279 Prevalence of cardiovascular risk factors in coronary patients from the Sahel region of Tunisia

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Archives of Cardiovascular Diseases Supplements (2011) 3, 89-94

year. At three months after MI, 20.6% of the patients were no longer treated with dual antiplatelet therapy. The results presented are likely to be an underestimation of adherence since some patients who buy their treatment, may not take it. This could explain some “resistance” described to antipletelet therapy.

Population risk is listed below Evaluated (%) Framingham (%)

Score (%)

Low

40

41

28

Medium

37

24

24

High

23

35

48

278

Physicians evaluation mismatched with Framigham for 50% of the patients and 27% were under-evaluated. Evaluation mismatched with SCORE for 53% of the patients, 38% were under-evaluated. Within the 25% of the patients having a Framingham score >20% and without a lipid lowering treatment, 70% was under evaluated by physicians. Within the 38% of the patients having a SCORE calculation 5% and without a lipid lowering treatment, 78% were under evaluated. Explanatory factors for under-evaluation in primary prevention according to SCORE OR

CI 95%

Treated HBP vs no HBP

2,55

2.04-3.19

Gender (male)

2,44

2,16-2,76

LDLc

2,13

1,78-2,55

Smoker

1,82

1,52-2,19

Chronic inflammatory disease

1,19

1,00-1,42

Age

1,16

1,15-1,17

Conclusion: This study underlines the mismatch between GP perceived CVR and calculated CVR, especially for high CVR patient. Males, patients with treated HBP and with high LDL-c were at increased risk of CVR underevaluation.

January 15th, Saturday 2011

277 Adherence to dual antiplatelet therapy after myocardial infarction: results from a french health insurance reimbursement database Philippe Latry (1), Thierry Couffinhal (2), Marianne Lafitte (2), Claude Peter (1), Karin Martin-Latry (3) (1) Direction Régionale du Service Médical d'Aquitaine, Bordeaux, France - (2) Hôpital Haut-Lévêque, Centre d’exploration, de prévention et de traitement de l’athérosclérose, Pessac, France - (3) Université Bordeaux 2, Inserm U657, Bordeaux, France

Cardiovascular disease is associated with an increased risk of chronic obstructive pulmonary disease in a population screened by spirometry Emilie Bérard (1), Vanina Bongard (2), Dany Brouquières (3), Dorota Taraszkiewicz (4), Nicolas Roche (5), Thierry Perez (6), Stéphane Fievez (7), François Deschamps (8), Roger Escamilla (3), Jean Ferrières (4) (1) INSERM U558, Département d'Epidémiologie, Toulouse Cedex, France - (2) CHU, University School of Medicine, Epidemiology, INSERM U558, Toulouse, France - (3) Toulouse University Hospital, Respiratory Medicine, Toulouse, France - (4) CHU Rangueil, Service de Cardiologie B, Toulouse Cedex 9, France - (5) Hôtel-Dieu, Respiratory Medecine, Paris, France - (6) Hôpital Calmette, CHRU de LILLE, Service EFR et Pôle des Maladies Respiratoires, Lille, France - (7) PFIZER, Outcomes Research, Paris, France - (8) Boehringer Ingelheim France, Medical Affairs, Respiratory Medicine, Paris, France Purpose: Chronic Obstructive Pulmonary Disease (COPD) is expected to be the third cause of mortality in the world in 2020. Paradoxically, this disease is widely underdiagnosed and its prevalence remains relatively unknown, in particular in people at cardiovascular risk for whom the association with COPD may worsen the prognosis. The aim of this study was to assess COPD prevalence in a population at cardiovascular risk and to analyse determinants of COPD. Methods: Our study was based on patients referred for cardiovascular check-up to a Preventive Cardiology Clinic in a University Hospital in 2009. Participants answered to questionnaires on socio-economic level, medical history and life style. They completed an extensive physical examination and a spirometry test. COPD prevalence was based on the spirometric classification proposed by the Global Initiative for chronic Obstructive Lung Disease. Determinants of COPD were assessed with logistic regression. Results: The sample comprised 502 participants (mean age: 57.4 ±11.1 years), including 60% of men, 17% of current smokers, 42% of former smokers and 10% of patients with a history of cardiovascular disease (ischemic heart disease, cerebrovascular or peripheral arterial disease). Ten-year risk of coronary heart disease according to the Framingham equation was intermediate (10-20%) for 33% of patients and high (> 20%) for 5%. After exclusion of asthmatic patients, 5.8% [95% CI: 3.9% - 8.2%] were spirometrically screened as COPD patients (Forced Expiratory Volume in one second / Forced Vital Capacity < 0.70). After adjustment for age, gender and smoking, the odds ratio for COPD was 4.44 [1.83-10.78] (p-value=0.001) in patients with a history of cardiovascular disease compared to those without. Besides, 86% of the patients screened with COPD had never been previously diagnosed. Conclusion: Patients with cardiovascular disease are at increased risk of COPD and thus should beneficiate from COPD screening.

