Prenatal Cannabis and Tobacco Co-Exposure and Its Association with Behavioural Outcomes in Middle Childhood: Co-exposition prénatale au cannabis et au tabac et son association avec les résultats comportementaux au cours de l'enfance intermédiaire.

OBJECTIVES: Cannabis legalization has triggered an increase in prenatal cannabis use. Given that tobacco is commonly co-used with cannabis, determining outcomes associated with prenatal cannabis and tobacco co-exposure is crucial. While literature exists regarding the individual effects of prenatal cannabis and tobacco exposure on childhood behaviour, there is a gap regarding their combined use, which may have interactive effects. Therefore, we investigated whether prenatal cannabis and tobacco co-exposure was associated with greater externalizing and internalizing problems in middle childhood compared to prenatal exposure to either substance alone or no exposure. METHODS: Baseline data from the Adolescent Brain Cognitive Development (ABCD) Study (collected in children ages 9-11) were used to explore differences in externalizing and internalizing scores derived from the Childhood Behavior Checklist across four groups: children with prenatal cannabis and tobacco co-exposure (CT, n = 290), children with prenatal cannabis-only exposure (CAN, n = 225), children with prenatal tobacco-only exposure (TOB, n = 966), and unexposed children (CTL, n = 8,311). We also examined if the daily quantity of tobacco exposure modulated the effect of cannabis exposure on outcomes. RESULTS: Adjusting for covariates, a 2 × 2 ANCOVA revealed significant main effects for prenatal cannabis (p = 0.03) and tobacco exposure (p < 0.001), and a significant interaction effect on externalizing scores (p = 0.032); no significant main effects or interactions were found for internalizing scores. However, interactions between daily quantity of cannabis and tobacco exposure significantly predicted both externalizing and internalizing scores (p < 0.01). CONCLUSIONS: These findings indicate that co-exposure is associated with greater externalizing problems than exposure to either substance alone, which did not differ from each other. Further, greater tobacco exposure may amplify the negative effect of cannabis exposure on both externalizing and internalizing behaviours in children. These findings underscore the need for interventions that target cannabis and tobacco co-use in pregnant women to circumvent their adverse impact on middle childhood behaviour.

Prenatal Cannabis and Tobacco Co-exposure and its Association with Middle Childhood BehavioursPlain Language SummaryGiven the high rates of both cannabis and tobacco use during pregnancy, we explored if their combined use was associated with greater problematic behaviour in 10-year-old children compared to either substance alone or no substance use. We found that children with prenatal co-exposure had greater externalizing behaviours, such as attention problems and aggression, compared to children with prenatal exposure to one of the substances or no exposure. Prenatal co-exposure, cannabis-only exposure and tobacco-only exposure had no effect on childhood internalizing behaviours (e.g., depression, anxiety). However, the amount of tobacco consumed by the mother amplified the negative effect of cannabis on both childhood externalizing and internalizing behaviours. These findings emphasize the need for specialized treatment for cannabis and tobacco co-use in pregnant women to circumvent the adverse impact of these substances on externalizing behaviours in middle childhood.

[A survey on tobacco-free areas at hospital entrances]. / Enquête sur la mise en place d'un lieu de santé sans tabac à l'hôpital.

INTRODUCTION: In a prevalence and opinion survey on smoking, this work focused on a strategy favoring tobacco-free areas at hospital entrances. METHODS: Outreach to the public occupying outdoor spaces led to immediate collection of responses over the course of 13 actions carried out in November 2022, a tobacco-free month. RESULTS: Thirty-two percent of the persons interrogated were smokers, 38% among patients, 26% among professionals and 18% among nursing students. A majority expressed support for smoke-free building entrances, which were viewed by half of the smokers as an encouragement to quit or cut down on their consumption. However, a quarter of participants anticipated difficulties, particularly the "heaviest" smokers. In the psychiatry sector, 54% were smokers, and they were relatively unfavorable to the initiative. As for non-smokers, most voiced discomfort regarding the smell of tobacco, the infiltration of smoke in indoor spaces, passive smoking, a negative image of the hospital, and the detrimental ecological impact. CONCLUSIONS: The tobacco-free hospital entrance initiative is relevant and of benefit to hospitals. In order to succeed, it must involve all stakeholders, whether they are users or professionals, in a concerted attempt to optimize assistance to smokers wishing to quit, by applying an educational and synergistic approach at all levels.

