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1.
Kidney Int ; 99(5): 1162-1172, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33359501

RESUMO

Endothelial dysfunction, one of many causes of arterial changes in end-stage kidney disease (kidney failure), is a likely link between early vascular aging and the risk of thrombosis or bleeding in this condition. To evaluate this, we compared links between arterial stiffness and endothelial/coagulation factors in 55 patients receiving hemodialysis therapy and 57 age-/sex-matched control individuals. Arterial stiffness was assessed from carotid-femoral pulse wave velocity, and coagulation status from the endogenous thrombin generating potential. Markers of endothelial dysfunction (von Willebrand factor, tissue factor pathway inhibitor), neutrophil extracellular traps and tissue factor-positive extracellular vesicles were higher in patients with kidney failure. Prothrombin fragments 1 and 2, and D-dimer markers of in vivo coagulation activation were also higher. However, in vitro in the presence of platelets, endogenous thrombin generating potential was lower and its downregulation by activated protein C impaired. Antiplatelet drugs did not affect these parameters. In multiple regression analysis, prothrombin fragments 1 and 2, D-dimer, factor VIII and monocyte-derived tissue factor-positive extracellular vesicles correlated with higher carotid-femoral pulse wave velocity. In patients with kidney failure, in vivo hypercoagulability occurred with reduced thrombin generation in platelet-rich plasma, likely explaining the opposing thrombotic and bleeding tendencies in patients with kidney failure. Importantly, arteriosclerosis is more closely related to a prothrombotic state. Thus, coagulation changes plus arterial stiffness highlight a major therapeutic challenge for anticoagulant and antiplatelet drug use.


Assuntos
Arteriosclerose , Insuficiência Renal , Coagulação Sanguínea , Estudos de Casos e Controles , Humanos , Análise de Onda de Pulso , Insuficiência Renal/etiologia , Trombina
2.
Eur Heart J ; 39(7): 599-606, 2018 02 14.
Artigo em Inglês | MEDLINE | ID: mdl-29281076

RESUMO

Aims: People with exaggerated exercise blood pressure (BP) have adverse cardiovascular outcomes. Mechanisms are unknown but could be explained through impaired neural baroreflex sensitivity (BRS) and/or large artery stiffness. This study aimed to determine the associations of carotid BRS and carotid stiffness with exaggerated exercise BP. Methods and results: Blood pressure was recorded at rest and following an exercise step-test among 8976 adults aged 50 to 75 years from the Paris Prospective Study III. Resting carotid BRS (low frequency gain, from carotid distension rate, and heart rate) and stiffness were measured by high-precision echotracking. A systolic BP threshold of ≥ 150 mmHg defined exaggerated exercise BP and ≥140/90 mmHg defined resting hypertension (±antihypertensive treatment). Participants with exaggerated exercise BP had significantly lower BRS [median (Q1; Q3) 0.10 (0.06; 0.16) vs. 0.12 (0.08; 0.19) (ms2/mm) 2×108; P < 0.001] but higher stiffness [mean ± standard deviation (SD); 7.34 ± 1.37 vs. 6.76 ± 1.25 m/s; P < 0.001) compared to those with non-exaggerated exercise BP. However, only lower BRS (per 1SD decrement) was associated with exaggerated exercise BP among people without hypertension at rest {specifically among those with optimal BP; odds ratio (OR) 1.16 [95% confidence intervals (95% CI) 1.01; 1.33], P = 0.04 and high-normal BP; OR, 1.19 (95% CI 1.07; 1.32), P = 0.001} after adjustment for age, sex, body mass index, smoking, alcohol, total cholesterol, high-density lipoprotein cholesterol, resting heart rate, and antihypertensive medications. Conclusion: Impaired BRS, but not carotid stiffness, is independently associated with exaggerated exercise BP even among those with well controlled resting BP. This indicates a potential pathway from depressed neural baroreflex function to abnormal exercise BP and clinical outcomes.


