RESUMO
Background and Purpose- Evidence links antidepressant use with cerebral small vessel disease; however, it remains unclear whether people with depression face comparable risk. This study aims to determine the association between antidepressant drug use and depression with markers of cerebral small vessel disease. Methods- One thousand nine hundred five participants (mean age, 72.5 years; 60% women) without stroke or dementia history underwent brain magnetic resonance imaging at baseline, and 1402 individuals underwent a second magnetic resonance imaging at 4 years. Outcomes were lacunes 3 to 15 mm and white matter hyperintensity volume (cm3) at baseline and follow-up. Exposure to antidepressants was grouped as (1) selective serotonin reuptake inhibitors (n=68), (2) tricyclics (n=40), (3) atypicals (n=24), (4) depressed nonusers (n=303), and (5) nondepressed/nonuser group (reference group, n=1470). Statistical analyses adjusted for propensity scores due to the nonrandomized exposure to antidepressant drugs. Results- There was an association between use of atypical antidepressants with lacunes at baseline (adjusted rate ratio, 2.59 [95% CI, 1.14-5.88]; P=0.023) and follow-up (adjusted rate ratio, 3.05 [95% CI, 1.25-7.43]; P=0.014). Lacunes at baseline were also associated with depressed nonusers (adjusted rate ratio, 1.53 [95% CI, 1.06-2.21]; P=0.023). Selective serotonin reuptake inhibitor users and depressed nonusers displayed higher total, periventricular, and deep white matter hyperintensity volumes at baseline. Selective serotonin reuptake inhibitor users had higher deep white matter hyperintensity volumes at follow-up. Conclusions- Users of atypical antidepressants, selective serotonin reuptake inhibitors, and depressed people without any antidepressant exposure all displayed markers of cerebral small vessel disease higher than the nondepressed/nonuser group. The findings suggest that cerebral small vessel disease is associated with depression and exposure to antidepressants.
Assuntos
Antidepressivos/uso terapêutico , Doenças de Pequenos Vasos Cerebrais/epidemiologia , Transtorno Depressivo/epidemiologia , Substância Branca/diagnóstico por imagem , Idoso , Antidepressivos de Segunda Geração/uso terapêutico , Antidepressivos Tricíclicos/uso terapêutico , Estudos de Casos e Controles , Doenças de Pequenos Vasos Cerebrais/diagnóstico por imagem , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Inibidores Seletivos de Recaptação de Serotonina/uso terapêuticoRESUMO
INTRODUCTION: Benzodiazepine use has been associated with increased risk of dementia. However, it remains unclear whether the risk relates to short or long half-life benzodiazepines and whether it extends to other psychotropic drugs. METHODS: Prospective cohort study among 8240 individuals ≥65, interviewed on medication use. Incident dementia confirmed by an end point committee after a multistep procedure. RESULTS: During a mean of 8 years of follow-up, 830 incident dementia cases were observed. Users of benzodiazepines at baseline had a 10% increased risk of dementia (adjusted hazard ratio [HR], 1.10; 95% confidence interval, 0.90-1.34). However, long half-life (>20 hours) benzodiazepine users had a marked increased risk of dementia (HR = 1.62; 1.11-2.37) compared with short half-life users (HR = 1.05; 0.85-1.30). Users of psychotropics had an increased risk of dementia (HR = 1.47; 1.16-1.86). DISCUSSION: Results of this large, prospective study show increased risk of dementia for long half-life benzodiazepine and psychotropic use.
