Microalbuminuria and markers of the atherosclerotic process: the D.E. S.I.R. study.

The relationship between microalbuminuria and tissue-type plasminogen activator antigen (tPA-ag) and fibrinogen was evaluated in non-diabetic subjects. Subjects were participants of the D.E.S.I. R. (Data from an Epidemiological Study on the Insulin Resistance syndrome) Study. Analyses were carried out on 2248 women and 2402 men for fibrinogen and on 272 women and 284 men for tPA-ag. Microalbuminuria was defined as urinary albumin concentration greater than 20 mg/l. Men with microalbuminuria had a 6% higher fibrinogen concentration than those without (3.07 g/l (95% confidence interval: 2.99,3.15) vs. 2.89 g/l (2.87,2.91), adjusted for age and smoking). This relationship existed in hypertensive as well as non-hypertensive subjects. The association between microalbuminuria and tPA-ag existed only in hypertensive men, those with microalbuminuria having a 21% higher tPA-ag than those without (4.39 ng/ml (3.70,5.08) vs. 3.63 ng/ml (3.32,3.94), adjusted for age and smoking). Adjustment for other risk markers for cardiovascular disease did not change the results. There was no relationship between microalbuminuria and these haemostatic factors in women. The results of this study suggest that in non-diabetic men, microalbuminuria is associated with fibrinogen, but with tPA-ag only when concomitant with hypertension.

Association between heart rate-corrected QT interval and coronary risk factors in 2,894 healthy subjects (the DESIR Study). Data from an Epidemiological Study on the Insulin Resistance syndrome.

In the prospective Data from an Epidemiological Study on the Insulin Resistance Syndrome, 2,894 healthy subjects aged 30 to 64 years had determinations of fasting glucose, insulin, serum lipid and fibrinogen concentrations, blood pressures, body mass index, and waist-hip ratio, as well as tobacco and alcohol consumptions and physical activity. A 12-lead electrocardiogram with automatic measurement of the QT interval was recorded and the formula used for heart rate correction was based on the best-fit regression between QT and heart rate. The QT duration was influenced by glucose homeostasis in both sexes, and increased in men with physical activity; there was a dose-effect relation for men who smoked.

Alcohol intake and fasting insulin in French men and women. The D.E.S.I.R. Study.

BACKGROUND: To study the relation between alcohol consumption and the fasting insulin concentration in a French population with a range of alcohol intakes. METHODS: 2.406 men and 2.500 women, aged 30 to 65 years who were not known as diabetic and with a non-diabetic fasting plasma glucose<7.0 mmol/l were studied. Insulin was assayed by a specific micro-enzyme immunoassay and alcohol intake was from a self-questionnaire. RESULTS: Fasting insulin concentration showed an inverse linear association with alcohol consumption, after adjustment for age and possible confounding factors (p for trend<0.0001 men; p<0.002 women), with a 29% higher insulin in non-drinkers compared to very heavy drinkers (> 80 g/day) in men (p<0.0001) and a 23% and 26% difference when compared to heavy drinkers (41-80 g/day) in men and women respectively (p<0.0001, p<0.003). This relation did not differ significantly according to whether the alcohol was consumed as wine, beer/cider or spirits. Fasting plasma glucose modified the relation between alcohol and insulin in men: while the negative relation alcohol-insulin was strong for fasting plasma glucose<6.0 mmol/l (p<0.0001), there was no association above 6.0 mmol/l (p=0.4). CONCLUSION: There is an inverse relation between alcohol consumption and fasting insulin concentrations. Some studies have found a U shaped relation, and this is probably due to the inclusion of diabetic subjects. As hyperinsulinemia has been shown to be positively associated with cardiovascular disease, it may be one of the variables that explains the protective effect of moderate alcohol consumption on cardiovascular disease.

[Pilot data from the Spirale project -- follow-up of occupational respiratory exposures]. / Les dispositifs pilotes existants du suivi post-professionnel : Spirale.

INTRODUCTION: The medical follow-up of individuals who have had occupational exposures to potential respiratory hazards is little known and under-utilised. The Spirale program aims to deliver this intervention effectively to all potential beneficiaries. METHODS: Spirale was introduced in two stages; i) identification of occupational exposures to asbestos or wood dust through a postal questionnaire; ii) for those initially identified, confirmation of exposure through attendance at a health centre for examination and further medical follow-up as necessary. RESULTS: In 2007, Spirale contacted 50,662 men born between 1942 and 1943, living in 13 departments in France. The initial response rate was 24%, rising to 50% after reminders. Seventy-two percent of people were identified as possibly having been exposed; 50% to asbestos, 3% to wood dust and 19% reporting a mixed exposure. Among the 8641 people located, 3843 (44.5%) benefited from an evaluation of their exposure. In total, 73.4% of people had their exposure to asbestos confirmed and in 1751 (64.2%) this was at a level to justify follow-up. CONCLUSION: TheSpirale program largely achieved its objective of location and initiation of medical monitoring of people who have been exposed through their work to respiratory carcinogens. It should now be implemented throughout the country.

Practical way to assess metabolic syndrome using a continuous score obtained from principal components analysis.

AIMS/HYPOTHESIS: We devised a practical continuous score to assess the metabolic syndrome, and assessed whether this syndrome score predicts incident diabetes and cardiovascular disease. SUBJECTS AND METHODS: Among 5,024 participants of the Data from an Epidemiological Study on the Insulin Resistance Syndrome (D.E.S.I.R.) cohort, we defined a metabolic syndrome score by the first principal component (PC1), using only the correlations between continuous metabolic syndrome measures (glucose, waist circumference, triglycerides, and systolic blood pressure). This metabolic syndrome score was highly correlated with a similar score also including insulin and HDL cholesterol (r ( s )=0.94). Over 9 years of follow-up, incident diabetes and cardiovascular disease (CVD) were predicted by logistic regression using the simpler metabolic syndrome score. RESULTS: The means of the metabolic syndrome measures differed between men and women. Nevertheless, as the degree of variance explained and the PC1 coefficients were remarkably similar, we used a common metabolic syndrome score. The metabolic syndrome score explained 50% of the variance of the metabolic syndrome measures, and waist circumference had the highest correlation (0.59) with this score. Each standard deviation increase in the metabolic syndrome score was associated with a markedly increased age-adjusted risk of developing diabetes (odds ratios: men 3.4 [95% CI 2.6-4.4]; women 5.1 [3.6-7.2]) and with increased incident CVD of 1.7 (1.4-2.1) in men and 1.7 (1.0-2.7) in women. CONCLUSIONS/INTERPRETATION: Our results, which should be confirmed in other populations, suggest that it is possible to evaluate the risk of the metabolic syndrome in a pragmatic fashion with a continuous score, obtained from principal components analysis of the basic, continuous syndrome measures.