Assuntos
Barorreflexo/fisiologia , Pressão Sanguínea/fisiologia , Exercício Físico/fisiologia , Hipertensão/fisiopatologia , Rigidez Vascular/fisiologia , Idoso , Artérias Carótidas/fisiopatologia , Teste de Esforço , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
3.
Diabetologia ; 61(5): 1089-1097, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29305626

RESUMO

AIMS/HYPOTHESIS: Hyperglycaemia has been associated with the incidence of all and specific types of cancer, distinct from the risks related to diabetes. The relationships between blood glucose and mortality rates related to all and specific cancers were analysed in comparison with all-cause or non-cancer-related mortality rates in a large, general primary care population in France. METHODS: Between January 1991 and December 2008, 301,948 participants (193,221 men and 108,727 women), aged 16-95 years (mean ± SD 44.8 ± 12.0 years for men and 45.1 ± 14.2 years for women), had a health check at the IPC Centre. All data collected in standard conditions during the health checks-up were used for statistical analysis All examinations were performed under fasting conditions and included a blood glucose measurement. Participants with known diabetes (<9%) were excluded from the analysis. Participants were classified into quintiles based on their blood glucose measurement and were followed for a maximum of 17 years (mean ± SD 9.2 ± 4.7 years) to assess all-cause, cancer and non-cancer mortality rates. RESULTS: A non-linear relationship was observed between cancer mortality rates and blood glucose quintile after adjustment for age and sex. There was a significant association between the group with the highest blood glucose level and cancer-related death (multivariate Cox model, HR [95% CI] 1.17 [1.03, 1.34]), while the group with normoglycaemia showed no association with cancer-related deaths. We did not observe a relationship between blood glucose and all-cause or non-cancer mortality rates. An excess risk of death was observed in the highest blood glucose quintile for gastrointestinal cancer and leukaemia. Adjustments for diabetes and aspirin use did not modify the results. However, this excess risk disappeared with use of glucose-lowering agents (HR [95% CI] 1.03 [0.74, 1.43]). CONCLUSIONS/INTERPRETATION: Hyperglycaemia is associated with significantly higher rates of cancer-related deaths, particularly in gastrointestinal cancer and leukaemia, but not with non-cancer-related deaths. The association is retained when taking into account confounding factors, including chronic aspirin treatment.


Assuntos
Hiperglicemia/complicações , Neoplasias/epidemiologia , Neoplasias/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Glicemia/análise , Estudos de Coortes , Feminino , Humanos , Hiperglicemia/epidemiologia , Incidência , Inflamação , Masculino , Pessoa de Meia-Idade , Dinâmica não Linear , Modelos de Riscos Proporcionais , Adulto Jovem
4.
Haematologica ; 103(4): 645-654, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29351982

RESUMO

The prevalence of the metabolic syndrome among adults from the French LEA childhood acute leukemia survivors' cohort was prospectively evaluated considering the type of anti-leukemic treatment received, and compared with that of controls. The metabolic profile of these patients was compared with that of controls. A total of 3203 patients from a French volunteer cohort were age- and sex-matched 3:1 to 1025 leukemia survivors (in both cohorts, mean age: 24.4 years; females: 51%). Metabolic syndrome was defined according to the National Cholesterol Education Program's Adult Treatment Panel III criteria. Metabolic syndrome was found in 10.3% of patients (mean follow-up duration: 16.3±0.2 years) and 4.5% of controls, (OR=2.49; P<0.001). Patients transplanted with total body irradiation presented the highest risk (OR=6.26; P<0.001); the other treatment groups also showed a higher risk than controls, including patients treated with chemotherapy only. Odd Ratios were 1.68 (P=0.005) after chemotherapy only, 2.32 (P=0.002) after chemotherapy and cranial irradiation, and 2.18 (P=0.057) in patients transplanted without irradiation. Total body irradiation recipients with metabolic syndrome displayed a unique profile compared with controls: smaller waist circumference (91 vs 99.6 cm; P=0.01), and increased triglyceride levels (3.99 vs 1.5 mmol/L; P<0.001), fasting glucose levels (6.2 vs 5.6 mmol/L; P=0.049), and systolic blood pressure (137.9 vs 132.8 mmHg; P=0.005). By contrast, cranial irradiation recipients with metabolic syndrome had a larger waist circumference (109 vs 99.6 cm; P=0.007) than controls. Regardless of the anti-leukemic treatment, metabolic syndrome risk was higher among childhood leukemia survivors. Its presentation differed depending on the treatment type, thus suggesting a divergent pathophysiology. This study is registered at clinicaltrials.gov identifier: 01756599.


Assuntos
Leucemia/complicações , Síndrome Metabólica/epidemiologia , Sobreviventes , Adulto , Antineoplásicos/uso terapêutico , Estudos de Casos e Controles , Irradiação Craniana , Feminino , França , Transplante de Células-Tronco Hematopoéticas/métodos , Humanos , Masculino , Prevalência , Fatores de Risco , Triglicerídeos/sangue , Circunferência da Cintura , Irradiação Corporal Total , Adulto Jovem
5.
J Clin Periodontol ; 45(7): 818-831, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29611224

RESUMO

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.