Assuntos
Benzodiazepinas/efeitos adversos , Demência/induzido quimicamente , Psicotrópicos/efeitos adversos , Idoso , Demência/epidemiologia , Feminino , Humanos , Masculino , Estudos Prospectivos , RiscoRESUMO
To test the hypothesis that age at retirement is associated with dementia risk among self-employed workers in France, we linked health and pension databases of self-employed workers and we extracted data of those who were still alive and retired as of December 31st 2010. Dementia cases were detected in the database either through the declaration of a long-term chronic disease coded as Alzheimer's disease and other dementia (International Classification of Disease codes G30, F00, F01, F03) or through the claim for reimbursement of one of the anti-dementia drugs. Data were analyzed using Cox proportional hazard model adjusting for potential confounders. Among the 429,803 retired self-employed workers alive on December 31st 2010, prevalence of dementia was 2.65 %. Multivariable analyses showed that the hazard ratio of dementia was 0.968 [95 % confidence interval = (0.962-0.973)] per each extra year of age at retirement. After excluding workers who had dementia diagnosed within the 5 years following retirement, the results remained unchanged and highly significant (p < 0.0001). We show strong evidence of a significant decrease in the risk of developing dementia associated with older age at retirement, in line with the "use it or lose it" hypothesis. Further evidence is necessary to evaluate whether this association is causal, but our results indicate the potential importance of maintaining high levels of cognitive and social stimulation throughout work and retiree life.
Assuntos
Cognição , Demência/diagnóstico , Emprego , Aposentadoria , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Demência/epidemiologia , Feminino , França/epidemiologia , Humanos , Incidência , Masculino , Prevalência , Modelos de Riscos Proporcionais , RiscoRESUMO
BACKGROUND: The relationship between blood pressure and dementia is incompletely understood in elderly individuals. Blood pressure variability may have a role in the risk of dementia. METHODS: This investigation was a cohort study of 6506 elderly individuals followed-up for 8 years (1999-2001 through 2008) with assessments at years 2, 4, and 7-8. Blood pressure was measured by electronic devices at baseline and at 2- and 4-year follow-up examinations. Cox proportional hazard models adjusted for potential confounders were used to estimate the risk of incident dementia according to blood pressure (means and coefficients of variation of the three measures). RESULTS: During the 40,151 person-years of follow-up 474 participants developed dementia. We observed no association between mean blood pressure and risk of dementia. In contrast, an increase of 1 standard deviation in the coefficient of variation of blood pressure was associated with a 10% increased risk of dementia. Analysis by deciles of the coefficient of variation showed that the higher the variability, the higher the risk of dementia (P<.02 for trend). In the fully adjusted Cox model, the risk of dementia for those in the highest decile of the coefficient of variation of systolic blood pressure was 1.77 (1.17-2.69) compared with the lowest decile. CONCLUSIONS: In this cohort study, variability of blood pressure during follow-up was associated with an increased risk of incident dementia, whereas mean blood pressure was not. Limitation of blood pressure fluctuation may be an important target to preserve cognitive function in the elderly.
Assuntos
Pressão Sanguínea , Demência/epidemiologia , Demência/fisiopatologia , Idoso , Monitorização Ambulatorial da Pressão Arterial , Estudos de Coortes , Feminino , Seguimentos , França/epidemiologia , Humanos , Masculino , Modelos de Riscos Proporcionais , RiscoRESUMO
BACKGROUND: Prospective national screening and surveillance programmes serve a range of public health functions. Objectively determining their adequacy and impact on disease may be problematic for rare disorders. We undertook to assess whether objective measures of disease surveillance intensity could be developed for the rare disorder sporadic Creutzfeldt-Jakob disease (CJD) and whether such measures correlate with disease incidence. METHOD: From 10 countries with national human prion disease surveillance centres, the annual number of suspected prion disease cases notified to each national unit (n=17,610), referrals for cerebrospinal fluid (CSF) 14-3-3 protein diagnostic testing (n=28,780) and the number of suspect cases undergoing diagnostic neuropathological examination (n=4885) from 1993 to 2006 were collected. Age and survey year adjusted incidence rate ratios with 95% CIs were estimated using Poisson regression models to assess risk factors for sporadic, non-sporadic and all prion disease cases. RESULTS: Age and survey year adjusted analysis showed all three surveillance intensity measures (suspected human prion disease notifications, 14-3-3 protein diagnostic test referrals and neuropathological examinations of suspect cases) significantly predicted the incidence of sporadic CJD, non-sporadic CJD and all prion disease. CONCLUSIONS: Routine national surveillance methods adjusted as population rates allow objective determination of surveillance intensity, which correlates positively with reported incidence for human prion disease, especially sporadic CJD, largely independent of national context. The predictive relationship between surveillance intensity and disease incidence should facilitate more rapid delineation of aberrations in disease occurrence and assessment of the adequacy of disease monitoring by national registries.