Background: The French guidelines recommend dual antiplatelet therapy after acute myocardial infarction (MI). Purpose: To estimate persistence of dual antiplatelet therapy after MI. Methods: A cohort study was conducted using data from the main French health insurance reimbursement database of the Aquitaine region (southwest France). Patients who have been hospitalized for MI in 2008 were first identified. Then, we looked for their reimbursement form of dual antiplatelet therapy (aspirin+clopidogrel) treatment for the following 12 months. Adherence was assessed by using two parameters: proportion of days covered by the treatment (medication availability) and persistence. The treatment persistence was the percentage of patients still treated at the end of the period. Discontinuation was defined as a minimum gap of 30 days between the theoretical end date of prescription reimbursed (based on a days’ supply) and the starting date of the next one. Results: Among the 634 patients identified, 40 had no reimbursement of dual antiplatelet therapy immediately after discharge. At three month, 15.2% of the remaining patients did not buy at least one of the two treatments. They were 48.2% at 12 months although the medication availability was 90%. Conclusion: Theses results suggest that while the patients have good medication availability, the treatment is often stopped before one

 © Elsevier Masson SAS. All rights reserved.

279 Prevalence of cardiovascular risk factors in coronary patients from the Sahel region of Tunisia Riadh Jemaa (1), Amani Kallel (1), Yosra Sédiri (1), Essia Boughezala (2), Habib Gamra (3), Faouzi Maatoug (3), Habib Ammar (4), Abdelhamid Ben Othmane (5), Ghabbara Abderraouf (1), Naziha Kaabachi (1) (1) Hôpital La Rabta, Biochimie, Tunis, Tunisie - (2) Hôpital Sahloul, Cardiologie, Sousse, Tunisie - (3) Hôpital Fattouma Bourguiba, Monastir, Tunisie - (4) Hôpital Farhat Hached, Cardiologie, Sousse, Tunisie - (5) Hôpital Taher Safar, Cardiologie, Mahdia, Tunisie Introduction: Cardiovascular diseases are the leading cause of mortality in the western countries at the same time they are beginning to appear with increasing frequency in developing countries. With the epidemiological transition phenomenon, Tunisia is now facing the growing prevalence of chronic diseases. The Tunisian epidemiological data on cardiovascular disease in the