Assuntos
Periodontite , Adulto , Humanos , Programas de Rastreamento , Pessoa de Meia-Idade , Autorrelato , Sensibilidade e Especificidade , Inquéritos e Questionários
6.
Kidney Int ; 91(3): 704-710, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28010886

RESUMO

Left ventricular hypertrophy is a strong causal risk factor of cardiovascular morbidity and death in end stage kidney failure, and its prognostic value is taken for granted in this population. However, the issue has never been formally tested by state-of-art prognostic analyses. Therefore, we determined the prognostic power of the left ventricular mass index (LVMI) for all-cause and cardiovascular death beyond and above that provided by well validated clinical risk scores, the annualized rate of occurrence cohort risk scores (ARO, all cause death risk and cardiovascular risk). Two large cohorts that measured LVMI in 207 hemodialysis patients in the South Italian CREED cohort and 287 patients in the French Hospital Manhes cohort were analyzed. Over a two year follow-up, 123 patients died (cardiovascular death 65%). In Cox models both the LVMI and the ARO risk scores were significantly related to all-cause and cardiovascular death. In prognostic analyses, LVMI per se showed an inferior discriminatory power (Harrell's C index) to that of the ARO risk scores (all-cause death: -10%; cardiovascular death: -5%). LVMI largely failed to improve model calibration based on the ARO risk scores, and added nonsignificant discriminatory power (Integrated Discrimination Index +2% and +3%) and quite limited reclassification ability (Net Reclassification Index +4.3%, and +8.8) to the ARO risk scores. Thus, while left ventricular hypertrophy remains a fundamental treatment target in end stage kidney failure, the measurement of LVMI solely for risk stratification is unwarranted in this condition.


Assuntos
Técnicas de Apoio para a Decisão , Ecocardiografia , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/epidemiologia , Falência Renal Crônica/epidemiologia , Adulto , Idoso , Causas de Morte , Distribuição de Qui-Quadrado , Feminino , França/epidemiologia , Humanos , Hipertrofia Ventricular Esquerda/mortalidade , Hipertrofia Ventricular Esquerda/terapia , Incidência , Itália/epidemiologia , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/mortalidade , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Valor Preditivo dos Testes , Prevalência , Prognóstico , Modelos de Riscos Proporcionais , Diálise Renal , Medição de Risco , Fatores de Risco , Fatores de Tempo
7.
Am J Nephrol ; 45(1): 72-81, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-27898419

RESUMO

BACKGROUND: Patients with end-stage renal disease (ESRD) are at a high risk of cardiovascular mortality (CVM). In patients with ESRD, arterial stiffness increases at an earlier age when compared to the general population and this contributes to the overall risk of cardiovascular mortality. The main objective of this study was to clarify the interplay between age and cardiovascular alterations in ESRD. METHODS: Prospective, observational cohort study initiated in April 1987 until the end of 1998 with events recorded until the end of the year 2000 at the F.H. Manhes Hospital Center, Fleury-Mérogis (in the Paris/Ile de France area). RESULTS: The study population consisted of 278 ESRD patients undergoing dialysis therapy. The mean ± SD age was 53 ± 16 years. The mean pulse-wave velocity (PWV) was ∼11 m/s, with ∼37% of patients having a PWV >12 m/s. During the follow-up period, 91 patients died from CV causes. PWV >12 m/s was associated with CVM in the unadjusted model but lost its prognostic value in patients >60 years (p for interaction = 0.008). In patients ≤60 years, PWV was found to be a strong and independent predictor of CVM with hazards ratio (95% CI) of 14.382 (7.120-29.047), p < 0.001, and it improved the prognostic reclassification of a model containing well-established prognostic variables. According to multivariable regression analysis, aortic PWV was strongly associated with age (R2 = 0.37, p < 0.001). CONCLUSION: A PWV >12 m/s provides important prognostic information in ESRD patients under 60 years of age, whereas in older patients, its prognostic relevance is lost. These findings are of critical relevance for early intervention guidance and trial end-point/treatment effect interpretation.


