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Guédon AF, De Freminville JB, Mirault T, Mohamedi N, Rance B, Fournier N, Paul JL, Messas E, Goudot G. Association of Lipoprotein(a) Levels With Incidence of Major Adverse Limb Events. JAMA Netw Open 2022; 5:e2245720. [PMID: 36480201 PMCID: PMC9856359 DOI: 10.1001/jamanetworkopen.2022.45720] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE High lipoprotein(a) (Lp[a]) levels are involved in the development of cardiovascular events, particularly in myocardial infarction, stroke, and peripheral artery disease. Studies assessing the Lp(a) levels associated with adverse lower-limb events are lacking. OBJECTIVE To assess the association between Lp(a) levels and incidence of major adverse limb events in unselected hospitalized patients. DESIGN, SETTING, AND PARTICIPANTS This large retrospective monocentric cohort study was conducted from January 1, 2000, to December 31, 2020. Data were derived from the clinical information system of the Hôpital Européen Georges-Pompidou, a Paris-based university hospital. Patients who underwent at least 1 Lp(a) measurement at the center during the study period were included. Patients who had no follow-up data or who had the first Lp(a) measurement after the study outcome had occurred were excluded. Data analyses were performed from May 2021 to January 2022. MAIN OUTCOMES AND MEASURES The primary outcome was the first inpatient major adverse limb event, defined as a major amputation, peripheral endovascular revascularization, or peripheral surgical revascularization, during follow-up. Secondary outcomes included individual components of the primary outcome. Lipoprotein(a) levels were categorized as follows: normal (<50 mg/dL), high (50 to <134 mg/dL), and very high (≥134 mg/dL); to convert Lp(a) values to milligrams per liter, multiply by 0.1. RESULTS A total of 16 513 patients (median [IQR] age, 58.2 [49.0-66.7] years; 9774 men [59.2%]) were included in the cohort. The median (IQR) Lp(a) level was 24 (10.0-60.0) mg/dL. The 1-year incidence of major adverse limb event was 2.44% in the overall population and 4.54% among patients with very high Lp(a) levels. High (adjusted accelerated failure time [AFT] exponential estimate: 0.43; 95% CI, 0.24-0.78; Benjamini-Hochberg-corrected P = .01) and very high (adjusted AFT exponential estimate: 0.17; 95% CI, 0.07-0.40; Benjamini-Hochberg-corrected P < .001) Lp(a) levels were independently associated with an increased risk of major adverse limb event. CONCLUSIONS AND RELEVANCE Results of this study showed that higher Lp(a) levels were independently associated with an increased risk of a major adverse limb event in hospitalized patients. The Lp(a) measurement needs to be taken into account to improve lower-limb vascular risk assessment.
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Affiliation(s)
- Alexis F. Guédon
- Vascular Medicine Department, Georges Pompidou European Hospital, Assistance Publique–Hôpitaux de Paris (APHP), Université Paris Cité, Paris, France
| | - Jean-Baptiste De Freminville
- Vascular Medicine Department, Georges Pompidou European Hospital, Assistance Publique–Hôpitaux de Paris (APHP), Université Paris Cité, Paris, France
| | - Tristan Mirault
- Vascular Medicine Department, Georges Pompidou European Hospital, Assistance Publique–Hôpitaux de Paris (APHP), Université Paris Cité, Paris, France
- Paris Cardiovascular Research Center (PARCC), Institut National de la Santé et de la Recherche Médicale (INSERM) U970, Université Paris Cité, Paris, France
| | - Nassim Mohamedi
- Vascular Medicine Department, Georges Pompidou European Hospital, Assistance Publique–Hôpitaux de Paris (APHP), Université Paris Cité, Paris, France
| | - Bastien Rance
- Department of Medical Informatics, Georges Pompidou European Hospital, APHP, Université Paris Cité, Paris, France
| | - Natalie Fournier
- Biology Department, Biochemistry Laboratory, Georges Pompidou European Hospital, APHP, Université Paris Cité, Paris, France
- Lip(Sys)2-EA7357, Athérosclérose et Macrophages: Impact Des Phospholipides e Des Fonctions Mitochondriales Sur l'efflux du Cholestérol Cellulaire, Université Paris-Saclay, UFR de Pharmacie, Chatenay-Malabry, France
| | - Jean-Louis Paul
