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1.
J Am Heart Assoc ; 9(7): e013836, 2020 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-32200718

RESUMO

Background The diet impact on cardiovascular diseases has been investigated widely, but the association between dietary patterns (DPs) and subclinical cardiovascular damage remains unclear. More informative DPs could be provided by considering metabolic syndrome components as intermediate markers. This study aimed to identify DPs according to generation and sex using reduced-rank regression (RRR) with metabolic syndrome components as intermediate markers and assess their associations with intima-media thickness, left ventricular mass, and carotid-femoral pulse-wave velocity in an initially healthy population-based family study. Methods and Results This study included 1527 participants from the STANISLAS (Suivi Temporaire Annuel Non-Invasif de la Santé des Lorrains Assurés Sociaux) cohort fourth examination. DPs were derived using reduced-rank regression according to generation (G1: age ≥50 years; G2: age <50 years) and sex. Associations between DPs and cardiovascular damage were analyzed using multivariable linear regression models. Although identified DPs were correlated between generations and sex, qualitative differences were observed: whereas only unhealthy DPs were found for both men generations, healthy DPs were identified in G2 ("fruity desserts") and G1 ("fiber and w3 oil") women. The "alcohol," "fast food and alcohol," "fried, processed, and dairy products," and "meat, starch, sodas, and fat" DPs in G1 and G2 men and in G1 and G2 women, respectively, were associated with high left ventricular mass (ß [95% CI], 0.23 [0.10-0.36], 0.76 [0.00-1.52], 1.71 [0.16-3.26], and 1.80 [0.45-3.14]). The "alcohol" DP in G1 men was positively associated with carotid-femoral pulse-wave velocity (0.22 [0.09-0.34]). Conclusions The DPs that explain the maximum variation in metabolic syndrome components had different associations with subclinical cardiovascular damage across generation and sex. Our results indicate that dietary recommendations should be tailored according to age and sex. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01391442.

2.
J Am Heart Assoc ; 9(7): e014758, 2020 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-32208829

RESUMO

Background PCSK9 (Proprotein convertase subtilisin/kexin type 9) binds low-density lipoprotein receptor, preventing its recycling. PCSK9 is a risk predictor and a biotarget in atherosclerosis. The PCSK9-rs562556 variant has been reported as a gain-of-function mutation. The aim of this study was to determine whether the PCSK9-low-density lipoprotein receptor-rs562556 axis is associated with carotid artery plaques between 2 visits separated by almost 20 years in a longitudinal population cohort. Methods and Results The STANISLAS (Suivi Temporaire Annuel Non-Invasif de la Santé des Lorrains Assurés Sociaux) cohort is a longitudinal familial cohort from the Lorraine region of France. Participants attending 2 visits (visit 1 and visit 4) separated by 18.5 years (mean) were included (n=997). Carotid artery plaques were determined with standardized vascular echography. The mean age of the adult population at visit 1 was 42±5 years. At visit 4, 203 (20.4%) participants had arterial plaques. Participants who developed arterial plaques were older (42.7±5.4 versus 41.7±4.7 years), more often male (60% versus 49%), smokers (29% versus 18%), with diabetes mellitus (6% versus 3%), and higher cholesterol levels (low-density lipoprotein cholesterol, 1.6±0.4 versus 1.5±0.3 g/L) (all P<0.05). The independent factors associated with arterial plaques were age, smoking, and low-density lipoprotein cholesterol. Higher PCSK9 levels were associated with arterial plaques on top of the clinical model (odds ratio, 2.14; 95% CI,= 1.28-3.58); the missense mutation coding the single-nucleotide polymorphism rs562556 was associated with both higher PCSK9 concentration and incident carotid arterial plaques. Conclusions Higher PCSK9 concentration was associated with the development of arterial plaques almost 20 years in advance in a healthy middle-aged population. Mutations of the single-nucleotide polymorphism rs562556 associated with both PCSK9 levels and arterial plaques reinforce the potential causality of our findings. PCSK9 inhibitors could be useful for primary cardiovascular prevention.

