients' quality of life. A LDL-Cholesterol of 4,9 mmol/l has recently been suggested as the cut-off for starting lipid lowering therapy, but remains controversial because the majority of people above this threshold do not have primary monogenic dyslipidemia. The age at which therapy should be initiated as well as the targets for treatment are also controversial.

Les dyslipidémies familiales sont plus rares que les causes communes, mais il est important de ne pas les manquer vu qu'elles sont liées à un risque augmenté de maladie cardiovasculaire précoce et que les scores de risque ne sont pas valables chez ces patients. Un dépistage et une prise en charge précoces reposant sur une optimisation de l'hygiène de vie et une éviction des facteurs de risque cardiovasculaire permettent de retarder la survenue des complications cardiovasculaires et ainsi d'améliorer la qualité de vie des patients. Un seuil de LDL de 4,9 mmol/l pour débuter un traitement hypolipémiant a récemment été proposé, mais reste controversé car la majorité des patients au-dessus de ce seuil n'a pas une forme familiale. L'âge de début d'un traitement et les cibles de traitement sont également controversés.

[Physical activity counseling Referring to an adapted physical activity specialist†: example of the Step by Step+ project]. / Conseil en activité physique - Sa délégation vers une spécialiste en activité physique adaptée†: le projet Pas à Pas.

The health benefits of regular physical activity are undeniable. There is a dose-response relationship between total physical activity and health outcomes, and thus every opportunity should be seized to exercise more. Among the methods used to increase the level of physical activity, physical activity counselling delivered in clinical practice is effective. The Pas à Pas+ project presented in this article allows to extend the advice from the healthcare professional and to lead up the patient to a physically more active lifestyle, providing a support in physical activity on prescription. There are several -challenges that need to be addressed in order to anchor definitely physical activity counselling and its delegation to professionals in adapted physical activity in the healthcare setting.

Les bénéfices d'une activité physique régulière pour la santé sont indéniables. Il existe une relation dose-réponse entre la quantité totale d'activités physiques pratiquées et la santé, si bien que chaque occasion doit être saisie pour bouger davantage. Parmi les moyens permettant d'augmenter le niveau d'activité physique de la population, le conseil réalisé en pratique clinique est ­efficace. Le projet Pas à Pas+ présenté dans cet article permet de prolonger le conseil du ou de la professionnelle de santé et d'accompagner concrètement le ou la patiente vers un mode de vie plus actif à travers une prestation de suivi en activité physique sur délégation médicale. Plusieurs défis doivent être relevés afin d'ancrer solidement dans le domaine des soins le conseil en ­matière d'activité physique et sa délégation vers des profes­sionnelles de l'activité physique adaptée.

[Aspirin for primary cardiovascular prevention : the end of an era ?] / Aspirine en prévention cardiovasculaire primaire†: la fin d'une époque†?

Low-dose aspirin in primary prevention of cardiovascular disease is still debated. Recent clinical trials of aspirin vs placebo reported an unfavourable risk-benefit ratio with an increase in major bleedings without reduction on the occurrence of non-fatal cardiovascular events. These studies also highlight that current cardiovascular risk calculators overestimate cardiovascular risk, which is probably related to the improvement in the management of cardiovascular risk factors over the last decades. In accordance with European cardiovascular prevention recommendations, aspirin should not be prescribed for the primary prevention of cardiovascular disease.

L'aspirine à faible dose en prévention primaire des maladies cardiovasculaires (CV) ne fait pas l'unanimité. De nouvelles études parues en 2018 mettent en évidence un rapport risques/bénéfices défavorable avec une augmentation des hémorragies majeures sans effets sur la survenue d'événements CV non mortels. Ces études soulignent également que les calculateurs actuels du risque CV surévaluent celui-ci, et ceci est probablement lié à l'amélioration depuis quelques décennies de la prise en charge des facteurs de risque CV. En accord avec les recommandations européennes de prévention CV, la prescription d'aspirine n'est donc plus recommandée aux adultes sans maladie CV manifeste.

Diabetes and baseline glucose are associated with inflammation, left ventricular function and short- and long-term outcome in acute coronary syndromes: role of the novel biomarker Cyr 61.

BACKGROUND: Hyperglycemia in the setting of an acute coronary syndrome (ACS) impacts short term outcomes, but little is known about longer term effects. We therefore designed this study to firstly determine the association between hyperglycemia and short term and longer term outcomes in patients presenting with ACS and secondly evaluate the prognostic role of diabetes, body mass index (BMI) and the novel biomarker Cyr61 on outcomes. METHODS: The prospective Special Program University Medicine-Acute Coronary Syndrome (SPUM-ACS) cohort enrolled 2168 patients with ACS between December 2009 and October 2012, of which 2034 underwent PCI (93.8%). Patients were followed up for 12 months. Events were independently adjudicated by three experienced cardiologists. Participants were recruited from four tertiary hospitals in Switzerland: Zurich, Geneva, Lausanne and Bern. Participants presenting with acute coronary syndromes and who underwent coronary angiography were included in the analysis. Patients were grouped according to history of diabetes (or HbA1c greater than 6%), baseline blood sugar level (BSL; < 6, 6-11.1 and > 11.1 mmol/L) and body mass index (BMI). The primary outcome was major adverse cardiac events (MACE) which was a composite of myocardial infarction, stroke and all-cause death. Secondary outcomes included the individual components of the primary endpoint, revascularisations, bleeding events (BARC classification) and cerebrovascular events (ischaemic or haemorrhagic stroke or TIA). RESULTS: Patients with hyperglycemia, i.e. BSL ≥ 11.1 mmol/L, had higher levels of C-reactive protein (CRP), white blood cell count (WBC), creatinine kinase (CK), higher heart rates and lower left ventricular ejection fraction (LVEF) and increased N-terminal pro-brain natriuretic peptide. At 30 days and 12 months, those with BSL ≥ 11.1 mmol/L had more MACE and death compared to those with BSL < 6.0 mmol/L or 6.0-11.1 mmol/L (HR-ratio 4.78 and 6.6; p < 0.001). The novel biomarker Cyr61 strongly associated with high BSL and STEMI and was independently associated with 1 year outcomes (HR 2.22; 95% CI 1.33-3.72; Tertile 3 vs. Tertile 1). CONCLUSIONS AND RELEVANCE: In this large, prospective, independently adjudicated cohort of in all comers ACS patients undergoing PCI, both a history of diabetes and elevated entry glucose was associated with inflammation and increased risk of MACE both at short and long-term. The mediators might involve increased sympathetic activation, inflammation and ischemia as reflected by elevated Cyr61 levels leading to larger levels of troponin and lower LVEF. Trial registration Clinical Trial Registration Number: NCT01000701. Registered October 23, 2009.