[Patient education and patient at risk. A new approach in cardiology]. / Education thérapeutique et patient a haut risque: une nouvelle approche en cardiologie.

For more than 10 years, preventive cardiology has obtained many positive results. Cardiologists can alter the prognosis of cardiovascular disease in primary and secondary prevention. In primary prevention or during the chronic phases of coronary artery disease, prevention is mainly based on drugs. However, prevention can be achieved only if patients have a good understanding of their disease, fair relationships with their physicians and a strict compliance with their treatments. Patient education is useful for the patient in order to control cardiovascular risk. In France, the PEGASE program evaluates the efficacy of an educational program in high risk patients. The final objective of this program is to spread this educational program for high risk patients to cardiologists all over the country.

Malnutrition and wasting, immunodepression, and chronic inflammation as independent predictors of survival in HIV-infected patients.

To analyze the long-term survival factors associated with HIV infection, a prospective follow-up study of 165 HIV-infected patients was performed after a clinical, nutritional, and biological evaluation. Survival rate could be determined in 129 patients after a follow-up of 42 mo before the use of protease inhibitors. After univariate analysis, multivariate analysis was performed with the Cox regression proportional-hazard model. Survival curves were calculated and compared with the Kaplan, Meier, and log-rank tests. The study also analyzed the factors associated with impaired nutritional status at the beginning of the study and their effects on the long-term follow-up. Factors that could explain body weight loss before the study were the level of intakes, resting energy expenditure, chronic diarrhea, and the number of previous opportunistic infections. In the long-term follow-up, univariate analysis showed that nutritional status could be separated into four classes of body weight loss (BWL) by degree of loss (BWL < or = 5%, 5% < BWL < or = 10%, 10% < BWL < or = 20%, BWL > 20%); lean body mass (adjusted to height), body cell mass, CD4 count, albumin, prealbumin, and C-reactive protein (CRP) were all significant predictors. Age, stage of disease, number of previous opportunistic infections, and antiviral therapies were not associated with a change in survival. With the multivariate model, only CD4 counts, lean body mass/height squared, and CRP remained significant independent predictors of survival after controlling for other factors.

Xmn1 restriction polymorphism of apolipoprotein AI gene and lipoprotein levels in obesity.

The aim of this study was to assess any association between an Xmn1 restriction site polymorphism of the apo AI gene and lipoprotein levels in obesity. A cross sectional study was made of lipid variables in relation to genetic and anthropometric factors in obese people at the Nutrition Outpatient Clinic of Bichat Hospital in Paris, France. The subjects were 97 unrelated French Caucasian subjects (65 women and 32 men) selected on the basis of 20% over-weight. The following main outcome measures were recorded: body mass index (BMI) and waist to hip ratio (WHR), cholesterol (C) and triglyceride (TG) concentrations in serum and lipoproteins (including HDL subfractions), apolipoproteins AI and B, determination of apo AI Xmn1 genotypes. Three alleles, designated X1, X2, X3, could be detected with frequencies 0.84, 0.12, and 0.04 respectively. The X2 carriers had higher concentrations of LpA-I, A-II (HDL particles containing both Apo AI and Apo AII) in the whole group: 0.90 vs 0.77 and 0.72 g/l in X1X1 and X1X3 respectively (P < 0.01). The genotype X1X2 was also associated with higher HDL-C in obese men (0.47 vs 0.36 g/l in X1X1, P < 0.05). In X1X1 women, BMI was positively correlated with serum and VLDL-TG (P < 0.05) and negatively with HDL2-C (P < 0.05), WHR being positively correlated with serum TG (P < 0.05), VLDL-TG (P < 0.01) and negatively with HDL-(P < 0.05) and HDL2-C (P < 0.01). These correlations were not found in subjects carrying the X2 allele.(ABSTRACT TRUNCATED AT 250 WORDS)

Polymorphisms of uncoupling protein (UCP) and beta 3 adrenoreceptor genes in obese people submitted to a low calorie diet.

OBJECTIVE: To investigate whether the genetic polymorphisms of the uncoupling protein (UCP) and beta 3 adrenergic receptor (beta 3 AR) were associated with differences of weight loss in obese patients submitted to a low calorie diet. DESIGN: Longitudinal, clinical intervention study of a 25% restriction in energy intake with respect to genotypes. SUBJECTS: 163 patients with a body mass index above 27. MEASUREMENTS: Body weight and body mass index at baseline and after 2.5 months, genotypes by polymerase chain reaction followed by enzymatic digestion. RESULTS: For the UCP polymorphism, two alleles, 1 and 2 were identified with respective frequencies of 0.27 and 0.73. The allele 1 was associated with lower body weight loss after diet: 4,6,5.7 and 7.1 kg for the 1-1, 1-2 and 2-2 genotypes respectively (P < 0.05). No difference in weight loss was found according to the beta 3 AR Trp64Arg mutation. CONCLUSIONS: A genetic variant of the UCP gene is associated with a resistance to low calorie diet. This result, together with previous data on body weight gain, supports the hypothesis of a role of UCP and brown adipose tissue in the body weight regulation in humans. The importance of the Trp64Arg mutation of the beta 3 AR in the resistance to low calorie diet is still to demonstrate.