Prévalence et facteurs associés à la co-consommation d'alcool et de tabac dans la commune de Natitingou, Bénin.

INTRODUCTION: La consommation d'alcool et la consommation de tabac entraînent chacune des risques importants pour la santé. L'objectif de cette étude était d'étudier la prévalence de la co-consommation d'alcool et de tabac ainsi que les facteurs associés dans la commune de Natitingou en 2016. MÉTHODES: Il s'agissait d'une étude transversale à caractère analytique. L'enquête s'est déroulée en octobre 2016 et a porté sur un échantillon de 270 sujets. Elle a été menée selon une technique de sondage aléatoire à plusieurs degrés. Les données collectées ont été analysées avec le logiciel R. RÉSULTATS: Sur les 270 sujets interrogés, 72,2 % étaient des hommes. L'âge moyen était de 30,7 ± 9,2 ans. La prévalence de la co-consommation était de 33,7 % [IC95% : 28,1 %-39,7 %]). Les facteurs associés à la co-consommation d'alcool et de tabac étaient : le sexe masculin (ORa = 2,1 ; p = 0,023), la dipsomanie (ORa = 1,4 ; p = 0,032), le fait d'avoir des amis buveurs ou fumeurs (ORa = 2,8 ; p = 0,004), le fait de suivre les publicités des médias sur les boissons alcoolisées (ORa = 1,9 ; p = 0,029) et le faible coût /accessibilité des deux substances (ORa = 2,1 ; p = 0,011). CONCLUSION: Cette étude a montré qu'il est important de dépasser la prévention centrée sur la personne qui consiste à sensibiliser et à prendre en charge pour adopter des mesures de prévention structurelle (notamment législatives).

Smoking and short-term response to intravitreal anti-Vascular Endothelial Growth Factor injections in neovascular age-related macular degeneration.

PURPOSE: To evaluate the role of smoking status on the response to three monthly intravitreal anti-Vascular Endothelial Growth Factor (anti-VEGF) injections in treatment-naive neovascular AMD (nAMD) patients. METHODS: We conducted a single-center, retrospective, case-control cohort study in Belgium. RESULTS: Intravitreal treatment (IVT) was performed in 147 eyes of 131 patients, including 92 females (70%). Mean age at the time of the first IVT was 79±9 years. Seventeen patients (13%) were actively smoking at the time of the anti-VEGF IVT. On average, active smokers were 11 years younger than non-smokers when starting IVT treatment. They also showed more frequent subretinal fluid than non-smokers (94% vs. 65%). Mann-Whitney analyses comparing change in central macular thickness and change in logarithm of the minimum angle of resolution visual acuity between active smokers and non-smokers showed no significant difference in treatment response between both groups. Likewise, no significant difference was found when comparing treatment response between patients with less than 10 pack-years (PY) (including never-smokers) and patients with over 10 PY. In a binary logistic regression model, male patients responded worse to anti-VEGF IVT than their female counterparts, with an odds ratio (OR) of 0.27 for good response. This was the only statistically significant predictor of treatment response. CONCLUSION: Our study failed to demonstrate an effect of smoking on the short-term treatment response to anti-VEGF in nAMD.

[Male infertility, environment and lifestyle]. / Infertilité masculine, environnement et mode de vie.

BACKGROUND: Since the 1970s, there has been a quantitative and qualitative decline in sperm parameters. The main hypothesis to explain such a rapid evolution is the involvement of environmental and behavioral phenomena. METHODS: A bibliographic search limited to English and French literature in men published before 7/2023 was carried out on the links between fertility and pollution, xenobiotics, tobacco, narcotics, cannabis, alcohol, weight, sport, sedentary lifestyle, sleep and anabolics. RESULTS: Profound changes in lifestyle have occurred over the past 50 years: reduced sleep time, sedentary lifestyle, dietary changes, tobacco consumption, use of narcotics and anabolics. These changes have a proven impact on spermogram parameters, and should be corrected in an effort to optimize reproductive health. Other environmental parameters: pollution, exposure to heavy metals, exposure to xenobiotics, phthalates and pesticides… will be more difficult to exclude from patients' daily lives, but deserve to be taken more into account. CONCLUSION: This review should help the urologist to assess and counsel patients in order to improve their reproductive health. These factors should be routinely investigated in infertile men.