Assuntos
Doenças Cardiovasculares/epidemiologia , Falência Renal Crônica/terapia , Análise de Onda de Pulso , Diálise Renal , Rigidez Vascular , Adulto , Fatores Etários , Idoso , Aorta/fisiopatologia , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/fisiopatologia , Estudos de Coortes , Feminino , Humanos , Falência Renal Crônica/epidemiologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Medição de Risco
8.
Arterioscler Thromb Vasc Biol ; 36(10): 2115-24, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27585698

RESUMO

OBJECTIVE: We hypothesized that subclinical markers of vascular structure and function, which are independent predictors of cardiovascular disease, would be less frequent in subjects with ideal than poor cardiovascular health (CVH) as defined by the American Heart Association (AHA). APPROACH AND RESULTS: Carotid parameters were measured using high-precision echotracking device in 9155 nonreferred participants attending a health checkup in a large health center in Paris (France) between 2008 and 2012. According to the AHA, participants with 0 to 2, 3 to 4, and 5 to 7 metrics (smoking, physical activity, body mass index, diet, blood glucose and total cholesterol, blood pressure) at the ideal level were categorized as having poor, intermediate, and ideal CVH. Carotid parameters were dichotomized according to their median value, and multivariable logistic regression analysis was performed. Mean age was 59.5 (SD 6.3) years; 39% were females, and ideal CVH was present in 10.11% of the study participants. After adjustment for age, sex, education, and living alone and compared with a poor CVH, an ideal CVH was associated with lower common carotid artery intima-media thickness (odds ratio=1.64; 95% confidence interval 1.40, 1.93), absence of carotid plaques (odds ratio=2.14; 95% confidence interval 1.60, 2.87), lower Young's elastic modulus (odds ratio=2.43; 95% confidence interval 2.07, 2.84), and higher carotid distensibility coefficient (odds ratio=2.90; 95% confidence interval 2.47, 3.41). CONCLUSIONS: In community subjects aged 50 to 75 years, ideal CVH was associated with substantially less arterial stiffness and thickness. These associations might contribute to the lower risk of cardiovascular diseases in subjects with ideal CVH.


Assuntos
Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/fisiopatologia , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/fisiopatologia , Espessura Intima-Media Carotídea , Nível de Saúde , Placa Aterosclerótica , Rigidez Vascular , Fatores Etários , Idoso , Doenças Assintomáticas , Doenças das Artérias Carótidas/epidemiologia , Distribuição de Qui-Quadrado , Estudos Transversais , Módulo de Elasticidade , Feminino , Humanos , Estilo de Vida , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Paris/epidemiologia , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Fatores de Risco , Comportamento de Redução do Risco , Fatores Sexuais , Fatores Socioeconômicos , Inquéritos e Questionários
9.
BMC Public Health ; 17(1): 960, 2017 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-29258476

RESUMO

BACKGROUND: Walkable neighborhoods are purported to impact a range of cardiometabolic outcomes through increased walking, but there is limited research that examines multiple cardiometabolic outcomes. Additionally, few Walk Score (a novel measure of neighborhood walkability) studies have been conducted in a European context. We evaluated associations between neighborhood Walk Score and selected cardiometabolic outcomes, including obesity, hypertension and heart rate, among adults in the Paris metropolitan area. METHODS AND RESULTS: We used data from the second wave of the RECORD Study on 5993 participants recruited in 2011-2014, aged 34-84 years, and residing in Paris (France). To this existing dataset, we added Walk Score values for participants' residential address. We used multilevel linear models for the continuous outcomes and modified Poisson models were used for our categorical outcomes to estimate associations between the neighborhood Walk Score (both as a continuous and categorical variable) (0-100 score) and body mass index (BMI) (weight/height2 in kg/m2), obesity (kg/m2), waist circumference (cm), systolic blood pressure (SBP) (mmHg), diastolic blood pressure (DBP) (mmHg), hypertension (mmHg), resting heart rate (RHR) (beats per minute), and neighborhood recreational walking (minutes per week). Most participants lived in Walker's Paradise (48.3%). In multivariate models (adjusted for individual variables, neighborhood variables, and risk factors for cardiometabolic outcomes), we found that neighborhood Walk Score was associated with decreased BMI (ß: -0.010, 95% CI: -0.019 to -0.002 per unit increase), decreased waist circumference (ß: -0.031, 95% CI: -0.054 to -0.008), increased neighborhood recreational walking (ß: +0.73, 95% CI: +0.37 to +1.10), decreased SBP (ß: -0.030, 95% CI: -0.063 to -0.0004), decreased DBP (ß: -0.028, 95% CI: -0.047 to -0.008), and decreased resting heart rate (ß: -0.026 95% CI: -0.046 to -0.005). CONCLUSIONS: In this large population-based study, we found that, even in a European context, living in a highly walkable neighborhood was associated with improved cardiometabolic health. Designing walkable neighborhoods may be a viable strategy in reducing cardiovascular disease prevalence at the population level.