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Archives of Cardiovascular Diseases Supplements (2011) 3, 89-94

hospital environment are scare. The aim of this study was to evaluate the prevalence of cardiovascular risk factors and their association in patients in Sahel (Tunisia), hospitalised for coronary disease in coronary care units at Sahloul and Farhat Hached (Sousse), fattouma Bourguiba (Monastir) and Tahar Sfar (Mahdia) hospitals, over the period 1994-1998. Patients and methods: The clinical features of 4138 patients (71.9% men with a mean age of 60.5 years, 2039 myocardial infarction, 2099 unstable angina) on hospital admission were analysed. Results: The prevalence of smoking was 57.7%, with a statistically significant difference between men (78.7%) and women (2.5%). The prevalence of hypertension (blood pressure 140/90 mmHg) was 38.4%. There is a statically significant difference in the prevalence of hypertension (p<0.001) between men (30%) and women (60.1%). The prevalence of diabetes (glycemia > 1.26 g/l) was 44.9%. The prevalence was higher in women (55.3%) than in men (40.8%, p<0.001). The prevalence of obesity (BMI 30 kg/m2) (24.8%) was higher in women (30.2%) than in men (22.7%), p<0.001. The prevalence of dyslipidemia (CT > 2.5 g/l and/or TG> 1.5 g/l) was 37.2%. The percentage was higher in women (39.5%) than in men (36.2%). Twenty six percent of the patients had one cardiovascular risk factor, 30% had two, 21.6% had three factors and 10% had four or more factors. Conclusion: With this risk factor profile a national strategy of primary prevention and heart promotion is needed in Tunisia.

280 Impact of ozone air pollution on ischemic cerebral and cardiac events in Dijon, France. Yannick Bejot (1), Jean Bernard Henrotin (1), Guy Victor Osseby (1), Marianne Zeller (2), Yves Cottin (2), Maurice Giroud (1) (1) Faculté de Médecine, Université de Bourgogne, Dijon Stroke Registry, Dijon, France - (2) IFR 100 santé-STIC, LPPCE, Dijon, France Background: There is strong evidence that short-term exposure to ozone (O3) is associated with respiratory disease and death, but the effects of shortterm exposure to ozone on ischemic heart and cerebrovascular disease have not been clearly established. Methods: Daily levels of urban O3 pollution, the incidence of first-ever, recurrent, fatal and non-fatal ischemic cerebro-vascular events (ICVE) and myocardial infarction (MI) were compared using a bi-directional case-crossover design analysis. We analysed 1 574 ICVE and 913 MI that occurred in Dijon, France from 2001 to 2007. Sulphur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), particulate matter with an aerodiameter of 10µg/m3 (PM10) were used to create bi-pollutant models. Using the adjusted Odd Ratios (OR), the effects of O3 exposure were calculated for every 10 µg/m3 increase in pollutants in multivariate logistic models adjusted for all possible confounders. Results: We found a statistically significant association between even lowlevels of O3 and recurrent ICVE with a 3-day lag (OR=1.115; 95%CI: 1.0271.209). The association was marginally significant for recurrent MI with 1–day lag (OR=1.147; 95 % CI: 0.999-1.318). For incident events, we detected no significant association. In stratified analysis by vascular risk factors, we observed for ICVE an association with each vascular risk factor (OR=1.523; 95 % CI: 1.149-2.018) while for MI, an association with O3 was found when hypercholesterolemia was present (OR=1.111; 95 %: 1.020-1.211). Moreover, we noted an increase in the strength of association with an increasing number of combined factors. Conclusion: From this population-based study, recurrent ICVE and MI could be triggered by short-term exposure to even low levels of O3, especially among subjects with severe vascular risk factors. As a result, preventive strategies could be designed for such subjects.

281 Very low caloric diet in obese female enables the improvement of the hemostatic balance through the reduction of leptin levels, PAI-1 concentrations and platelet release of procoagulant microparticles Olivier Morel (1), Florina Luca (2), Lelia Grunebaum (3), Laurence Jesel (4), Nicolas Meyer (5), Dominique Desprez (6), Françoise Dignat-George (7), Florence Toti (8), Chantal Simon (2), Bernard Goichot (2)



