Sex differences in adherence to antihypertensive treatment in patients aged above 55: The French League Against Hypertension Survey (FLAHS).

Despite the availability of efficient therapies to reduce the risk of cardiovascular complications, poor adherence to antihypertensive (anti-HTN) drugs is frequent, especially during the first year of treatment and among uncontrolled/resistant hypertensive patients. The aim of the study was to identify factors associated with adherence to anti-HTN treatment and to examine whether they differ across sex. A total of 2743 treated hypertensive participants to the cross-sectional Metascope survey (France, 2015) aged 55 years or more were included. The authors measured adherence to anti-HTN treatment using the 6-item Girerd compliance test. Variations in adherence were examined using the Rao-Scott statistics and Poisson regression. Overall, 63.6% of participants were adherent to anti-HTN treatment. Adherence was more frequent among women than men (69% vs 58%, P < 10-4 ). For both sexes, level of adherence was positively associated with age (P < 10-4 ), but inversely associated with number of anti-HTN tablets, number of tablets taken for metabolic diseases, history of cardiovascular diseases, number of other chronic diseases (all P < 10-4 ). The inverse relationship between adherence and the number of anti-HTN tablets significantly differed between sexes (P < 10-4 ): Adherence decreased sharply when taking two or more anti-HTN tablets in men, whereas the decrease in women was only observed when taking three or more anti-HTN tablets. This study suggests that adherence to anti-HTN treatment is higher among women, decreases with the number of tablets prescribed, and differentially so across sex. Reducing the number of tablets for anti-HTN treatment may improve adherence, especially among men and patients with multiple comorbidities.

Self-report assessment of severe periodontitis: Periodontal screening score development.

AIM: To derive from a validated questionnaire a periodontal screening score (PESS), intended as a user-friendly tool to identify individuals at risk of periodontitis in epidemiological studies. METHODS: A French 12-item self-reported questionnaire was developed by translating English questions previously used for periodontitis screening and surveillance. After a cognitive evaluation, the questionnaire was validated in a sample of 232 individuals (mean age: 46.1 ± 12.6 years) receiving full-mouth periodontal examination, including probing pocket depth and clinical attachment level recordings. Case definition was based on the American Academy of Periodontology/Centers for Disease Control and Prevention criteria. Logistic regression analyses and C-statistics were used to assess the validity and accuracy of the questionnaire and to develop the PESS. RESULTS: The sample was constituted of 109 individuals with severe periodontitis, who were compared with 123 individuals with no/moderate periodontitis. The questionnaire had moderate-to-high accuracy in identifying severe cases; the PESS (calculated on five self-report items, age, and smoking) showed a sensitivity of 78.9% and a specificity of 74.8%, with an area under the receiver operating characteristics curve of 0.821. CONCLUSION: The PESS represents a valuable and accurate tool to screen for severe periodontitis at the population level.

Association between individual and neighbourhood socioeconomic factors and masticatory efficiency: a cross-sectional analysis of the Paris Prospective Study 3.

BACKGROUND: There is a lack of evidence on the impact of socioeconomic factors on masticatory efficiency. The present study investigates the relationship between individual and neighbourhood socioeconomic factors (main exposure) and the number of masticatory units (MUs) used as surrogate of the masticatory efficiency (main outcome). METHODS: In this cross-sectional study nested in the Paris Prospective Study 3, 4270 adults aged 50-75 and recruited from 13 June 2008 to 31 May 2012 underwent a full-mouth examination. Number of MUs defined as pairs of opposing teeth or dental prostheses allowing mastication, number of missing teeth and gingival inflammation were documented. The individual component of the socioeconomic status was evaluated with an individual multidimensional deprivation score and education level. The neighbourhood component of the socioeconomic status was evaluated with the FDep99 deprivation index. Associations were quantified using marginal models. RESULTS: In multivariate analyses, having less than 5 MUs was associated with (1) the most deprived neighbourhoods (OR=2.27 (95% CI 1.63 to 3.17)), (2) less than 12 years of educational attainment (OR=2.20 (95% CI 1.66 to 2.92)) and (3) the highest individual score of deprivation (OR=3.23 (95% CI 2.24 to 4.65)). Associations with education and individual score of deprivation were consistent across the level of neighbourhood deprivation. Comparable associations were observed with the number of missing teeth. Associations with gingival inflammation were of lower magnitude; the relationship was present for deprivation markers but not for education. CONCLUSION: Poor masticatory efficiency is associated with low educational attainment and high deprivation scores.