Assuntos
Síndrome de Creutzfeldt-Jakob/epidemiologia , Monitoramento Epidemiológico , Doenças Priônicas/epidemiologia , Vigilância em Saúde Pública/métodos , Sistema de Registros , Austrália/epidemiologia , Canadá/epidemiologia , Europa (Continente)/epidemiologia , Humanos , IncidênciaRESUMO
Dementia is considered as underdiagnosed. We examined whether the proportion of persons aged 65 years and older who had been diagnosed as demented has changed over a 7-year period. The study population was constituted by a cohort of about 70,000 persons who were representative of the French elderly covered by the national health care insurance plan. Data about all health care consumptions were extracted from the national insurance database. Patients using an antidementia drug, having a special dementia-related coverage status, or both were identified. Annual age-standardized and sex-standardized proportions of recognized dementia cases were estimated. Between 2004 and 2010, the overall standardized proportion of persons recognized as having dementia increased slightly but significantly (P<0.004) from 3.68% to 4.20%. The proportion of persons recognized as demented increased strongly with age. In 2010, it increased from 1.44% at age 70-74 to 10% at age more than 90 in men and from 1.30% to 17.0% in women. The proportion of cholinesterase inhibitor users decreased after the age of 85 years, whereas memantine use continued to increase. Our study suggested that, in 2010, >75% of the demented persons had been recognized and received pharmacological or/and nonpharmacological therapies for dementia.
Assuntos
Demência/epidemiologia , Demência/terapia , Idoso , Idoso de 80 Anos ou mais , Inibidores da Colinesterase/uso terapêutico , Bases de Dados Factuais , Demência/diagnóstico , Feminino , França , Humanos , Masculino , Programas Nacionais de SaúdeRESUMO
Incidence of dementia increases sharply with age and, because of the increase in life expectancy, the number of dementia cases is expected to rise dramatically over time. Some studies suggest that controlling some modifiable risk factors for dementia like diabetes or hypertension could lower its incidence. However, as treating these vascular factors would also reduce mortality risk, the actual impact of such public-health intervention on dementia prevalence is not known. Accounting for the impact of dementia and risk factors on mortality, the aim of this work was (1) to compute projections of age- and-sex specific prevalence of dementia in France from 2010 to 2030, (2) to evaluate how public-health interventions targeting risk factors for dementia could change these projections. Age-and-sex specific incidence of dementia and mortality of demented subjects were estimated from the Paquid population-based cohort using a semi-parametric illness-death model. Future global mortality rates and population sizes were obtained from national demographic projections. Under the assumption that life expectancy will increase by 3.5 years for men and 2.8 years for women by 2030, the number of subjects with dementia was estimated to increase by about 75% from 2010 to 2030 with a 200% increase after 90 years of age. Therapeutic intervention on the whole population reducing high blood pressure prevalence would lead to a decrease in both dementia incidence rates and mortality and would have a modest impact on the number of dementia cases. On the other hand, a preventive dementia treatment targeting ApoE4 carriers would probably not improve survival and hence would decrease dementia prevalence by 15-25%.
Assuntos
Demência/epidemiologia , Expectativa de Vida/tendências , Prevenção Primária/métodos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Previsões , França/epidemiologia , Política de Saúde , Humanos , Incidência , Masculino , Razão de Chances , Prevalência , Fatores de Risco , Fatores Sexuais , Fatores de TempoRESUMO
Several large cohort studies have been performed in France since the 1960s. Participants were recruited from general or occupational populations. Whatever their primary objective, these cohort studies provided important data on the prevalence and risk factors of major public health problems. The scientific value of these studies, which gave rise to a very large numbers of publications, is internationally recognized.