Assuntos
Doenças Cardiovasculares/epidemiologia , Planejamento Ambiental , Características de Residência/estatística & dados numéricos , Caminhada , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Frequência Cardíaca , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Paris/epidemiologia , Fatores de Risco
10.
J Am Soc Nephrol ; 27(6): 1837-46, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-26475595

RESUMO

Aging incurs aortic stiffening and dilation, but these changes are less pronounced in peripheral arteries, resulting in stiffness and geometry gradients influencing progression of the forward and reflected pressure waves. Because premature arterial aging is observed in ESRD, we determined the respective roles of stiffness and aortic geometry gradients in 73 controls and 156 patients on hemodialysis. We measured aortic pulse wave velocity (PWV) and brachial PWV to evaluate the stiffness gradient [(brachial PWV/aortic PWV)(0.5)] and ascending aortic and aortic bifurcation diameters to assess aortic taper (ascending aortic diameter/aortic bifurcation diameter). The global reflection coefficient was estimated from characteristic impedance and vascular resistance. Cox proportional hazard models were used to determine mortality risk. The age-associated increase in aortic PWV was higher in patients (P<0.001). In controls, aortic ascending and bifurcation diameters increased with age, with an unchanged aortic taper. In patients on hemodialysis, age did not associate with increased ascending aortic diameter but did associate with increased aortic bifurcation diameter and decreased aortic taper, both of which also associated with abdominal aortic calcifications and smaller global reflection coefficient (P<0.001). In patients, multivariate models revealed all-cause and cardiovascular mortality associated with age, aortic PWV, and aortic bifurcation diameter with high specificity and sensitivity. Using stiffness gradient, aortic taper, or global reflection coefficient in the model produced similar results. Thus, whereas aortic stiffness is a known independent predictor of mortality, these results indicate the importance of also evaluating the aortic geometry in patients on hemodialysis.


Assuntos
Aorta/patologia , Aorta/fisiopatologia , Hemodinâmica , Falência Renal Crônica/mortalidade , Falência Renal Crônica/fisiopatologia , Envelhecimento , Feminino , Humanos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Diálise Renal
11.
Clin Oral Investig ; 21(4): 975-983, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-27178314

RESUMO

OBJECTIVES: Sleep disorders (SDs), particularly sleep deprivation, may alter the immune system and induce systemic inflammation. Recent evidence supports an association between SDs and periodontal diseases. This cross-sectional epidemiological study aims to compare oral health variables, such as the amount of plaque/calculus, gingival inflammation, and masticatory function, in individuals with and without SDs. MATERIALS AND METHODS: The study population consisted in a French cohort of individuals who underwent medical and oral examinations between 2012 and 2013. Multivariate logistic regression and general linear models were used for group comparisons. RESULTS: Over a total of 29,870 individuals, 11,185 (37.4 %) reported to suffer from SDs on a regular basis. Compared to individuals without SDs, SD individuals were older (mean age 44.2 vs. 45.3 years; p < 0.0001), prevalently female (38.6 vs. 52.1 %; p < 0.0001), and with higher BMI (25.3 vs. 25.7; p < 0.0001). Moreover, SD individuals displayed a significantly higher prevalence of comorbidities, higher level of gingival inflammation (adjusted odds ratio 1.22 [95 % confidence interval 1.13-1.32]), and lower masticatory function (1.45 [1.33-1.58]). Short sleepers (<6 h of sleep/night) were found to be at an increased risk of gingival inflammation (1.25 [1.1-1.4]). SD individuals with moderate-to-high gingival inflammation showed a significantly increased risk of cardiovascular disease (1.39 [1.04-1.84]) compared to SD individuals with low or no gingival inflammation. CONCLUSIONS: Individuals with self-report SDs are at increased risk of gingival inflammation. The coexistence of SDs and gingival inflammation is associated with an increased risk of cardiovascular diseases. CLINICAL RELEVANCE: These findings provide evidence for an association between SDs and gingival inflammation and support further clinical and experimental studies.


