[Epidemiology of heart disease in diabetes]. / Les pathologies cardiaques du diabétique: données épidémiologiques.

Diabetes mellitus is a frequent disease--3% of the French population in 1999. Vital prognosis is essentially related to cardiac complications, at least in type 2 diabetic patients, that is 85 to 90% of diabetic subjects. The most frequently observed cardiac complications are symptomatic or silent ischemic coronary disease and myocardial events, followed by heart failure. These complications may also result from cardiac autonomic neuropathy, be manifested by arrhythmia and even lead to sudden death. Data on the prevalence and incidence of these events are scarce, and the epidemiologic characteristics are not the primary aim of publications. This review analyses: cardiovascular drug consumption in French diabetic and non diabetic patients, the incidence and prevalence rates of the most important cardiac complications from some large general prospective studies which included enough diabetic subjects, coronographic severity scores for diabetic and non-diabetic subjects, prognosis following treated coronary events, some prevalence data on cardiac autonomic neuropathy.

Genetic polymorphisms of the renin-angiotensin system and angiographic extent and severity of coronary artery disease: the CORGENE study.

Genetic polymorphisms of the renin-angiotensin system (RAS) have been associated with coronary artery disease (CAD) but no relation between these polymorphisms and coronary atherosclerosis has yet been systematically evaluated. The CORGENE study is a cross-sectional study involving 463 Caucasians who underwent standardized coronary angiography for established or suspected CAD [156 patients with a previous myocardial infarction (MI), 307 without MI]. Four angiographic scores assessing the extent and severity of the coronary lesions were obtained from a double visual analysis of each angiogram, arbitration being achieved by a quantitative measurement. Three different genotypes were analyzed: the angiotensin I-converting enzyme insertion/deletion (ACE I/D) polymorphism, the Met to Thr change at position 235 of the angiotensinogen gene (AGT M235T) and the A to C transition at position 1166 of the angiotensin II type-1 receptor gene (AT1R A1166C). No significant association was observed between these polymorphisms and the clinical characteristics of MI and non-MI subjects. While most classical risk factors were positively correlated with the angiographic scores, no significant relationship could be established with the three genotypes (r ranging from -0.08 to 0.05). Only one significant correlation was observed: between the presence of the AGT 235T allele and the extent of the coronary lesions (r = -0.19, P = 0.04) in patients with low-risk status. These overall results are not in favor of a role of these RAS genetic polymorphisms in the development of coronary atherosclerosis.

Longitudinal associations between plasma viscosity and cardiovascular risk factors in a middle-aged French population.

A recent prospective study has suggested that increased plasma viscosity may be associated with higher risk of coronary heart disease. A longitudinal approach was used to investigate associations between plasma viscosity and conventional risk factors in an apparently healthy French population aged 45-56 years (637 men and 431 women) over a 2-year follow-up period. In univariate analysis, change in plasma viscosity was significantly related to changes in smoking status, systolic and diastolic blood pressure, gamma glutamyl transferase (gamma GT), body mass index and triglycerides only in men, and to changes in total cholesterol, low-density lipoprotein (LDL) cholesterol and apolipoprotein (apo) B in both sexes. Change in plasma viscosity was also significantly associated with changes in fibrinogen and hemoglobin levels in both sexes. No association was found with age, high-density lipoprotein (HDL) cholesterol or apo A1 in both sexes, or with changes in smoking and menopausal status in women. In multiple stepwise regression analysis, independent determinants of change in plasma viscosity were changes in smoking status, systolic blood pressure, gamma GT, total cholesterol, fibrinogen and hemoglobin in men, and changes in fibrinogen and apo B in women. These results strengthen the hypothesis that increased plasma viscosity may be one of the mechanisms linking conventional risk factors to the risk of cardiovascular disease and suggest that its decrease may be obtained by appropriate life-style changes.

Hypocaloric diet and antihypertensive drug treatment. A randomized controlled clinical trial.

OBJECTIVE: To compare the amount of drug quantified by a score needed to control blood pressure in two groups of overweight hypertensive patients, receiving or not receiving a hypocaloric diet. DESIGN: Randomized controlled clinical trial. SETTING: Two hospital outpatient hypertension clinics. PATIENTS: Fifty-four subjects with a DBP between 95 and 110 mmHg and a weight > or = 110% of the ideal weight. INTERVENTION: Allocation to either drug treatment (DT) or hypocaloric diet (HD). In the HD group, after 2 months, an antihypertensive drug was administered to the subjects with a DBP > or = 90 mmHg, following the same scheme protocol as in the DT group. Subjects were followed during 10 months by a clinician only in the DT group and by a clinician and a dietician in the HD group. MAIN OUTCOME MEASURES: Score of treatment: hydrochlorothiazide 25 mg [score = 1] with, as needed to obtain a DBP < 90 mmHg, the addiction of enalapril 10 mg [score = 2], 20 mg [score = 3], and nifedipine 40 mg [score = 4]. RESULTS: At the end of the trial, 5 subjects were lost to follow-up in the HD group and 1 in the DT group (p > 0.05). Mean weight loss was 5.9 kg (sd = 1.2) in the HD and 2.3 kg (sd = 0.7) in the DT group (p = 0.02). Mean decrease in DBP was 18 mmHg (sd = 7) and 15 mmHg (sd = 8) in HD and DT groups respectively (p = 0.36). Mean DBP was 84 mmHg (sd = 7.8) in the HD group and 85 mmHg (sd = 7.2) in the DT group. In the HD group, 8 (38.1%) subjects had a DBP < 90 mmHg without any drug treatment. The mean drug treatment score was 0.86 (sd = 0.91) in the HD and 1.52 (0.70) in the DT group (p = 0.01). CONCLUSION: This study shows that in overweight hypertensives, the quantity of drug needed to achieve an acceptable level of BP is nearly reduced by 50% when an efficient hypocaloric diet is prescribed simultaneously.

[Variations in blood pressure measurement during systematic screening tests and their effects on public health]. / La variabilité de la mesure tensionnelle dans un examen de dépistage systématique et ses conséquences en santé publique.

The variability of blood pressure measurements is studied, in a standardized screening, by comparing the measures obtained during a medical examen and those made by technicians under different circumstances. This variability is important. A systematic bias is due to the digit preference for the zero value by the doctors. Besides, strong subject/obser interaction accounts partly for higher values measured in the medical exam. The mean blood pressures and the prevalence of hypertension are increased under some circumstances close to those of everyday life and labile hypertension is very frequent. The individual variability of the measure and the prevalence of hypertension are reduced by a standardized technique when applied under favorable circumstances by technicians. The reproductibility of this measure is good but the simultaneous taking into account of two successive measures still reduces much this prevalence. In these conditions it is very difficult to estimate the prevalence of hypertension in the population: an example is given where this frequency varies in the proportion of 1 to 6 according to the measures considered. The implications of this variability on the screening of hypertension are discussed.