[Smoking and smoking cessation among migrants in France: A qualitative study]. / « Un bien pour un mal ¼. Consommation et arrêt du tabac chez les migrants en France : une étude qualitative (TATAMI).

INTRODUCTION: The aim of this study is to identify factors related to smoking and smoking cessation as well as preferences for cessation methods reported by migrants in France. METHODS: Qualitative study using semi-directive interviews with migrants in the Parisian area thematically analyzed using an inductive approach. RESULTS: Sixteen interviews conducted. The stress and isolation induced by migration favor the increase of tobacco consumption. These two factors, as well as the lack of information on the resources available for quitting smoking, were identified as obstacles to cessation. The main motivations for quitting are the identified or experienced effects of smoking on their health and pressure from family members, especially children. Quitting is essentially a personal strategy centered on the true will to quit. The most popular method identified by the participants as the most effective in helping them to quit, is follow-up or therapy by a health professional combining listening and psychological support. DISCUSSION: For migrants, smoking is a resource to combat stress that increases during the migration process and upon arrival in the host country and presents a psychosocial dimension for the most isolated individuals. Smoking cessation must be accompanied and must take into account the specificities of this population as well as the expressed need for psychosocial support, as suggested by our results, to be most effective.

[Environmental and occupational risk factors for myelodysplastic syndrome]. / Facteurs de risques environnementaux et professionnels de syndrome myélodysplasique.

Chemotherapy and radiotherapy for a previous cancer can lead to subsequent myelodysplastic syndrome (MDS). However, these therapy-related cases are hypothesized to explain only 5 % of diagnosed MDS cases. Environmental or occupational exposure to chemicals or radiations has also been reported to be associated with higher risk of MDS. The present review analyses those studies evaluating the association of MDS with environmental or occupational risk factors. There is sufficient evidence that environmental or occupational exposure to ionizing radiation or benzene can cause MDS. Tobacco smoking is also a sufficiently documented riskfactor for MDS. A positive association has been reported between exposure to pesticides and MDS. However, there is only limited evidence that this association could be causal.

Schizotypal dimensions are associated with current but not former tobacco consumption.

OBJECTIVES: We aimed to study the relationship between tobacco smoking and attenuated psychosis measures taking into account several aspects of tobacco consumption that to date have not been explored and that could help understand this association, such as age of onset, the influence of former consumption and the duration of abstinence. METHODS: We investigated, in a sample of 580 students, the relationship between schizotypy (using the schizotypal personality questionnaire-brief in a Likert format) and smoking status, nicotine dependence (measured with the Fagerström test for nicotine dependence), age of onset of smoking and in former smokers, duration of smoking abstinence. RESULTS: 35.2% of the students were current smokers and 13.4% were former smokers. We found that current but not former smokers had higher scores of schizotypy (total, positive and disorganized) than non-smokers. We found no association between schizotypy scores and nicotine dependence or earlier age of onset of smoking. The duration of smoking abstinence, in former smokers, was inversely correlated to the score of positive and total schizotypy. CONCLUSIONS: Our results suggest that tobacco has a reversible effect on schizotypy, but more studies with a different design (controlled, longitudinal) and a more thorough exploration of potential confounders (e.g. cannabis) are needed before a firm conclusion can be reached.

Suggestibility, Facebook use and relationship with substance addictive behaviors.

OBJECTIVE: Several health issues related to the us of social networking sites (SNS) are documented. One concept that is not clearly studied is suggestibility as the tendency of a person to accept and internalize communication. The aim of the study is to test a model in which suggestibility of people can predict SNS use, which in turn can predict substance use. METHODS: Participants answered a questionnaire measuring suggestibility, alcohol consumption, dependence to nicotine and Facebook use. Linear regression and a structural equation model (SEM) were carried out to assess which utilization of Facebook variables explained best the level of alcohol consumption or nicotine dependence and to assess how suggestibility predicted Facebook use. RESULTS: Linear regression analyses indicate that only the number of friends on Facebook is a predictor of the level of alcohol consumption (P<0.001). Suggestibility predict the frequency of Facebook use (P<0.001) and of the number of friends on Facebook (P=0.022). The SEM demonstrates that participants with a higher level of suggestibility have more friends on the SNS, which can influence substance consumption. CONCLUSION: Individuals' level of suggestibility affects Facebook use. People with a higher level of suggestibility are more likely to have many friends on the SNS resulting in a possible environmental influence on substance use.