Assuntos
Estudos de Coortes , Métodos Epidemiológicos , HumanosRESUMO
BACKGROUND: A recent case-control study showed that transfusion recipients were at an increased risk of developing sporadic Creutzfeldt-Jakob disease (sCJD), suggesting that blood donors with silent preclinical sCJD could transmit the sCJD agent. We therefore estimated the annual number of French blood donors expected to have preclinical sCJD at the time of donation. STUDY DESIGN AND METHODS: We developed a mathematical model to estimate the number of blood donors who would subsequently develop sCJD, under various assumptions about how long their blood might be infective before clinical onset. The model used distributions by age group and sex for sCJD cases, blood donor population, French general population, and mortality in the general population. RESULTS: Using 1999 to 2008 data, modeling showed that, each year, a mean of 1.1 (standard deviation [SD], 0.3) donors were within 1 year of sCJD onset at the time of blood donation, 6.9 (SD, 0.5) donors were within 5 years, 18.0 (SD, 0.6) were within 10 years, and 33.4 (SD, 1.1) were within 15 years. CONCLUSION: Few donors are expected to be in the late preclinical stage of sCJD at the time of blood donation. This result and that of the worldwide absence of any epidemic increase in sCJD over the years indicate that this risk of transfusion-transmitted sCJD, if any, is likely to be very low.
Assuntos
Doenças Assintomáticas/epidemiologia , Doadores de Sangue/estatística & dados numéricos , Síndrome de Creutzfeldt-Jakob/epidemiologia , Síndrome de Creutzfeldt-Jakob/transmissão , Modelos Teóricos , Adolescente , Adulto , Idoso , Transfusão de Sangue/estatística & dados numéricos , Estudos de Casos e Controles , Síndrome de Creutzfeldt-Jakob/sangue , Estudos Epidemiológicos , Feminino , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Risco , Reação Transfusional , Adulto JovemRESUMO
The role of influenzalike illnesses and influenza vaccination in the development of Guillain-Barré syndrome (GBS), particularly the role of A/H1N1 epidemics and A/H1N1 vaccination, is debated. Data on all incident GBS cases meeting the Brighton Collaboration criteria that were diagnosed at 25 neurology centers in France were prospectively collected between March 2007 and June 2010, covering 3 influenzavirus seasons, including the 2009-2010 A/H1N1 outbreak. A total of 457 general practitioners provided a registry of patients from which 1,080 controls were matched by age, gender, index date (calendar month), and region to 145 cases. Causal relations were assessed by multivariate case-control analysis with adjustment for risk factors (personal and family history of autoimmune disorders, among others), while matching on age, gender, and calendar time. Influenza (seasonal or A/H1N1) or influenzalike symptoms in the 2 months preceding the index date was associated with GBS, with a matched odds ratio of 2.3 (95% confidence interval (CI): 0.7, 8.2). The difference in the rates of GBS occurring between influenza virus circulation periods and noncirculation periods was highly statistically significant (P = 0.004). Adjusted odds ratios for GBS occurrence within 6 weeks after seasonal and A/H1N1 vaccination were 1.3 (95% CI: 0.4, 4.1) and 0.9 (95% CI: 0.1, 7.6), respectively. Study results confirm that influenza virus is a likely risk factor for GBS. Conversely, no new concerns have arisen regarding influenza vaccination.
Assuntos
Síndrome de Guillain-Barré/epidemiologia , Vírus da Influenza A Subtipo H1N1 , Vacinas contra Influenza/uso terapêutico , Influenza Humana/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Estudos de Casos e Controles , Criança , Pré-Escolar , Intervalos de Confiança , Surtos de Doenças/estatística & dados numéricos , Feminino , França/epidemiologia , Síndrome de Guillain-Barré/etiologia , Humanos , Vacinas contra Influenza/efeitos adversos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco , Fatores Sexuais , Adulto JovemRESUMO
BACKGROUND: Surveillance of Creutzfeldt-Jakob disease (CJD) is still an important issue because of the variant CJD epidemic, which is in decline and also because of the emergence of novel forms of animal transmissible spongiform encephalopathy with zoonotic potential and the risk of nosocomial and blood transfusion-related transmission. Active surveillance has been implemented in most European countries and requires important human resources and funding. Here, we studied whether national mortality and morbidity statistics can be used as reliable indicators. METHODS: CJD data collected by the French national CJD surveillance centre were compared with data registered in the national mortality statistics. RESULTS: From 2000 to 2008, the two sources reported fairly similar numbers of CJD deaths. However, analysis of individual data showed important between-sources disagreement. Nearly 24% of CJD reported by the mortality register were false-positive diagnoses and 21.6% of the CJD cases diagnosed by the surveillance centre were not registered as CJD in the national mortality statistics. One out of 22 variant CJD cases was not reported as having any type of CJD in the mortality statistics. CONCLUSIONS: These findings raise doubt about the possibility of a reliable CJD surveillance only based on mortality data.