Smoking and the Association Between Depressive Symptoms and Absolute Neutrophil Count in the Investigations Préventives et Cliniques Cohort Study.

OBJECTIVES: Depressive symptoms have been associated with chronic low-grade inflammation, including elevated neutrophil count. Smokers often have both high neutrophil count and depressive symptoms. Thus, smoking could explain the cross-sectional association between depressive symptoms and neutrophil count. METHODS: Total white blood cell count and subtypes, including absolute neutrophil, lymphocyte, monocyte, basophil, and eosinophil counts, were measured in 44,806 participants (28,534 men; mean [standard deviation] age = 38.9 [11.4] years), without a history of chronic disease or current medication. Depressive symptoms were assessed with the Questionnaire of Depression, Second Version, Abridged. Smoking status was self-reported and categorized in five classes. Sex, age, alcohol intake, self-rated health, body mass index, glycemia, physical activity, household composition, occupational status, and education were included as covariates. Associations were examined with general linear models and causal mediation analyses. RESULTS: After adjustment for all covariates except smoking, depressive symptoms were positively associated with neutrophil count only (ß = 5.83, standard error [SE] = 2.41, p = .014). After further adjustment for a semiquantitative measure of smoking, this association was no longer significant (ß = 2.40, SE = 2.36, p = .30). Causal mediation analyses revealed that smoking mediated the association (p < .001), accounting for 57% of its total variance. In contrast, depressive symptoms were negatively associated with lymphocyte count in fully adjusted model only (ß = -3.21, SE = 1.11, p = .004). CONCLUSIONS: Smoking may confound or mediate the association between depressive symptoms and neutrophil count. These results advocate for including an accurate measure of smoking in future studies addressing this association. When considering the link between depression and inflammation, one should not overlook the noxious effects of smoking.

Work economic sectors and cardiovascular risk factors: cross-sectional analysis based on the RECORD Study.

BACKGROUND: Little is known on the comparative effect of work economic sectors on multiple cardiovascular risk factors. Such information may be useful to target Public health interventions, e.g., through the occupational medicine. We investigated whether and how a large panel of cardiovascular risk factors varied between 11 work economic sectors. METHODS: Data on 4360 participants from the French RECORD Study geolocated at their residence were analyzed. Ten outcomes were assessed: body mass index (BMI), waist circumference, systolic and diastolic blood pressure (BP), pulse pressure, total cholesterol, glycaemia, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and resting heart rate. Multilevel linear regression models stratified by sex and adjusted for individual and neighborhood sociodemographic characteristics were estimated. RESULTS: Among men, the Health and social work sector was found to be the most protective sector for BMI, waist circumference, and glycaemia (while the Construction sector and the Transport and communications sector tended to be unfavorable for these outcomes). The Health and social work sector was also associated with higher HDL cholesterol among men. However, men working in the Health and social work sector showed the highest systolic BP and pulse pressure. Women working in the Health and social work sector had the highest BMI, the largest waist circumference, and the most elevated systolic and diastolic BP. The Commercial and repair of vehicles sector, the Transport and communication sector, and the Collective, social, and personal services sector were associated with a more favorable profile for these risk factors among women. CONCLUSION: Work economic sectors contribute to shape metabolic and cardiovascular parameters after adjustment for individual/neighborhood sociodemographic characteristics. However, patterns of associations varied strikingly according to the risk factor examined and between men and women. Such findings may be useful to target interventions for reducing cardiovascular risk, e.g., through the occupational medicine.

The environmental correlates of overall and neighborhood based recreational walking (a cross-sectional analysis of the RECORD Study).