Attitude of community pharmacists toward patients with a substance-related disorder (heroin, alcohol and tobacco), estimation of harmfulness and knowledge of these substances, and continuing education: A pilot cross-sectional study.

OBJECTIVES: To investigate attitude of community pharmacists toward patients with a substance-related disorder (heroin, alcohol and tobacco). MATERIAL AND METHODS: The attitudes were assessed thanks to the Attitude to Mental Illness Questionnaire (AMIQ) for heroin, alcohol and tobacco-related disorders in three independent groups of pharmacists. Estimation of substance-related harmfulness, knowledge of substance-related disorders and activities/needs for continuing education on substance-related disorders were also recorded. RESULTS: Thirty-five pharmacists were included (heroin: 11, alcohol: 10 and tobacco: 14). AMIQ scores for heroin-related disorder were negative and lower than for alcohol (P<0.01) and tobacco (P<0.001). AMIQ scores for alcohol-related disorder were lower than for tobacco (P<0.05). The estimation of heroin-related harmfulness was higher than for alcohol and tobacco (P<0.001). The estimations of knowledge of substance-related disorders were lower for opioid and alcohol than for tobacco (P<0.001). AMIQ scores and the needs for continuing education on each associated addiction showed a positive relation (P<0.01). CONCLUSION: Pharmacists had a negative attitude toward heroin and alcohol-related disorders. A positive attitude toward patients with a substance-related disorder was associated with a need for continuing education. Efforts should be made to change attitudes and to promote continuing education on heroin and alcohol-related disorders.

Pathophysiology of nicotine, place of nicotine substitutes and electronic cigarettes in plastic surgery: A review of the literature.

OBJECTIVE: Smokers are more likely to undergo postoperative complications after plastic surgeries. Our main purpose was to update nicotine's effects after plastic surgeries and assess whether nicotine-replacement therapy and vaping are safe enough to be recommended in peri-operatory circumstances. METHODS: We set up a literature review including 40 documents from 1986 to 2020 available on Pubmed. RESULTS: Nicotine has undeniable detrimental effects on patients undergoing plastic surgeries like cutaneous necrosis, skin flap failure and surgical site infection. Nevertheless, this toxicity seems to depend on the plasma concentration of nicotine and thus on the way of administration. While smoking is definitely harmful, nicotine replacement therapies (NRT) like patches and gums do not appear to increase postoperative risks based on available studies. The situation is different with the electronic cigarette since the pharmacokinetic parameters are close to those of the traditional cigarette. Even if powerful studies are lacking because the device is recent, preliminary in vitro studies and case reports suggest non-zero surgical risks for e-cigarette users. CONCLUSION: It seems more appropriate to suggest stopping all nicotine intake before and after plastic surgery. However, if strict cessation is not achievable, it appears preferable to use nicotine replacement therapies rather than e-cigarettes and most of all tobacco.

[Smoking behaviours among staff of two university hospitals in Paris, 2021]. / Tabagisme du personnel de deux hôpitaux de l'Assistance Publique­Hôpitaux de Paris, 2021.

INTRODUCTION: A survey on smoking prevalence was conducted among staff at the Georges Pompidou and Corentin Celton hospitals in the framework of the "smoke-free hospital" project. It aimed to determine the smoking status of different categories of personnel, their desire to be helped to quit and, as regards healthcare staff, whether or not they were encouraging patients who smoked to try to quit. METHODS: From February to May 2021, an anonymous survey was distributed, first on paper in the occupational health unit, and then online in all wards. RESULTS: All in all, 775 people, three quarters of whom were women, participated in the survey (15% of the workforce). Among the respondents, 27% said they smoked: 29.6% of the men and 26.1% of the women. Unsurprisingly, the age group with the highest prevalence was 18-24years. High prevalence was likewise found among technical and administrative staff. More than half of the smokers, who consumed an average of 8 cigarettes a day, were interested in receiving smoking cessation support. As regards smoking cessation support for patients, 49% of medical and nursing staff (70% of the doctors) frequently or systematically advised them to quit. CONCLUSION: Our results illustrate a need to reach high-prevalence categories of smokers in a hospital setting, the objective being to help them to consider quitting, and also a need to train health professionals in smoking cessation counseling.

Deep tillage reduces the dependence of tobacco (Nicotiana tabacum L.) on arbuscular mycorrhizal fungi and promotes the growth of tobacco in dryland farming.