Assuntos
Doenças da Boca/complicações , Saúde Bucal , Transtornos do Sono-Vigília/complicações , Adulto , Estudos Transversais , Feminino , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças da Boca/epidemiologia , Transtornos do Sono-Vigília/epidemiologia , Inquéritos e Questionários
12.
Am J Epidemiol ; 184(8): 570-578, 2016 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-27659779

RESUMO

Environmental health studies have examined associations between context and health with individuals as statistical units. However, investigators have been unable to investigate momentary exposures, and such studies are often vulnerable to confounding from, for example, individual-level preferences. We present a Global Positioning System (GPS)-based methodology for segmenting individuals' observation periods into visits to places and trips, enabling novel life-segment investigations and case-crossover analysis for improved inferences. We analyzed relationships between built environments and walking in trips. Participants were tracked for 7 days with GPS receivers and accelerometers and surveyed with a Web-based mapping application about their transport modes during each trip (Residential Environment and Coronary Heart Disease (RECORD) GPS Study, France, 2012-2013; 6,313 trips made by 227 participants). Contextual factors were assessed around residences and the trips' origins and destinations. Conditional logistic regression modeling was used to estimate associations between environmental factors and walking or accelerometry-assessed steps taken in trips. In case-crossover analysis, the probability of walking during a trip was 1.37 (95% confidence interval: 1.23, 1.61) times higher when trip origin was in the fourth (vs. first) quartile of service density and 1.47 (95% confidence interval: 1.23, 1.68) times higher when trip destination was in the fourth (vs. first) quartile of service density. Green spaces at the origin and destination of trips were also associated with within-individual, trip-to-trip variations in walking. Our proposed approach using GPS and Web-based surveys enables novel life-segment epidemiologic investigations.


Assuntos
Acelerometria/métodos , Planejamento Ambiental , Sistemas de Informação Geográfica/estatística & dados numéricos , Mapeamento Geográfico , Caminhada/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Cross-Over , Feminino , França , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade
13.
Psychosom Med ; 77(9): 1039-49, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26461856

RESUMO

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.


Assuntos
Depressão/epidemiologia , Neutrófilos , Fumar/epidemiologia , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Glicemia/análise , Causalidade , Estudos Transversais , Depressão/sangue , Depressão/imunologia , Feminino , Hábitos , Humanos , Contagem de Leucócitos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Fumar/sangue , Fumar/imunologia , Fumar/psicologia , Fatores Socioeconômicos
14.
Int J Behav Nutr Phys Act ; 11: 124, 2014 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-25260793

RESUMO

BACKGROUND: Accurate information is lacking on the extent of transportation as a source of physical activity, on the physical activity gains from public transportation use, and on the extent to which population shifts in the use of transportation modes could increase the percentage of people reaching official physical activity recommendations. METHODS: In 2012-2013, 234 participants of the RECORD GPS Study (French Paris region, median age = 58) wore a portable GPS receiver and an accelerometer for 7 consecutive days and completed a 7-day GPS-based mobility survey (participation rate = 57.1%). Information on transportation modes and accelerometry data aggregated at the trip level [number of steps taken, energy expended, moderate to vigorous physical activity (MVPA), and sedentary time] were available for 7,644 trips. Associations between transportation modes and accelerometer-derived physical activity were estimated at the trip level with multilevel linear models. RESULTS: Participants spent a median of 1 h 58 min per day in transportation (8.2% of total time). Thirty-eight per-cent of steps taken, 31% of energy expended, and 33% of MVPA over 7 days were attributable to transportation. Walking and biking trips but also public transportation trips with all four transit modes examined were associated with greater steps, MVPA, and energy expenditure when compared to trips by personal motorized vehicle. Two simulated scenarios, implying a shift of approximately 14% and 33% of all motorized trips to public transportation or walking, were associated with a predicted 6 point and 13 point increase in the percentage of participants achieving the current physical activity recommendation. CONCLUSIONS: Collecting data with GPS receivers, accelerometers, and a GPS-based electronic mobility survey of activities and transportation modes allowed us to investigate relationships between transportation modes and physical activity at the trip level. Our findings suggest that an increase in active transportation participation and public transportation use may have substantial impacts on the percentage of people achieving physical activity recommendations.


Assuntos
Acelerometria , Sistemas de Informação Geográfica , Atividade Motora , Meios de Transporte/estatística & dados numéricos , Adulto , Idoso , Ciclismo/estatística & dados numéricos , Coleta de Dados , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paris , Inquéritos e Questionários , Caminhada/estatística & dados numéricos
15.
Int J Behav Nutr Phys Act ; 11(1): 20, 2014 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-24555820

RESUMO

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.