- Biology Department, Biochemistry Laboratory, Georges Pompidou European Hospital, APHP, Université Paris Cité, Paris, France
- Lip(Sys)2-EA7357, Athérosclérose et Macrophages: Impact Des Phospholipides e Des Fonctions Mitochondriales Sur l'efflux du Cholestérol Cellulaire, Université Paris-Saclay, UFR de Pharmacie, Chatenay-Malabry, France
| | - Emmanuel Messas
- Vascular Medicine Department, Georges Pompidou European Hospital, Assistance Publique–Hôpitaux de Paris (APHP), Université Paris Cité, Paris, France
- Paris Cardiovascular Research Center (PARCC), Institut National de la Santé et de la Recherche Médicale (INSERM) U970, Université Paris Cité, Paris, France
| | - Guillaume Goudot
- Vascular Medicine Department, Georges Pompidou European Hospital, Assistance Publique–Hôpitaux de Paris (APHP), Université Paris Cité, Paris, France
- Paris Cardiovascular Research Center (PARCC), Institut National de la Santé et de la Recherche Médicale (INSERM) U970, Université Paris Cité, Paris, France
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Méloux A, Béjot Y, Rochette L, Cottin Y, Vergely C. Brain-Heart Interactions During Ischemic Processes: Clinical and Experimental Evidences. Stroke 2019; 51:679-686. [PMID: 31856693 DOI: 10.1161/strokeaha.119.027732] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Alexandre Méloux
- From the Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2, EA 7460), Université de Bourgogne-Franche-Comté, Dijon, France (A.M., L.R., C.V.).,Department of Cardiology (A.M., Y.C.), University Hospital of Dijon, France
| | - Yannick Béjot
- Department of Neurology (Y.B.), University Hospital of Dijon, France
| | - Luc Rochette
- From the Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2, EA 7460), Université de Bourgogne-Franche-Comté, Dijon, France (A.M., L.R., C.V.)
| | - Yves Cottin
- Department of Cardiology (A.M., Y.C.), University Hospital of Dijon, France
| | - Catherine Vergely
- From the Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2, EA 7460), Université de Bourgogne-Franche-Comté, Dijon, France (A.M., L.R., C.V.)
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Naito R, Miyauchi K, Nojiri S, Suzuki N, Daida H. Differences in Clinical Features in Patients with Acute Coronary Syndrome and Stroke: Japanese Multicenter Registry Results. Intern Med 2018; 57:3233-3240. [PMID: 29877288 PMCID: PMC6287985 DOI: 10.2169/internalmedicine.1020-18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective Coronary artery and cerebrovascular disease are the main causes of non-communicable diseases. In particular, acute coronary syndrome (ACS) and ischemic stroke are the most serious conditions of coronary artery disease and cerebrovascular disease, respectively. Therefore, it is important to prevent these conditions by identifying populations at high risk of these diseases. We sought to investigate the differences in the clinical features of patients with these atherothrombotic diseases in nationwide Japanese multicenter registries. Gender differences were also examined. Methods The dataset of the two nationwide multicenter registries for ACS [Prevention of AtherothrombotiC Incidents Following Ischemic Coronary (PACIFIC)] and ischemic stroke [Effective Vascular Event REduction after STroke (EVEREST)] was analyzed. Clinical features were examined and compared using datasets from the two registries. Results A total of 6,878 patients (PACIFIC: n=3,426, EVEREST: n=3,452) were evaluated. The patients' background characteristics were significantly different between the two populations. Patients with ACS tended to be younger, had a higher body mass index, had a greater prevalence of diabetes mellitus and dyslipidemia, were current smokers, and more often had a prior history of ischemia heart disease than patients with a stroke. Hypertension was more prevalent in patients with stroke than in those with ACS. The differences in patients' background characteristics between ACS and stroke in men were similar to those in the whole sample. However, the prevalence of hypertension in women was similar between the ACS and stroke groups, in contrast to the results from the whole sample. Conclusion Patients' background characteristics were significantly different between those with ACS and stroke. Gender differences were also observed.