Assuntos
Síndrome de Creutzfeldt-Jakob/mortalidade , Vigilância da População/métodos , Sistema de Registros/normas , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Síndrome de Creutzfeldt-Jakob/diagnóstico , Erros de Diagnóstico , Feminino , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos TestesRESUMO
BACKGROUND: stroke has been shown to follow a social gradient with incidence rising as socioeconomic status decreases. OBJECTIVE: to examine the relationship between socioeconomic status and ischaemic stroke risk amongst older people. SETTING: the Cities of Bordeaux, Dijon and Montpellier in France. SUBJECTS AND METHODS: nine thousand and two hundred and ninety-four non-institutionalised persons aged 65 years or more followed for 6 years. RESULTS: the distribution of cardiovascular risks factors was consistent with the classical finding of more favourable risk profiles among the advantaged socioeconomic groups. One hundred and thirty-six individuals developed a first ever ischaemic stroke (incidence rate: 3.2 per 1,000 py (person-years), 95% CI 2.7-3.8). The age- and sex-adjusted incidence of ischaemic stroke increased with increasing level of income (from 2.4 to 4.1 per 1,000 py, P = 0.04). In the multivariable analysis adjusting for cardiovascular risk factors, the higher income group displayed a 80% increased risk of ischaemic stroke compared with less wealthy participants (hazards ratio 1.77, 95% CI 1.20-2.61). CONCLUSIONS: in this community-based sample of older individuals, a higher level of household income was associated with a higher risk of ischaemic stroke, a reversal of the social gradient usually reported in younger age groups. Selective survival is one of the potential explanations for this unexpected finding.
Assuntos
Renda , Classe Social , Acidente Vascular Cerebral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Seguimentos , França , Humanos , Incidência , Masculino , Análise Multivariada , Fatores de RiscoRESUMO
OBJECTIVE: We studied the relation between Parkinson disease (PD) and professional exposure to pesticides in a community-based case-control study conducted in a population characterized by a high prevalence of exposure. Our objective was to investigate the role of specific pesticide families and to perform dose-effect analyses. METHODS: PD cases (n = 224) from the Mutualité Sociale Agricole (France) were matched to 557 controls free of PD affiliated with the same health insurance. Pesticide exposure was assessed using a 2-phase procedure, including a case-by-case expert evaluation. Analyses of the relation between PD and professional exposure to pesticides were first performed overall and by broad category (insecticides, fungicides, herbicides). Analyses of 29 pesticide families defined based on a chemical classification were restricted to men. Multiple imputation was used to impute missing values of pesticide families. Data were analyzed using conditional logistic regression, both using a complete-case and an imputed dataset. RESULTS: We found a positive association between PD and overall professional pesticide use (odds ratio [OR] = 1.8, 95% confidence interval [CI] = 1.1-3.1), with a dose-effect relation for the number of years of use (p = 0.01). In men, insecticides were associated with PD (OR = 2.2, 95% CI = 1.1-4.3), in particular organochlorine insecticides (OR = 2.4, 95% CI = 1.2-5.0). These associations were stronger in men with older onset PD than in those with younger onset PD, and were characterized by a dose-effect relation in the former group. INTERPRETATION: Our results support an association between PD and professional pesticide exposure, and show that some pesticides (ie, organochlorine insecticides) may be more particularly involved.