BACKGROUND: Preliminary evidence suggests that recreational walking has different environmental determinants than utilitarian walking. However, previous studies are limited in their assessment of environmental exposures and recreational walking and in the applied modeling strategies. Accounting for individual sociodemographic profiles and weather over the walking assessment period, the study examined whether numerous street network-based neighborhood characteristics related to the sociodemographic, physical, service, social-interactional, and symbolic environments were associated with overall recreational walking and recreational walking in one's residential neighborhood and could explain their spatial distribution. METHODS: Based on the RECORD Cohort Study (Paris region, France, n=7105, 2007-2008 data), multilevel-spatial regression analyses were conducted to investigate environmental factors associated with recreational walking (evaluated by questionnaire at baseline). A risk score approach was applied to quantify the overall disparities in recreational walking that were predicted by the environmental determinants. RESULTS: Sixty-nine percent of the participants reported recreational walking over the past 7 days. Their mean reported recreational walking time was 3h 31mn. After individual-level adjustment, a higher neighborhood education, a higher density of destinations, green and open spaces of quality, and the absence of exposure to air traffic were associated with higher odds of recreational walking and/or a higher recreational walking time in one's residential neighborhood. As the overall disparities that were predicted by these environmental factors, the odds of reporting recreational walking and the odds of a higher recreational walking time in one's neighborhood were, respectively, 1.59 [95% confidence interval (CI): 1.56, 1.62] times and 1.81 (95% CI: 1.73, 1.87) times higher in the most vs. the least supportive environments (based on the quartiles). CONCLUSIONS: Providing green/open spaces of quality, building communities with services accessible from the residence, and addressing environmental nuisances such as those related to air traffic may foster recreational walking in one's environment.

Residential neighborhood, geographic work environment, and work economic sector: associations with body fat measured by bioelectrical impedance in the RECORD Study.

PURPOSE: Studies of associations between geographic environment and obesity have mostly examined body mass index and focused on residential neighborhoods. We investigated associations between residential neighborhoods, geographic work environments, and work economic sectors and the fat mass index (FMI) and percentage of fat mass (%FM). METHODS: Data on 4331 participants from the French RECORD Study geolocated at their residence and workplace were analyzed. Body composition was assessed by bioelectrical impedance analyzers. Multilevel linear regression was used to investigate the determinants of FMI and %FM. RESULTS: After adjustment, among men, the FMI and %FM increased independently with decreasing density of population and educational level in the residential neighborhood. Among women, the residential educational level was related to the FMI and %FM. Among men, a higher FMI and %FM were observed among participants working in the construction and transportation/communication sectors than in the education sector. For women, the FMI was higher among participants working in the public administration and health/social work sectors than in the transport/communication sector. A long home-work distance was associated with a higher FMI among women. There was evidence that body mass index cannot fully capture work economic sector effects on fat mass. CONCLUSIONS: Public health interventions to reduce social/territorial disparities in obesity should also consider the different contexts to which the participants belong, such as residential environments and work economic sectors.

Multiple dimensions of residential environments, neighborhood experiences, and jogging behavior in the RECORD Study.

OBJECTIVE: The purpose of this study was to examine the associations between a broad range of environmental characteristics and jogging behavior while taking into account different complementary outcomes to describe the behavior. METHODS: Using the RECORD Cohort Study (7290 participants, 2007-2008, Paris region, France), multilevel models were used to investigate individual/neighborhood variables associated with the probability of jogging; the time spent jogging; and the location of the practice. RESULTS: The presence and quality of green and open spaces was associated both with a greater probability of jogging [risk ratio (RR) for the first vs. the fourth quartile=1.22, 95% credible interval (CrI): 1.03-1.44] and with the practice of jogging within rather than outside the neighborhood (RR=1.29; 95% CrI: 1.10-1.53). Moreover, a high social cohesion and the presence of enjoyable places were associated with a higher probability of jogging (RR=1.15; 95% CrI: 1.00-1.31; RR=1.22; 95% CrI: 1.03-1.44) while the presence of parks or a lake increased the probability of jogging inside rather than outside the neighborhood (RR=1.29; 95% CrI: 1.10-1.53; RR=1.14; 95% CrI: 1.03-1.26). CONCLUSIONS: Paying attention to physical and social environments, related neighborhood experiences, and attitudes toward health may be an effective approach to promote outdoor physical activity.