The traditional shallow tillage method reduces soil quality and affects the efficiency of agricultural production. Using conventional rotary tillage (12 cm) as the control, Yunyan 87 as the test variety, and paddy soil as the test site, we studied the effects of deep tillage (subsoiling 30 cm) on soil nutrients, arbuscular mycorrhizal fungi (AMF), and tobacco (Nicotiana tabacum L.) growth. The results showed that deep tillage increased the content of organic carbon, available phosphorus (AP), and available potassium (AK) in the 20-40 cm soil layer. The AMF community was also affected by deep tillage. Glomus, the dominant genus in both groups, increased significantly in soil after deep tillage. The AMF colonization rate was lower than that of conventional rotary tillage. Deep tillage was beneficial for tobacco growth in the middle and late stages. The root growth and nutrient content of the tobacco plants increased. Deep tillage significantly improved the output value of tobacco plants. Deep tillage is conducive to improving soil fertility, promoting the vigorous growth of roots, reducing the dependence of tobacco on AMF, and promoting the high quality and yield of tobacco in the drylands of Hunan.

[Factors associated with medical residents' brief counseling]. / L'aide au sevrage tabagique : la pratique du conseil minimal par les résidents en médecine.

INTRODUCTION: Smoking is a public health problem. Physicians have an important role in the fight against smoking, particularly by means of the brief advice they can give. The aim of this work was to study the prevalence of brief advice application by medical residents and to identify factors that may condition its practice. METHODS: We conducted a descriptive and analytical study with prospective data collection that included 302 residents practicing in Tunisia who had agreed to respond to an online questionnaire submitted in February and March 2020. RESULTS: Residents' mean age was 28±2 years and the gender ratio was 0.65. Sixty-four percent of them were non-smokers. During their practice, 94% systematically identified their patients' smoking status, but 61.9% were unfamiliar with the concept of brief advice. Residents' brief advice application rate was 57.6%. In multivariate analysis, the factors impacting brief advice application were: gender (OR=0.321, p=0.0001), familiarity with brief counseling (OR=2.808, p=0.002) and having observed brief advice being given by a senior physician (OR=2.328, p=0.0001). CONCLUSION: The rate of brief advice application remains low. On this subject, improved theoretical and practical teaching during medical studies is essential.

[Tobacco and alcohol consumption in women treated for breast cancer in a department of surgical oncology: Frequent behaviours to consider]. / Consommations de tabac et d'alcool chez des femmes traitées pour un cancer du sein dans un service de chirurgie oncologique : des comportements fréquents à considérer.

INTRODUCTION: Tobacco and alcohol represent the two most important risk factors increasing cancer incidence and mortality, particularly among women with breast cancer. However, few researches have focused on the consumption of psychoactive substances in women treated for breast cancer. The present study describes the prevalence of tobacco and alcohol consumption and their relationships with the sociodemographic, medical and psychological variables in a population of women receiving surgery treatment for breast cancer. METHODS: Between October 2014 and August 2015, a group of women receiving breast cancer treatment were recruited to participate to a screening and brief intervention program (SBI) for the consumption of tobacco and alcohol, adapted to the oncology context. Data on tobacco and alcohol consumption were collected using two questionnaires : the smoking status identification (NIDA) and alcohol consumption (AUDIT-C). A questionnaire for socio- demographic data and two for psychological data (Thermometer of psychological distress; ESAS), have been used. The medical data were reported by participants and verified on medical records. RESULTS: In a total of 11 months, 120 women with breast cancer were included in this study. A large majority of patients were hospitalized for a first-time cancer (80.8%), type invasive ductal carcinoma (70.8%) and were receiving surgery as primary treatment (45%). Furthermore, 30.8% of the women reported tobacco consumption and 38.4% high-risk alcohol consumption. Regarding mental health, 40.8% presented moderate to intense levels of psychological distress. No significant relationships were found between consumption scores and sociodemographic, medical or psychological characteristics. Only the patient's age was negatively associated with tobacco consumption. DISCUSSION: Tobacco and at-risk alcohol consumption are frequently reported behaviors during breast cancer treatment. Intervention strategies targeting risk behaviors related to addictive consumption should be implemented during the full treatment of breast cancer patients.

[The interest of a nurse and dietician pair in smoking cessation]. / L'intérêt d'un binôme infirmière et diététicienne tabacologues dans le sevrage tabagique.