Assuntos
Exposição Ocupacional , Doença de Parkinson Secundária/induzido quimicamente , Doença de Parkinson Secundária/epidemiologia , Praguicidas/efeitos adversos , Adolescente , Adulto , Idoso , Doenças dos Trabalhadores Agrícolas/induzido quimicamente , Doenças dos Trabalhadores Agrícolas/diagnóstico , Doenças dos Trabalhadores Agrícolas/epidemiologia , Estudos de Casos e Controles , Feminino , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson Secundária/diagnóstico , Adulto JovemRESUMO
OBJECTIVE: Variant Creutzfeldt-Jakob disease (vCJD) was first reported in the United Kingdom in 1996. Since then, the majority of cases have been observed in the United Kingdom where there was a major epidemic of bovine spongiform encephalopathy. France was the second country affected. To address the hypothesis of the involvement of a common strain of agent, we have compared clinical, neuropathological, and biochemical data on vCJD patients from both countries. METHODS: In France and the United Kingdom, epidemiological and clinical data were obtained from analysis of medical records and direct interview of the family of the patients using the same standardized questionnaire in both countries. When brain material was available, we performed with similar methods a comparative study of brain lesions and PrP(res) glycoform ratios in both vCJD populations. RESULTS: Clinical data, genetic background, neuropathological finding, and biochemical findings in the 185 patients observed in France (n = 23) and the United Kingdom (n = 162) were similar except for age at death. Currently, blood transfusion is a risk factor identified only in the United Kingdom. INTERPRETATION: The close similarity between the cases of vCJD in France and the United Kingdom supports the hypothesis that a common strain of infectious agent is involved in both countries. The 5-year delay in the peak that we observed in France compared with the United Kingdom fits well with the increase in the importation of beef products to France from the United Kingdom between 1985 and 1995.
Assuntos
Síndrome de Creutzfeldt-Jakob/epidemiologia , Síndrome de Creutzfeldt-Jakob/genética , Adolescente , Adulto , Encéfalo/patologia , Criança , Síndrome de Creutzfeldt-Jakob/patologia , Feminino , França/epidemiologia , Humanos , Masculino , Prontuários Médicos/estatística & dados numéricos , Pessoa de Meia-Idade , Proteínas PrPSc/metabolismo , Estudos Retrospectivos , Fatores de Risco , Inquéritos e Questionários , Reação Transfusional , Reino Unido/epidemiologia , Adulto JovemRESUMO
BACKGROUND AND PURPOSE: The relationship between white matter lesions (WMLs) and the apolipoprotein E genotype has been controversial from cross-sectional studies and no longitudinal finding has been reported. We investigated whether the apolipoprotein E genotype influences baseline and evolution over 4-year follow-up of WML volumes in a population-based sample of 1779 nondemented subjects aged 65 to 80 years old at enrollment. METHODS: The sample consisted of 3C-Dijon study participants who had 2 cerebral MRIs, at entry and at 4-year follow-up. WML volumes were estimated using a fully automatic procedure. We performed analysis of covariance to evaluate the relationship between apolipoprotein E genotype and WML load and progression. RESULTS: Multivariable analyses showed that epsilon4epsilon4 individuals had both significantly higher WML volume at baseline and higher WML increase over 4-year follow-up than noncarriers and heterozygous of the epsilon4 allele for apolipoprotein E genotype. CONCLUSION: These findings suggest it might be important to take into account WML severity when assessing the relationship between apolipoprotein E and dementia.