3.
Fam Pract ; 2020 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-31995189

RESUMO

BACKGROUND: Vaccination postponement is an important contributing factor to low vaccination coverage. The causes of vaccine postponement are numerous, but the presence of viral infection, whether febrile or not, is the most frequent cause. OBJECTIVE: The objective was to explore the factors motivating the practice of vaccination postponement in a child with an infection by general practitioners (GPs) and paediatricians. METHODS: An exploratory qualitative study using semi-directive individual interviews was carried out among GPs and paediatricians in a French region between November 2015 and January 2018. After the interviews were fully transcribed, an analysis of the data was performed using an inductive method derived from the grounded theory. RESULTS: Fourteen GPs and four paediatricians participated in the study. Vaccination postponement during infection in children is rooted in doctors' practices; it is considered a low-risk habit that is shared with parents, and vaccine hesitancy reinforces this practice. In children presenting with an infection, the presence of uncertainty about vaccine safety and effectiveness seems to justify postponing vaccination. The organization of a consultation dedicated to vaccination catch-up was cited as the best tool to limit the effects of vaccination delay on vaccination coverage. DISCUSSION: In children presenting with an infection, vaccination postponement is widely used by GPs and paediatricians. Simplification of the vaccination catch-up process and clear and consistent recommendations on the indications and modalities for vaccination postponement would be useful.

4.
Minerva Pediatr ; 2019 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-31833349

RESUMO

BACKGROUND: Early adolescence (10-16 years) is a crucial period for physical, mental and cognitive development where a wide range of school, behaviour and health-related difficulties may occur. These issues may be aggravated in adolescents with early affective/sexual live and contraceptive consultation. This study assessed the risk of school, behaviour and health-related problems among younger boys and girls having a contraceptive consultation. Such knowledge would inform care providers about their main role in monitoring and caring adolescent problems. METHODS: This cross-sectional study included 1559 middle-school adolescents from north- eastern France (mean age 13.5+1.3). They completed a questionnaire gathering socioeconomic features, obesity, school difficulties, substances use, physical health, psychological health, social relationship, violence, sexual abuse, and suicide behaviours. Data were analysed for each gender separately using logistic regression models. RESULTS: The contraceptive consultation concerned 6.7% of girls and 3.2% of boys (P=0.002). Based on odds ratio (adjusted for age, school-class level and socioeconomic factors), both boys and girls with contraceptive consultation had 2-to-7-time higher risk of consumption of alcohol, tobacco, cannabis and other drogues, poor physical health, relational problems, and perpetrated violence. Additionally, the girls had a 4-time higher risk of low academic-performance and being obese while the boys had 6-to-37-time higher risk of sexual abuse, school dropout ideation, suicide ideation and suicide attempts. CONCLUSIONS: Although based on self-reported data, we found that primary care providers play a prominent role in detecting and monitoring school, behaviour and health-related problems during adolescent contraceptive consultations.

5.
Presse Med ; 48(11 Pt 1): 1301-1305, 2019 Nov.
Artigo em Francês | MEDLINE | ID: mdl-31727486

RESUMO

Menopause requires the implementation of organized screening and dedicated care pathways in collaboration with the attending physician, the gynaecologist-obstetrician and the cardiovascular physician. It will be necessary to take into account the hormonal specificities of the cardiovascular risk, in order to know-how to properly prescribe hormonal treatments.


Assuntos
Procedimentos Clínicos/organização & administração , Hipertensão/terapia , Menopausa , Cardiologia , Feminino , França , Ginecologia , Humanos , Hipertensão/diagnóstico , Pessoa de Meia-Idade , Obstetrícia , Equipe de Assistência ao Paciente/organização & administração
6.
Presse Med ; 48(11 Pt 1): 1261-1264, 2019 Nov.
Artigo em Francês | MEDLINE | ID: mdl-31735525

RESUMO

The impact of antihypertensive drugs on blood pressure does not differ according to the sex. There are women-specific conditions or medical conditions encountered more frequently among womens that guide the selection of therapy such as a desire to become pregnant, a pregnancy, a polycystic ovarian syndrome, breast cancer, osteoporosis or migraine.