Heart rate and completed suicide: evidence from the IPC cohort study.

OBJECTIVE: Many suicide-related features such as affective disorders, impulsivity, and hostility have been associated with an aberrant regulation of heart rate (HR) and blood pressure (BP). Moreover, the neural bases of HR and BP regulation are similar to those of emotion regulation. The present study examined whether high resting HR or BP would be associated with an increased risk of suicide. METHODS: Resting HR and BP were measured among 204,600 men (mean [standard deviation] age = 44.5 [12.1] years) and 119,110 women (mean [standard deviation] age = 45.0 [14.0] years), together with depressive mood and perceived stress. Age, marital status, working status, socioeconomic status, physical activity, alcohol intake, and current medications were self-reported. Dates and causes of death were obtained from the French National Institute of Statistics and Economic Studies and the French National Cause-of-Death Registry, respectively. RESULTS: During a mean follow-up of 9.1 years, 133 participants (106 men) completed suicide. Resting HR, but not BP, was positively associated with suicide, together with depressive mood, perceived stress, low body mass index, male sex, status as a current smoker, and taking a psychotropic medication. Adjusting for these covariates, resting HR still independently predicted suicide. Ten additional beats per minute increased the risk of suicide by 19% in the unadjusted model and by 24% to 37% in the adjusted models. CONCLUSIONS: Resting HR and suicide risk may share some biologic determinants, such as genetic factors or neural bases. These results may inform further attempts to understand how suicide is mediated at a brain level.

Why socially deprived populations have a faster resting heart rate: impact of behaviour, life course anthropometry, and biology--the RECORD Cohort Study.

Although studies have shown that resting heart rate (RHR) is predictive of cardiovascular morbidity/mortality, few studies focused on the epidemiology and social aetiology of RHR. Using the RECORD Cohort Study (7158 participants, 2007-2008, Paris region, France), we investigated individual/neighbourhood socioeconomic variables associated with resting heart rate, and assessed which of a number of psychological factors (depression and stress), behaviour (sport-related energy expenditure, medication use, and alcohol, coffee, and tobacco consumption), life course anthropometric factors (body mass index, waist circumference, and leg length as a marker of childhood environmental exposures), and biologic factors (alkaline phosphatase and gamma-glutamyltransferase) contributed to the socioeconomic disadvantage-RHR relationship. Combining individual/neighbourhood socioeconomic factors in a socioeconomic score, RHR increased with socioeconomic disadvantage: +0.9 [95% credible interval (CrI): +0.2, +1.6], +1.8 (95% CrI: +1.0, +2.5), and +3.6 (95% CrI: +2.9, +4.4) bpm for the 3 categories reflecting increasing disadvantage, compared with the lowest disadvantage category. Twenty-one percent of the socioeconomic disadvantage-RHR relationship was explained by sport practise variables, 9% by waist circumference, 7% by gamma-glutamyltransferase, 5% by alkaline phosphatase, and 3% by leg length. Future research should further clarify the mechanisms through which socioeconomic disadvantage influences resting heart rate, as a pathway to social disparities in cardiovascular morbidity/mortality.

Assessment and significance of arterial stiffness in patients with chronic kidney disease.

PURPOSE OF REVIEW: To review the most recent publications concerning the pathophysiology and clinical impact of arterial stiffening in patients with chronic kidney disease and those with end-stage renal disease. RECENT FINDINGS: The results of recent studies confirmed that arterial stiffening is independently associated with decreased glomerular filtration rate and increased decline in parallel kidney function, and is predictive of kidney disease progression and the patient's cardiovascular outcome. Arterial stiffening is of multifactorial origin, including arterial calcifications, systemic inflammation, malnutrition, vitamin deficiencies, endothelial dysfunction, and bone activity. SUMMARY: Arterial stiffness and intensity of wave reflections are considered the principal determinants of systolic blood and pulse pressures, and their measurements are increasingly used to assess cardiovascular risk. Aortic stiffness has independent predictive value for all-cause and cardiovascular mortality in general populations and in patients with end-stage renal disease. Arterial stiffening in patients with chronic kidney disease and those with end-stage renal disease is of multifactorial origin with extensive arterial calcifications representing a major covariate. Carotid-femoral pulse wave velocity is a direct measure of aortic stiffness and is the 'gold standard' for its evaluation in clinical and epidemiological studies.