Assuntos
Apolipoproteínas E/genética , Encéfalo/patologia , Demência/genética , Demência/patologia , Predisposição Genética para Doença/genética , Fibras Nervosas Mielinizadas/patologia , Idoso , Idoso de 80 Anos ou mais , Apolipoproteína E4/genética , Encéfalo/metabolismo , Encéfalo/fisiopatologia , Estudos de Coortes , Análise Mutacional de DNA , Demência/fisiopatologia , Progressão da Doença , Feminino , Testes Genéticos , Genótipo , Humanos , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Masculino , Polimorfismo Genético/genética , Índice de Gravidade de DoençaRESUMO
BACKGROUND AND PURPOSE: External validation of the Framingham stroke risk function has been rarely performed. We assessed its predictive ability in a population-based cohort of French elderly. METHODS: The sample comprised 6913 subjects from the 3C Study, aged 65 to 84 at baseline, who were followed up to 6 years. Predictive accuracy of the original Framingham stroke risk function was assessed in a 3-step procedure: comparison between the Framingham and 3C cohorts of the prevalence of selected risk factors and the associated relative risks (RR) for stroke, comparison of the predicted to the observed number of stroke events (calibration), and ability to separate high-risk from low-risk participants (discrimination). We also compared predictive performances of the original Framingham, the recalibrated Framingham, and the local stroke risk functions. RESULTS: During follow-up, 110 incident strokes occurred. For most risk factors, RRs were comparable between the 2 cohorts, except for age in women. The original Framingham stroke risk function applied to the 3C cohort overestimated the 6-year absolute risk for stroke by a factor of 3.7 for men and 4.4 for women. However, the recalibrated Framingham and 3C functions did not show any over- or underestimation of stroke risk. The 3 stroke risk functions (original, recalibrated, and 3C) provided acceptable discrimination with areas under the ROC curve ranging from 0.67 to 0.73. CONCLUSIONS: The original Framingham stroke risk function strongly overestimated the stroke risk for 3C participants. Derived Framingham stroke score sheets should not be directly used by physicians in the French elderly population.
Assuntos
Idoso/fisiologia , Acidente Vascular Cerebral/epidemiologia , Fatores Etários , Idoso de 80 Anos ou mais , Calibragem , Estudos de Coortes , Interpretação Estatística de Dados , Feminino , França/epidemiologia , Humanos , Masculino , População , Modelos de Riscos Proporcionais , Curva ROC , Reprodutibilidade dos Testes , Medição de Risco , Fatores de Risco , Fatores SexuaisRESUMO
BACKGROUND AND PURPOSE: White matter lesions (WMLs) have been shown to be associated with the risk of stroke in previous studies but little is known about the prediction of other vascular events. We evaluated the risk of stroke and other vascular events according to WML volume in a large population-based sample. We also studied WML volume by type (deep or periventricular) in relation to these events. METHODS: The 3-City Study is a population-based prospective cohort of people aged >or=65 years followed up for, on average, 4.9 years. Among them, 1643 participants free of prevalent vascular events had quantitative measurements of WML volume at baseline using a fully automatic method. The risks of incident major vascular events according to WML volume were evaluated using Cox proportional hazards models. RESULTS: The risk of incident stroke significantly increased with increasing baseline WML volume and was multiplied by 5 for those in the highest quartile of WML volume. Nonstroke vascular events' incidence was not associated with WML volumes, whatever their type. CONCLUSIONS: WMLs are an independent predictor of stroke in the elderly. This association is specific because WMLs are not associated with the risk of other vascular events.
Assuntos
Encefalopatias/complicações , Doenças Cardiovasculares/embriologia , Acidente Vascular Cerebral/epidemiologia , Idoso , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de RiscoRESUMO
BACKGROUND: Brain atrophy and white-matter lesions (WML) are common features at cerebral MRI of both normal and demented elderly people. In a population-based study of 1,792 elderly subjects aged 65-80 years, free of dementia, who had a cerebral MRI at entry, we investigated the relationship between WML volume and brain atrophy markers estimated by hippocampal, gray matter (GM) and cerebrospinal fluid (CSF) volumes. METHODS: An automated algorithm of detection and quantification of WML was developed, and voxel-based morphometry methods were used to estimate GM, CSF and hippocampal volumes. To evaluate the relation between those volumes and WML load, we used analysis of covariance and multiple linear regression models adjusting for potential confounders and total intracranial volumes. RESULTS: Age was highly correlated with WML load and all brain atrophy markers. Total WML volume was negatively associated with both GM (beta = -0.03, p < 0.0001) and hippocampal volumes (beta = -0.75, p = 0.0009) and positively with CSF volumes (beta = 0.008, p = 0.02) after controlling for sex, age, education level, hypertension and apolipoprotein E genotype. Evidence for a relationship between brain atrophy markers and WML was stronger for periventricular WML. We found that the relationship between WML and hippocampal volumes was independent of other brain tissue volumes. CONCLUSION: These results suggest that, in the brain of nondemented elderly subjects, degenerative processes and vascular changes co-occur and are related independently of vascular risk factors.