Assuntos
Anti-Hipertensivos/uso terapêutico , Hipertensão/tratamento farmacológico , Fatores Etários , Anti-Hipertensivos/efeitos adversos , Pressão Sanguínea/efeitos dos fármacos , Neoplasias da Mama/induzido quimicamente , Feminino , Humanos , Transtornos de Enxaqueca , Osteoporose/complicações , Osteoporose/tratamento farmacológico , Síndrome do Ovário Policístico/tratamento farmacológico , Gravidez , Fatores Sexuais , Espironolactona/efeitos adversos
7.
PLoS One ; 14(9): e0220460, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31509852

RESUMO

BACKGROUND: To explore the perception of home blood pressure monitoring (HBPM) by general practitioners (GPs) in everyday practice in order to identify facilitators and barriers to its implementation in daily practice. METHODS: A qualitative study comprising the conduct of six focus groups between October 2016 and February 2017, gathering 41 general practitioners in primary care practice in Lorraine (North Eastern France), with thematic and comprehensive analysis. RESULTS: The first reasons given by GPs to explain their difficulties with HBPM (Home Blood Pressure Monitoring) implementation were the usual lack of time, material and human resources. However, all of these motives masked other substantial limiting factors including insufficient knowledge regarding HBPM, poor adherence to recommendations on HBPM and fear of losing their medical authority. GPs admitted that HBPM use could enhance patient observance and decrease therapeutic inertia. Despite this observation, most GPs used HBPM only at the time of diagnosis and rarely for follow-up. One explanation for GP reluctance towards HBPM may be, along with guidelines regarding hypertension, HBPM is perceived as being a binding framework and being difficult to implement. This barrier was more predominantly observed among aging GPs than in young GPs and was less frequent when GPs practiced in multidisciplinary health centers because the logistical barrier was no longer present. DISCUSSION: In order to improve HBPM implementation in everyday practice in France, it is necessary to focus on GP training and patient education. We must also end "medical power" in hypertension management and turn to multidisciplinary care including nurses, pharmacists and patients.

9.
Presse Med ; 48(11 Pt 1): 1222-1228, 2019 Nov.
Artigo em Francês | MEDLINE | ID: mdl-31303372

RESUMO

Erectile dysfunction (ED) is not routinely discussed with patients in cardiology practices whereas it may impact the ability of patients to stay on therapy. Most of the studies about ED and antihypertensive therapies have several methodological limitations. Diuretics and beta-blockers have been shown to have a deleterious effect on ED. ISRA inhibitors, calcium antagonists, vasodilator beta-blockers and alpha-blockers have been shown to have a neutral impact on ED. Angiotensin 2 inhibitors, nebivolol and alpha-blockers use has sometimes beneficial effect on ED. In case of ED due to antihypertensive treatment, drugs can be switched each other but careful attention in patients with a high cardiovascular risk is required.


Assuntos
Anti-Hipertensivos/efeitos adversos , Hipertensão/tratamento farmacológico , Disfunções Sexuais Fisiológicas/induzido quimicamente , Antagonistas de Receptores Adrenérgicos alfa 1/uso terapêutico , Antagonistas Adrenérgicos beta/efeitos adversos , Antagonistas Adrenérgicos beta/uso terapêutico , Bloqueadores do Receptor Tipo 2 de Angiotensina II/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Bloqueadores dos Canais de Cálcio/efeitos adversos , Bloqueadores dos Canais de Cálcio/uso terapêutico , Doenças Cardiovasculares/tratamento farmacológico , Diuréticos/efeitos adversos , Diuréticos/uso terapêutico , Substituição de Medicamentos , Humanos , Masculino , Antagonistas de Receptores de Mineralocorticoides/efeitos adversos , Fatores de Risco , Disfunções Sexuais Fisiológicas/prevenção & controle
10.
Sante Publique ; Vol. 31(1): 19-29, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31210513