The Tobacco Coordination Unit of the Caen Normandy University Hospital assists smokers in their efforts to quit or reduce their tobacco consumption. In addition to the usual individual consultations, a consultation with a nurse-dietician pair is offered to patients for whom individual work on smoking and eating behaviors has reached an impasse. This unconventional approach allows for a more effective consultation method that is better adapted to certain types of patients treated in tobaccoology.

TABADO 2 : une stratégie d'accompagnement au sevrage tabagique des adolescents en milieu scolaire.

La consommation de tabac est une des premières causes de mortalité évitable au niveau mondial. La dépendance au tabac s'observe dès l'adolescence. En complément des actions visant à prévenir l'entrée des jeunes dans le tabagisme, il est donc nécessaire de développer des stratégies spécifiques pour les adolescents déjà fumeurs. Un programme d'accompagnement au sevrage tabagique pour adolescents, TABADO, a montré son efficacité lors d'un essai contrôlé mené dans des centres de formation des apprentis en 2007/2009. En 2018, l'Institut national du cancer a souhaité généraliser TABADO au niveau national et l'étendre aux lycées professionnels. Pour accompagner ce processus de mise à l'échelle, il était essentiel d'élaborer la théorie d'intervention et d'analyser la transférabilité de TABADO en conditions de vie réelle et dans de nouveaux contextes, et de proposer les adaptations correspondantes. Une recherche spécifique a été conduite et détaillée par ailleurs. L'objectif de cette publication pragmatique est de présenter la nouvelle stratégie TABADO 2 aux acteurs et décideurs de santé publique, et le guide afférent développé pour les accompagner dans la mise en œuvre.Une étude de cas multiples (n = 10) a été menée à partir de la mise en œuvre de TABADO dans trois régions françaises, qui reposait sur des observations, entretiens et séminaires de retour d'expérience. Elle a mis en évidence l'adaptation de l'intervention aux contextes locaux, ainsi que de nouveaux leviers interventionnels mis en œuvre. De plus, les investigations ont montré que pour instaurer un climat favorable à la démarche d'arrêt de la consommation de tabac et soutenir son maintien sur la durée, il était nécessaire d'inscrire TABADO dans une stratégie globale de l'établissement scolaire et de son environnement. Cette démarche a permis de proposer une transformation de l'intervention TABADO en une nouvelle stratégie - TABADO 2 - et de proposer un guide pour accompagner son déploiement national.

Tobacco-related cardiovascular risk in women: New issues and therapeutic perspectives.

BACKGROUND: Smoking is the main modifiable risk factor for stroke and myocardial infarction, particularly in women; its prevalence in France is evolving, and new patterns of nicotine consumption have emerged. AIMS: To present contemporary data on smoking prevalence and the use of electronic cigarettes, and to describe current knowledge of the cardiovascular risk specificities and the effectiveness of withdrawal methods in women. METHOD: We identified studies by searching the MEDLINE bibliographic database between 1995 and 2020, and the Weekly Epidemiological Bulletin (Bulletin Épidémiologique Hebdomadaire) published by the French health authorities. RESULT: In recent years, smoking prevalence among French women has decreased overall, except in the oldest age group (aged>55 years). At the same time, the incidence of hospitalization for cardiovascular events has increased worryingly among women smokers aged<65 years. Active smoking in women is associated with an increased risk of premature myocardial infarction, and a risk of stroke that increases with the number of cigarettes consumed per day; it is also responsible for increased cardiovascular events in women taking oestrogen-progestin contraception. Quitting smoking reverses these effects in the long term, and women are just as likely to quit smoking as men. CONCLUSIONS: Stopping smoking must be a priority objective for women smokers, for primary and secondary prevention, and they should systematically be offered a validated method of cessation or even electronic cigarettes.

Mes ennemis, les facteurs de risque My enemies, the risk factors.

We have to distinguish between non-modifiable risk factors such as age, gender, heredity, (we cannot fight against these enemies), and modifiable risk factors (avoidable) such as hypertension, smoking, diabetes, and dyslipidemia. Environmental factors, bad diet, sedentary lifestyle, and smoking are the basis of these risk factors. Cardiovascular disease due to these risk factors is clinically silent during a given period, then symptoms occur which can eventually lead to death. Nine risk factors explain the occurrence of 90 % of myocardial infarctions (MI), their correction avoid 80 % of MI. Despite the presence of several studies proving that secondary prevention reduces coronary mortality, the management of cardiovascular risk factors is not optimal.