Assuntos
Planejamento Ambiental , Recreação , Características de Residência , Caminhada/estatística & dados numéricos , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paris , Estudos Retrospectivos , Fatores Socioeconômicos , Inquéritos e Questionários
16.
BMC Public Health ; 14: 750, 2014 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-25059313

RESUMO

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.


Assuntos
Doenças Cardiovasculares/epidemiologia , Ocupações/economia , Ocupações/estatística & dados numéricos , Classe Social , Adolescente , Adulto , Fatores Etários , Idoso , Glicemia/análise , Pressão Sanguínea , Índice de Massa Corporal , Doenças Cardiovasculares/sangue , Colesterol/sangue , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paris/epidemiologia , Fatores de Risco , Fatores Socioeconômicos , Circunferência da Cintura
17.
Blood Purif ; 35(1-3): 16-21, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23343541

RESUMO

BACKGROUND: Accelerated arterial aging and inadequate outward arterial remodeling are observed in end-stage renal disease (ESRD) patients. Whether these changes could be closely associated with arterial calcifications has never been investigated. METHODS: 155 ESRD patients and 105 age-, sex-, and blood pressure-matched control subjects were included. Common carotid artery (CCA) pressure, diameter, intima-media thickness, elastic modulus, and presence of calcified plaques were measured ultrasonographically. Carotid artery stiffness was determined from simultaneously recorded CCA diameter and stroke changes in diameter and CCA pressure waveforms, obtained by applanation tonometry. RESULTS: Compared with control subjects, ESRD patients had increased CCA systolic and pulse pressures (p < 0.001), larger CCA diameter (p < 0.001) and CCA intima-media thickness (p < 0.01) and similar CCA relative wall thickness. In ESRD patients the arterial remodeling was associated with increased CCA elastic modulus/stiffness (p < 0.001). In ESRD patients the association between CCA elastic modulus and age was characterized by a steeper slope (p = 0.03), but after separation of uremic patients according to the presence of calcifications, the accelerated aging was observed only in calcified subjects. Despite higher CCA systolic and pulse pressures, the CCA relative wall thickness was similar to controls indicating an inadequate pressure-associated remodeling. Moreover, the positive systolic pressure/relative thickness correlation observed in control subjects was lost with paradoxical negative correlation in calcified ESRD patients (p = 0.03). CONCLUSION: These results indicate that, in ESRD patients, accelerated arterial aging and inadequate arterial hypertrophy are closely associated with the calcifications of arterial walls. Inadequate hypertrophy is responsible for high circumferential stress applied on the vessels.


Assuntos
Envelhecimento/patologia , Artérias Carótidas/patologia , Falência Renal Crônica/patologia , Calcificação Vascular/patologia , Adulto , Idoso , Pressão Sanguínea , Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/fisiopatologia , Espessura Intima-Media Carotídea , Estudos de Casos e Controles , Módulo de Elasticidade , Feminino , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/diagnóstico por imagem , Falência Renal Crônica/fisiopatologia , Masculino , Pessoa de Meia-Idade , Volume Sistólico , Calcificação Vascular/complicações , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/fisiopatologia , Resistência Vascular , Rigidez Vascular
18.
Arterioscler Thromb Vasc Biol ; 31(5): 1226-32, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21293010

RESUMO

OBJECTIVE: To investigate in women older than 60 whether aortic stiffness or pulse pressure (PP) is associated with selected procoagulant or anticoagulant factors and to examine whether pulsatile stretch influences these factors in human vascular smooth muscle cells (VSMCs) in vitro. METHODS AND RESULTS: Aortic pulse wave velocity (PWV) and carotid PP were studied in 123 apparently healthy postmenopausal women. PWV, PP, von Willebrand factor, and free tissue factor pathway inhibitor (TFPI), but not mean arterial pressure, increased with age. Free TFPI and PWV were positively correlated, even after adjustment for age and PP and other confounding parameters. In vitro, 5% or 10% pulsatile stretch (at 1 Hz) enhanced TFPI synthesis and secretion by VSMCs in a time-independent manner (1 to 48 hours) without changes in protein level of smooth muscle myosin heavy chain. Application of 5% static stretch had no effect. CONCLUSIONS: In postmenopausal women, free TFPI increases as vascular wall function deteriorates and PP increases. These findings are supported by the increase in TFPI synthesized by VSMCs in response to cyclic stress in vitro. They suggest that VSMCs require pulsatility to interfere with the coagulation process and highlight the relevance of plasma free TFPI levels to cardiovascular diseases.