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Affiliation(s)
- Ryo Naito
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Japan
| | - Katsumi Miyauchi
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Japan
| | - Shuko Nojiri
- Clinical Research Support Center, Juntendo University School of Medicine, Japan
| | - Norihiro Suzuki
- Department of Neurology, Keio University School of Medicine, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Japan
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Béjot Y, Daubail B, Giroud M. Epidemiology of stroke and transient ischemic attacks: Current knowledge and perspectives. Rev Neurol (Paris) 2015; 172:59-68. [PMID: 26718592 DOI: 10.1016/j.neurol.2015.07.013] [Citation(s) in RCA: 144] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 07/09/2015] [Accepted: 07/22/2015] [Indexed: 11/26/2022]
Abstract
Because of the growing size and aging of the world's population, the global burden of stroke is increasing dramatically. Current epidemiological data indicate that 16.9 million people suffer a stroke each year, which represents a global incidence of 258/100,000/year, with marked differences between high- and low-income countries, and an age-adjusted incidence 1.5 times higher in men than in women. Although primary prevention has contributed to a decrease in stroke incidence in high-income countries, the so-called 'epidemiological transition' has led to an increase in incidence in middle-to-low-income countries as well. In addition, the incidence of ischemic stroke in young adults is on the rise, suggesting a need for specific preventative interventions in that age group. The number of stroke survivors almost doubled between 1990 and 2010, and has now reached 33 million people. According to epidemiological projections, this number will rise to 77 million by 2030. In France, the number of hospitalizations for an acute cerebrovascular event was about 138,000 in 2009, accounting for 3% of the total national health expenditure. Outcomes after stroke are frequently impaired by complications, including motor handicaps, dementia, depression, fatigue, and a high risk of early rehospitalization and institutionalization, with adverse consequences in terms of socioeconomic costs. In addition, there are 5.9 million stroke-related deaths worldwide every year. Finally, although many analytical epidemiological studies have considerably increased our knowledge of risk factors for stroke, the recent INTERSTROKE study provided evidence that 10 risk factors alone accounted for 88% of all strokes. Many of these risk factors are modifiable, which suggests that efforts should be made to promote interventions that aim to reduce the risk of stroke. A new 'mass approach' aiming to reduce the level of stroke risk factors in all people in a region, regardless of any given individual's level of risk, is currently still being developed. This interesting and innovative way to spread stroke awareness is based on the use of an internationally validated mobile-phone application that can calculate the risk of stroke for any given individual, and also contains a section to educate people on stroke warning symptoms and signs.
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Affiliation(s)
- Y Béjot
- Dijon Stroke Registry, EA4184, Department of Neurology, University Hospital and Medical School of Dijon, University of Burgundy, 21079 Dijon cedex, France.