RESUMO

INTRODUCTION: Appendicitis is well known by the general and medical population. Yet, the number of appendectomies varies by a factor of one to four depending on French departments.Purpose of research: This study aimed to compare, according to French schooling departments, the representations and attitudes of parents facing abdominal pain of their children, and their use of health care system. We selected three departments which have different proportions of use of appendectomy according to the DRESS's rapport of 2014. Meurthe-et-Moselle's rank is between 15.65 and 23.48/10 000 people, Seine-et-Marne's rank is between 23.48 and 31.30/10 000, and Jura's rank is superior to 31/10 000. RESULTS: 797 questionnaires were analyzed (45.2%). Significant differences exist in the answers of the three departments. Residents of the Jura region and, in a lesser measure, Seine-et-Marnaises answered differently than Meurthe-et-Mosellanses. The first two were the populations who experienced the most appendectomies and the Meurthe-et-Mosellanses the least. Parents who lived in departments of high rank of appendectomy thought more of acute appendicitis when confronted with their children's abdominal pain, and feared less of appendectomy. They were also more in favor of surgical treatment than parents from Meurthe-et-Moselle. CONCLUSION: Knowledge, attitude and use of health care system seem to influence management of acute appendicitis in children's population and can explain, at least partially, the variations of the appendectomy rate in France. Targeted information for physicians may improve the understanding of patients and reassure them if needed in the purpose of reducing this factor of influence of practices.


Assuntos
Dor Aguda/psicologia , Apendicectomia , Apendicite/cirurgia , Conhecimentos, Atitudes e Prática em Saúde , Pais/psicologia , Adulto , Criança , França , Humanos , Inquéritos e Questionários
11.
Psychiatry Res ; 273: 30-36, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30639561

RESUMO

A prospective study often receives a low participation rate that may alter the results quality. This study assessed the participation bias for a confidential non-anonymous adolescent survey among 1559 middle-school adolescents from north-eastern France (mean age 13.5 ±â€¯1.3). They completed an anonymous questionnaire gathering demographic/socioeconomic features as well as school, behavior and health-related difficulties, and adolescent's assent to participate with perceived parents' consent (APC) if they were contacted for a confidential non-anonymous survey at home. Such a survey received an APC of 60%. The logistic model including all socioeconomic factors and school, behavior and health-related difficulties showed that the adolescents with APC were less often male (adjusted odds ratio = 0.77, p = 0.014), non-European immigrant (0.48, p = 0.016), living with a single parent (0.72, p = 0.046), in manual-worker families (0.69, p = 0.007), had less often low parents' education (0.70, p = 0.002), body-mass-index measurement refusal (0.60, p = 0.010), no regular physical/sports activity (0.70, p = 0.035), poor social relationships (0.73, p = 0.046) and poor living environment (0.63, p = 0.007). The percentage of subjects with APC steadily decreased with the number of these criteria: from 74% for 0 criterion to 19% for 6-8 criteria. Because of these possible strong participation biases the construction of adolescent cohorts and the results interpretation should be made with prudence.


Assuntos
Comportamento do Adolescente/psicologia , Inquéritos Epidemiológicos/métodos , Vigilância da População/métodos , Qualidade de Vida/psicologia , Adolescente , Comportamento do Adolescente/fisiologia , Criança , Estudos Transversais , Feminino , França/epidemiologia , Humanos , Masculino , Pais/psicologia , Estudos Prospectivos , Instituições Acadêmicas , Fatores Socioeconômicos
12.
Fam Pract ; 36(3): 276-283, 2019 05 23.
Artigo em Inglês | MEDLINE | ID: mdl-30165649