(1) Pôle d'activité Médico-Chirurgicale Cardiovasculaire, NHC, Strasbourg, France - (2) CHU Strasbourg, Département de Médecine Interne et de Nutrition, Strasbourg, France - (3) CHU Strasbourg, Département d'Hémostase, Strasbourg, France - (4) Hôpitaux Universitaires de Strasbourg, Strasbourg, France - (5) Hôpitaux Universitaires de Strasbourg, Département de Biostatistique, Strasbourg, France - (6) Hôpitaux Universitaires de Strasbourg, Unité d’Hémostase, Strasbourg, France - (7) Faculté de Pharmacie, Marseille, France - (8) INSERM 770 et Université de Strasbourg, Strasbourg, France Background: Abdominal obesity and metabolic syndrome are important risk factors of atherothrombosis. In obesity, metabolic and inflammatory – mediated tissular injury could contribute to enhanced shedding of procoagulant microparticles (MPs). At sites of endothelium injury, the swift recruitment of procoagulant-MPs enables the initiation of blood coagulation and thrombus growth. Objectives: In obese female, we sought to evaluate the impact of vey low caloric diet (VLCD) on procoagulant MPs levels, fibrinolytic status, inflammation and endothelium damage. Methods: Circulating biomarkers of vascular damage, fibrinolytic status, platelet activation, inflammation were measured before, 30 and 90 days after VLCD. Microparticles were measured by flow cytometry and capture assays. Their procoagulant abilities were quantified by functional prothrombinase assay and their cellular origin were determined (endothelium, platelet, leukocyte, lymphocyte and erythrocyte phenotypes). Results: 24 obese females (39 ± 10 yr) were prospectively enrolled. At baseline, higher PAI-l or platelet-derived procoagulant MPs levels were respectively evidenced in patients with metabolic syndrome or insulin resistance (HOMA>2.4). Procoagulant leukocytes-derived MPs were associated with waist circumference at baseline (r = 0.534: p = 0.010) and at 90 days follow-up (r = 0.487; p = 0.021). At 90 days, weight reduction (-9.8%) was associated with a lowering of blood pressure, improvement of metabolic parameters and a significant reduction of PAI-1 (-38%), procoagulant plateletderived MPs (-43%) and leptin (-32%) levels. Conclusion: In obese female, very low caloric diet enables an overall improvement of the haemostatic balance characterized by the reduction of PAI-levels, a fibrinolysis inhibitor, diminished platelet release of procoagulant MPs and reduction of leptin levels, an adipocyte-derived cytokine.

282 Ophtalmologic follow-up of diabetic patients managed by Gps or diabetologists : results of FOCUS survey Hartemann Agnès (1), Denis Pouchain (2), Pascale Massin (3) (1) CHU Pitié Salpêtrière, Diabétologie, Paris, France - (2) Cabinet médical Dr Pouchain, Vincennes, France - (3) CHU Lariboisière, Ophtalmologie, Paris, France Objective: To describe the ophthalmological follow up and cardiologistsnephrologists' involvements in diabetic patients managed by GPs or diabetologists. Methods: Transversal and observational survey conducted in 2009, by 1112 GPs and 188 specialists. Results: 2577 diabetic patients (T1D or T2D) have been included; 63% were males, and mean age was 62 years. Mean diabetes duration was 10 years. Most of them were hypertensive (72%), 68% had a dyslipidemia and 30% a non proliferative diabetic retinopathy. Nearly all patients have been followed by ophthalmologists (70% have been seen once a year). In patients having a diabetic retinopathy (DR), treatments have been intensified in 80 % of them with a visit to the specialist. Visits to cardiologists were more frequent (82%) compared to nephrologists (7%), even the existence of a microalbuminuria or proteinuria in 20% of patients. The HbA1c was : - T1D patients: 10.9% with HbA1c < 6.5 and 33.1% with HbA1c <7%. - T2D patients: 21.4% with HbA1c < 6.5 and 52% with HbA1c <7%. Blood pressure targets (BP <130/80 mmHg) have been reached by 12% of patients.

 © Elsevier Masson SAS. All rights reserved.