| | - B Daubail
- Dijon Stroke Registry, EA4184, Department of Neurology, University Hospital and Medical School of Dijon, University of Burgundy, 21079 Dijon cedex, France
| | - M Giroud
- Dijon Stroke Registry, EA4184, Department of Neurology, University Hospital and Medical School of Dijon, University of Burgundy, 21079 Dijon cedex, France
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Bezin J, Girodet PO, Rambelomanana S, Touya M, Ferreira P, Gilleron V, Robinson P, Moore N, Pariente A. Choice of ICD-10 codes for the identification of acute coronary syndrome in the French hospitalization database. Fundam Clin Pharmacol 2015; 29:586-91. [DOI: 10.1111/fcp.12143] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 07/24/2015] [Accepted: 08/18/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Julien Bezin
- Université de Bordeaux; Bordeaux F-33076 France
- CIC Bordeaux CIC1401; Bordeaux F-33076 France
- INSERM U657; Bordeaux F-33076 France
- CHU Bordeaux; Service de Pharmacologie Clinique; Bordeaux F-33076 France
| | - Pierre-Olivier Girodet
- Université de Bordeaux; Bordeaux F-33076 France
- CIC Bordeaux CIC1401; Bordeaux F-33076 France
- CHU Bordeaux; Service de Pharmacologie Clinique; Bordeaux F-33076 France
| | | | - Maëlys Touya
- Université de Bordeaux; Bordeaux F-33076 France
- CHU Bordeaux; Service de Pharmacologie Clinique; Bordeaux F-33076 France
| | - Paul Ferreira
- Université de Bordeaux; Bordeaux F-33076 France
- CHU Bordeaux; Service de Pharmacologie Clinique; Bordeaux F-33076 France
| | - Véronique Gilleron
- CHU Bordeaux; Service d'Information Médicale; Pôle de Santé Publique; Bordeaux F-33076 France
| | - Philip Robinson
- Université de Bordeaux; Bordeaux F-33076 France
- ADERA; Pessac F-33608 France
| | - Nicholas Moore
- Université de Bordeaux; Bordeaux F-33076 France
- CIC Bordeaux CIC1401; Bordeaux F-33076 France
- INSERM U657; Bordeaux F-33076 France
- CHU Bordeaux; Service de Pharmacologie Clinique; Bordeaux F-33076 France
| | - Antoine Pariente
- Université de Bordeaux; Bordeaux F-33076 France
- CIC Bordeaux CIC1401; Bordeaux F-33076 France
- INSERM U657; Bordeaux F-33076 France
- CHU Bordeaux; Service de Pharmacologie Clinique; Bordeaux F-33076 France
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Lainay C, Benzenine E, Durier J, Daubail B, Giroud M, Quantin C, Béjot Y. Hospitalization Within the First Year After Stroke. Stroke 2015; 46:190-6. [DOI: 10.1161/strokeaha.114.007429] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Claire Lainay
- From the Dijon Stroke Registry, EA4184, Department of Neurology, University Hospital and Medical School of Dijon (C.L., J.D., B.D., M.G., Y.B.); and Department of Medical Informatics, Division of Medical Informatics University Hospital, Dijon, Inserm U866 (E.B., C.Q.), University of Burgundy, France
| | - Eric Benzenine
- From the Dijon Stroke Registry, EA4184, Department of Neurology, University Hospital and Medical School of Dijon (C.L., J.D., B.D., M.G., Y.B.); and Department of Medical Informatics, Division of Medical Informatics University Hospital, Dijon, Inserm U866 (E.B., C.Q.), University of Burgundy, France
| | - Jérôme Durier
- From the Dijon Stroke Registry, EA4184, Department of Neurology, University Hospital and Medical School of Dijon (C.L., J.D., B.D., M.G., Y.B.); and Department of Medical Informatics, Division of Medical Informatics University Hospital, Dijon, Inserm U866 (E.B., C.Q.), University of Burgundy, France
| | - Benoit Daubail
- From the Dijon Stroke Registry, EA4184, Department of Neurology, University Hospital and Medical School of Dijon (C.L., J.D., B.D., M.G., Y.B.); and Department of Medical Informatics, Division of Medical Informatics University Hospital, Dijon, Inserm U866 (E.B., C.Q.), University of Burgundy, France
| | - Maurice Giroud
- From the Dijon Stroke Registry, EA4184, Department of Neurology, University Hospital and Medical School of Dijon (C.L., J.D., B.D., M.G., Y.B.); and Department of Medical Informatics, Division of Medical Informatics University Hospital, Dijon, Inserm U866 (E.B., C.Q.), University of Burgundy, France
| | - Catherine Quantin
- From the Dijon Stroke Registry, EA4184, Department of Neurology, University Hospital and Medical School of Dijon (C.L., J.D., B.D., M.G., Y.B.); and Department of Medical Informatics, Division of Medical Informatics University Hospital, Dijon, Inserm U866 (E.B., C.Q.), University of Burgundy, France
| | - Yannick Béjot
- From the Dijon Stroke Registry, EA4184, Department of Neurology, University Hospital and Medical School of Dijon (C.L., J.D., B.D., M.G., Y.B.); and Department of Medical Informatics, Division of Medical Informatics University Hospital, Dijon, Inserm U866 (E.B., C.Q.), University of Burgundy, France
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