RESUMO

BACKGROUND: Undiagnosed arterial hypertension is frequent. Whether it is associated with gender and the absence of cardiovascular-disease warning signs is unknown. Knowledge of the features of undiagnosed-hypertension subjects may help their identification in primary care. OBJECTIVE: To examine whether gender, alcohol consumption, smoking status, health status, cardiovascular diseases/diabetes, familial hypertension history, anti-cholesterol treatment, GP-consultation frequency, body mass index (BMI), waist circumference and metabolic measurements were associated with having undiagnosed hypertension among hypertensive subjects. METHODS: This population-based study included 281 hypertensive adults (aged 50-76 years): 222 subjects with diagnosed and treated-hypertension and 59 undiagnosed-hypertension subjects (no hypertension history, office and 24-h ambulatory blood pressures ≥140/90 and ≥130/80 mmHg, respectively). Subjects' characteristics, clinical and biological measurements, health problems and blood pressures were collected. Data were analyzed using adjusted odds ratios (OR) computed with multivariable logistic regression models. RESULTS: Undiagnosed-hypertension represented 21% of hypertensive subjects. Multivariable logistic regression modeling showed that five risk factors were associated with undiagnosed-hypertension among hypertensive subjects: male gender (OR = 4.61, P < 0.001), no cardiovascular diseases/diabetes (OR=8.51, P < 0.001), no familial hypertension history (OR = 3.15, P = 0.002), number of GP consultations per year (3+, 1-2, and 0; OR = 3.18 per 1-category increase, P < 0.001), and lower waist circumference (OR = 1.05 per 1-cm decrease, P = 0.002). Living alone, alcohol consumption, health status, anti-cholesterol treatment, BMI, and blood glucose were also significant factors (P < 0.05) in bivariate analysis. CONCLUSION: Undiagnosed-hypertension subjects exhibit specific features associated with their hypertension awareness. These findings help understand undiagnosed-hypertension risk patterns and enable better identification of affected subjects for lifestyle management and care.


Assuntos
Pressão Sanguínea , Hipertensão/diagnóstico , Hipertensão/etiologia , Estilo de Vida , Idoso , Consumo de Bebidas Alcoólicas/efeitos adversos , Anticolesterolemiantes/administração & dosagem , Glicemia/metabolismo , Determinação da Pressão Arterial , Índice de Massa Corporal , Feminino , Nível de Saúde , Humanos , Hipertensão/fisiopatologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fatores de Risco
13.
Eur J Clin Microbiol Infect Dis ; 37(9): 1637-1645, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29876774

RESUMO

Despite group A streptococci being an infrequent cause of pharyngitis in adult outpatients, sore throat remains a common indication for antibiotic prescription. This prospective multicentre non-randomised study describes a community pharmacy-based antimicrobial stewardship intervention consisting in the implementation of rapid antigen testing (RAT) for the management of adults with sore throat. Trained pharmacists triaged patients presenting with symptoms of pharyngitis using the modified Centor score. Those at risk for streptococcal infection were tested with RAT. Patients with a positive RAT were invited to consult a physician, whereas others were offered a symptomatic treatment. All patients received educational leaflets and were asked to fill in a follow-up form 7 days later. Ninety-eight pharmacies in one French region participated, and 559 patients were included over 6 months. RAT was proposed in 367 (65.7%) cases, and it was positive in 28 (8.3%). The follow-up form was returned by 140 (38.5%) participants. Of these, 10/10 patients with positive RAT further consulted a physician and were prescribed an antibiotic treatment, whereas 96.5% (110/114) of patients with negative results and not having any other reason to seek for doctor's advice did not consult. All participants found the intervention useful. Pharmacists spent 6-15 min to perform the intervention, and 98.6% (73/74) of pharmacists giving a feedback declared to be ready to implement this intervention in daily practice, if endorsed and reimbursed. Our results suggest that a pharmacy-based programme for the management of sore throat is feasible and could increase adherence to guidelines.


Assuntos
Testes Imunológicos/estatística & dados numéricos , Farmácias/estatística & dados numéricos , Faringite/diagnóstico , Infecções Estreptocócicas/diagnóstico , Streptococcus pyogenes/isolamento & purificação , Antibacterianos/uso terapêutico , Feminino , Seguimentos , França , Fidelidade a Diretrizes , Humanos , Masculino , Farmácias/normas , Farmacêuticos , Faringite/tratamento farmacológico , Estudos Prospectivos , Encaminhamento e Consulta/estatística & dados numéricos , Infecções Estreptocócicas/tratamento farmacológico
14.
J Hypertens ; 36(10): 2077-2084, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29878971