Cardiovascular risk as defined in the 2003 European blood pressure classification: the assessment of an additional predictive value of pulse pressure on mortality.

OBJECTIVES: This study determines the predictive value of brachial pulse pressure for cardiovascular stroke and coronary mortality in a large population categorized by blood pressure level. METHODS: The population was composed of 69,989 subjects aged more than 50 years and divided into 'optimal', 'normal' and 'normal high' normotensive subjects, and grades 1, 2, 3 hypertensive subjects as defined in the 2003 European Guidelines for Management of Hypertension. Hazard ratios for mortality were evaluated using Cox regression models before and after adjustment for pulse pressure. To further assess the role of pulse pressure in mortality, subjects were also classified as 'normotensive' and 'hypertensive' whether they were with or without elevated pulse pressure (> or =60 mmHg). RESULTS: By comparison with 'optimal' values, before adjustment for pulse pressure, the hazard ratio for cardiovascular, coronary and stroke mortality increased markedly for blood pressure groups as defined by the European blood pressure classification. For cardiovascular and coronary mortality, the hazard ratio was significant both in the 'high normal' and hypertensive ranges. For stroke mortality, hazard ratio was significant only in the hypertensive ranges. After adjustment to pulse pressure, hazard ratio remained unmodified for stroke mortality. For coronary mortality, the risk was attenuated in 'high normal' and all hypertensive groups. A study of the pulse pressure classification in subjects dichotomized as normotensive and hypertensive subjects indicated that pulse pressure was an independent risk factor for cardiovascular mortality. CONCLUSION: Increased pulse pressure predicts cardiovascular mortality, acting more on coronary than cerebral vessels. This finding involves all blood pressure ranges, including subjects with low diastolic but normal systolic blood pressure.

[Diabetes and socio-economic deprivation. A study in a large French population]. / Diabète et précarité. Etude d'une vaste population française.

Socio-economically deprived subjects are reported to have an increased risk of diabetes and related complications. The aim of this study was to confirm this relation in a large French population. The study subjects consisted of 32,435 men and 16,378 women aged from 35 to 80 years who had a free health checkup at the IPC Center (Investigations Preventives et Cliniques, Paris-Ile de France) between January 2003 and December 2006. Socio-economic deprivation was evaluated by using the EPICES approach (Evaluation de la Précarité et des Inégalités de santé dans les Centres d'Examens de Santé de France). Socio-economically deprived subjects were defined as those with scores in the 5th quintile. The prevalence of diabetes among deprived men and women was respectively 6% and 7% at age 35-59 years, and 18% and 15% at age 60-80 years. The prevalence of diabetes increased with level of deprivation. Compared to the 1st quintile of the EPICES score distribution, diabetes was three to eight times more frequent in the 5th quintile. After taking into account age, the body mass index, waist circumference, and anxiety and depression, the risk that deprived subjects would be diabetic (odds ratio) was respectively 4.2 and 5.2 for men and women aged 35-39 years, and 3.5 and 2.2 for those aged 60-80 years. The following cardiovascular risk markers were significantly higher or more frequent among deprived subjects: body mass, abdominal obesity, high blood pressure and the metabolic syndrome in women; and lower HDL cholesterol, higher triglyceride levels, proteinuria, a higher heart rate and additional ECG abnormalities in both men and women. Other indicators of poor health were also more frequent among deprived subjects, including anxiety and depression, smoking (among men), elevated gamma-GT and alkaline phosphatase levels, lung vital capacity, visual disorders, and dental plaque. Finally, deprived subjects also had more limited access to health care. Thus, socio-economic status markedly influences the risk of diabetes, independently of confounding factors. Several markers of cardiovascular risk and poor health were significantly more frequent among socio-economically deprived subjects, who also had more limited access to health care.