Assuntos
Encefalopatias/patologia , Encéfalo/patologia , Imageamento por Ressonância Magnética , Idoso , Algoritmos , Atrofia , Encefalopatias/líquido cefalorraquidiano , Encefalopatias/complicações , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/patologia , Demência/etiologia , Demência/patologia , Feminino , França , Hipocampo/patologia , Humanos , Modelos Lineares , Masculino , Testes Neuropsicológicos , Tamanho do Órgão , Vigilância da População , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Índice de Gravidade de DoençaRESUMO
OBJECTIVE: The aim of this study was to assess the relationship of tea consumption with common carotid artery intima-media thickness (CCA-IMT) and carotid plaques. METHODS AND RESULTS: The study was performed on 6597 subjects aged > or = 65 years, recruited in the French population for the Three-City Study. Atherosclerotic plaques in the extracranial carotid arteries and CCA-IMT were measured using a standardized protocol. Results were tested for replication in another, younger, French population sample (EVA-Study, 1123 subjects). In the Three-City Study, increasing daily tea consumption was associated with a lower prevalence of carotid plaques in women: 44.0%, 42.5%, and 33.7% in women drinking no tea, 1 to 2 cups/d, and > or = 3 cups/d (P=0.0001). This association was independent of age, center, major vascular risk factors, educational level, and dietary habits (adjOR=0.68[95%CI:0.54 to 0.86] for women drinking > or = 3 cups/d compared with none). There was no association of tea consumption with carotid plaques in men, or CCA-IMT in both genders. In the EVA-Study, carotid plaque frequency was 18.8%, 18.5%, and 8.9% in women drinking no tea, 1 to 2 cups/d, and > or = 3 cups/d (P=0.08). CONCLUSIONS: In a large sample of elderly community subjects we showed for the first time that carotid plaques were less frequent with increasing tea consumption in women.
Assuntos
Doenças das Artérias Carótidas/epidemiologia , Artéria Carótida Primitiva/efeitos dos fármacos , Artéria Carótida Primitiva/patologia , Comportamento Alimentar , Chá , Idoso , Doenças das Artérias Carótidas/diagnóstico por imagem , Artéria Carótida Primitiva/diagnóstico por imagem , Feminino , França/epidemiologia , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Estudos Prospectivos , Fatores Sexuais , Túnica Íntima/diagnóstico por imagem , Túnica Íntima/efeitos dos fármacos , Túnica Íntima/patologia , Túnica Média/diagnóstico por imagem , Túnica Média/efeitos dos fármacos , Túnica Média/patologia , UltrassonografiaRESUMO
OBJECTIVE: Arterial mechanical properties are of growing interest in the understanding of cardiovascular disease development. We aimed to determine the predictive value of carotid wall mechanics on coronary heart disease (CHD) in the Three-City study. METHODS AND RESULTS: At baseline, 3337 participants aged > or =65 years underwent a carotid B-mode ultrasonography. During a median follow-up of 43.4 months, 128 CHD occurred. Increased carotid distension (relative stroke change in lumen diameter) was significantly associated with CHD risk. Comparison of subjects in tertile 3 versus those in tertile 1 (reference) showed a hazard ratio (HR) of 1.80 (95% CI, 1.17 to 2.75). Controlling for various confounders including age, heart rate, brachial (or carotid) pulse pressure, and common carotid intima-media thickness did not alter the association between carotid distension and CHD with a HR of 1.79 (95% CI, 1.12 to 2.86; tertile 3 versus tertile 1). Brachial and carotid pulse pressures were also independently associated with CHD. No association was found between CHD and carotid distensibility coefficient, cross-sectional compliance coefficient, Young's elastic modulus, or beta stiffness index. CONCLUSIONS: In the elderly, increased carotid distension was independently predictive of CHD. This simple and noninvasive parameter might be of particular interest for cardiovascular risk assessment.