RESUMO

BACKGROUND: Aortic stiffness is a feature of arterial aging and is associated with dismal cardiovascular prognosis. We examined whether central and general adiposity is an independent predictor of accelerated aortic stiffening 20 years later in initially healthy midlife individuals. METHODS: Participants from the STANISLAS cohort study (826 initially healthy participants aged 30-60 from the Lorraine region in France) underwent clinical and biological measurements at baseline (1994-1995) and after ≈20 years (2011-2016). Adiposity measurements included waist circumference/BMI ratio, BMI, waist circumference, and 'body shape index' [waist circumference/(BMI height)]. Real carotid-femoral pulse wave velocity (cfPWV) was measured at end of follow-up. Our primary analysis was to test the association between waist circumference/BMI ratio and cfPWV. RESULTS: In a multiple linear regression model adjusted for sex, age and mean arterial pressure, waist circumference -to-BMI ratio was positively associated (for 1SD increase) with higher cfPWV [regression coefficient ß = 0.32, 95% confidence interval (CI) 0.19-0.45, P < 0.001]. The cfPWV was less strongly associated with body shape index (ß = 0.17, 95% CI 0.022-0.32, P < 0.05) and negatively associated with BMI (-0.20, 95% CI -0.31 to -0.093, P < 0.001) and waist circumference (-0.14, 95% CI -0.28 to 0.00, P < 0.05). Sensitivity analyses demonstrated that the risk of cfPWV associated with waist circumference-to-BMI ratio remained significant after adjustment for heart rate, metabolic risk factors and inflammatory markers. CONCLUSION: Central adiposity (and more specifically waist circumference-to-BMI ratio) is an independent predictor of 20-year subsequent aortic stiffness in initially healthy midlife subjects.


Assuntos
Doenças Cardiovasculares/epidemiologia , Obesidade Abdominal , Rigidez Vascular , Adulto , Índice de Massa Corporal , Doenças Cardiovasculares/etiologia , Artérias Carótidas/fisiologia , Estudos de Coortes , Feminino , Artéria Femoral/fisiologia , França/epidemiologia , Humanos , Modelos Lineares , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fluxo Pulsátil , Análise de Onda de Pulso , Fatores de Risco , Circunferência da Cintura
15.
Clin Res Cardiol ; 107(10): 887-896, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29680861

RESUMO

BACKGROUND: Diastolic dysfunction (DD) is increasingly common. However, its metabolic determinants are poorly known. This study aims to determine which metabolic and inflammatory features predict DD in initially healthy adults. METHODS: We prospectively analyzed the association between metabolic features and DD in 728 initially healthy adults aged 30-60 from Eastern France enrolled in the STANISLAS population-based cohort. Clinical and biological cardiovascular features were collected at baseline (1994-1995). DD was assessed twenty years later (2011-2016) by echocardiography using current international guidelines. For replication purposes, 1463 subjects from the Malmö Preventive Project cohort were analyzed. RESULTS: In the STANISLAS cohort, 191 subjects (26.2%) developed DD. In age-sex-adjusted logistic models, significant predictors of DD were body mass index (BMI, odds ratio for 1-standard-deviation increase (OR) 1.28, 95% CI 1.08-1.52), waist circumference (WC, OR 1.48, 95% CI 1.18-1.84), waist-hip ratio (OR 1.53, 95% CI 1.16-2.02), systolic blood pressure (OR 1.19, 95% CI 1.00-1.43) and triglycerides (TG, OR 1.18, 95% CI 1.00-1.40). Subjects with elevated WC (> 80th percentile) and TG (> 50th percentile) had a twofold higher DD risk (age-sex-adjusted odds ratio 2.00, 95% CI 1.20-3.31, P = 0.008), whereas no such interplay was observed for BMI. In the Malmö cohort, BMI was similarly associated with DD; participants with both elevated BMI and TG were at higher DD risk (age-sex-adjusted odds ratio 1.61, 95% CI 1.18-2.20, P = 0.002). CONCLUSIONS: Subjects with elevated WC and TG may have a higher long-term DD risk. Prevention targeting visceral obesity may help reduce the incidence of DD.