Assuntos
Envelhecimento/sangue , Coagulação Sanguínea , Pressão Sanguínea , Lipoproteínas/sangue , Músculo Liso Vascular/metabolismo , Miócitos de Músculo Liso/metabolismo , Pós-Menopausa/sangue , Fluxo Pulsátil , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Aorta/metabolismo , Aorta/fisiopatologia , Biomarcadores/sangue , Artérias Carótidas/metabolismo , Artérias Carótidas/fisiopatologia , Células Cultivadas , Estudos Transversais , Elasticidade , Células Endoteliais/metabolismo , Feminino , Humanos , Modelos Lineares , Mecanotransdução Celular , Pessoa de Meia-Idade , Músculo Liso Vascular/fisiopatologia , Estresse Mecânico , Fatores de Tempo
19.
Prev Med ; 55(1): 50-5, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22564774

RESUMO

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.


Assuntos
Planejamento Ambiental , Comportamentos Relacionados com a Saúde , Corrida Moderada/psicologia , Qualidade de Vida , Características de Residência/estatística & dados numéricos , Meio Social , Adulto , Idoso , Doença Crônica/prevenção & controle , Estudos de Coortes , Feminino , França , Humanos , Relações Interpessoais , Corrida Moderada/fisiologia , Masculino , Pessoa de Meia-Idade , Análise Multinível , Avaliação de Resultados em Cuidados de Saúde , Fatores Socioeconômicos
20.
Am J Clin Nutr ; 115(3): 694-704, 2022 03 04.
Artigo em Inglês | MEDLINE | ID: mdl-34791007

RESUMO

BACKGROUND: The effects of a dietary supplementation with the vegetable ω-3 α-linolenic acid (ALA) on cardiovascular homeostasis are unclear. In this context, it would be interesting to assess the effects of camelina oil. OBJECTIVE: This study aimed to assess the cardiovascular and metabolic effects of camelina oil in hypertensive patients with metabolic syndrome. METHODS: In a double-blind, placebo-controlled randomized study, treated essential hypertensive patients with metabolic syndrome received, during 6 mo, either cyclodextrin-complexed camelina oil containing ≈ 1.5 g ALA/d (n = 40) or an isocaloric placebo (n = 41), consisting of the same quantity of cyclodextrins and wheat starch. Anthropometric data, plasma lipids, glycemia, insulinemia, creatininemia, TBARs, high-sensitivity C-reactive protein, and n-3, n-6, and n-9 fatty acids in erythrocyte membranes were measured. Peripheral and central blood pressures, arterial stiffness, carotid intima-media thickness, and brachial artery endothelium-dependent flow-mediated dilatation (FMD) and endothelium-independent dilatation were assessed. RESULTS: Compared with placebo, camelina oil increased ALA (mean ± SD: 0 ± 0.04 compared with 0.08 ± 0.06%, P <0.001), its elongation product EPA (0 ± 0.5 compared with 0.16 ± 0.65%, P <0.05), and the n-9 gondoic acid (GA; 0 ± 0.04 compared with 0.08 ± 0.04%, P <0.001). No between-group difference was observed for cardiovascular parameters. However, changes in FMD were associated with the magnitude of changes in EPA (r = 0.26, P = 0.03). Compared with placebo, camelina oil increased fasting glycemia (-0.2 ± 0.6 compared with 0.3 ± 0.5 mmol/L, P <0.001) and HOMA-IR index (-0.8 ± 2.5 compared with 0.5 ± 0.9, P <0.01), without affecting plasma lipids, or inflammatory and oxidative stress markers. Changes in HOMA-IR index were correlated with the magnitude of changes in GA (r = 0.32, P <0.01). Nutritional intake remained similar between groups. CONCLUSION: ALA supplementation with camelina oil did not improve vascular function but adversely affected glucose metabolism in hypertensive patients with metabolic syndrome. Whether this adverse effect on insulin sensitivity is related to GA enrichment, remains to be elucidated.


Assuntos
Ácidos Graxos Ômega-3 , Hipertensão , Síndrome Metabólica , Espessura Intima-Media Carotídea , Método Duplo-Cego , Ácidos Graxos Ômega-3/farmacologia , Humanos , Hipertensão/tratamento farmacológico , Síndrome Metabólica/tratamento farmacológico
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