Assuntos
Síndrome Metabólica/complicações , Obesidade/complicações , Disfunção Ventricular Esquerda/etiologia , Função Ventricular Esquerda/fisiologia , Adulto , Índice de Massa Corporal , Compostos de Cetrimônio , Estudos de Coortes , Diástole , Combinação de Medicamentos , Feminino , Seguimentos , França/epidemiologia , Voluntários Saudáveis , Humanos , Incidência , Masculino , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/metabolismo , Pessoa de Meia-Idade , Miristatos , Ácidos Nicotínicos , Obesidade/epidemiologia , Obesidade/metabolismo , Estudos Prospectivos , Fatores de Risco , Simeticone , Ácidos Esteáricos , Triglicerídeos/sangue , Disfunção Ventricular Esquerda/epidemiologia , Disfunção Ventricular Esquerda/fisiopatologia
18.
J Am Med Dir Assoc ; 18(5): 451.e13-451.e25, 2017 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-28279605

RESUMO

OBJECTIVES: The longitudinal ADELAHYDE-2 study aims to identify the factors associated with cognitive impairment/decline and white matter hyperintensities burden. METHODS: Longitudinal single-center study comprising two visits separated by approximately 7 years. A total of 131 patients completed the two visits. The primary outcome was global memory composite scale, while the secondary outcome was white matter hyperintensities (WMH/Fazekas scale) load. RESULTS: Global memory at visit 2 (V2) was largely influenced by age, smoking status, glycated hemoglobin, and history of stroke already present at visit 1 (V1). These variables accounted for ∼51% of the memory alterations at V2. WMH at V2 was likely influenced by age, left ventricular hypertrophy, diabetes mellitus, carotid intima-media thickness, and body mass index at V1. These findings accounted for ∼37% of the WMH changes at V2. Increase in pulse wave velocity from V1 to V2 showed a trend for association with memory deterioration (adjusted estimates = 0.06; P = .067), whereas smoking and increase in systolic blood pressure (trend) were associated with an increment in WMH (adjusted estimates = 0.49; P = .047 and adjusted estimates = 0.01; P = .08, respectively). On the other hand, angiotensin-converting enzyme inhibitor/angiotensin receptor blockers and statins (trend) were likely to be protective (adjusted estimates for angiotensin-converting enzyme inhibitor/angiotensin receptor blockers = -0.49; P = .049, and adjusted estimates for statins = -0.46; P = .055). CONCLUSIONS: Several readily identifiable factors are associated with memory deterioration and WMH, many of which are potentially modifiable. Interventions aimed to control these risk factors need to be tested prospectively in order to assess their cognitive protective value.


Assuntos
Hipertensão/complicações , Transtornos da Memória/etiologia , Substância Branca/irrigação sanguínea , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Substância Branca/diagnóstico por imagem
19.
Fundam Clin Pharmacol ; 31(1): 83-103, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27862304

RESUMO

High blood pressure in pregnancy remains, by its complications, the leading cause of morbidity as well as maternal and fetal mortality. The frequency (5-10% of pregnancies) and the potential severity of this disease, for both mother and child, encourage to standardize and to optimize our medical practices. If the short-term complications for the mother and child are well known, long-term ones for the mother are beginning to be better identified. The onset of hypertension during pregnancy disrupts the classic organization of health care and requires the intervention of the general practitioner and/or an obstetrician, a gynecologist, a midwife, a cardiologist, a nephrologist. There is not always a care coordinator, and decisions are sometimes taken with delay. This is what drove the French Society of Hypertension, in partnership with the French National College of Gynecologists-Obstetricians, to develop a consensus proposing easy-to-use guidelines. Educating women and all health professionals to hypertension and its management, in line with current scientific data, is one of the major challenges of this consensus.


Assuntos
Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão Induzida pela Gravidez/terapia , Guias de Prática Clínica como Assunto , Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Monitorização Ambulatorial da Pressão Arterial/métodos , Doença Crônica , Feminino , França , Humanos , Gravidez , Sociedades Médicas
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