Oral Condition and Incident Coronary Heart Disease: A Clustering Analysis

Poor oral health has been linked to coronary heart disease (CHD). Clustering clinical oral conditions routinely recorded in adults may identify their CHD risk profile. Participants from the Paris Prospective Study 3 received, between 2008 and 2012, a baseline routine full-mouth clinical examination and an extensive physical examination and were thereafter followed up every 2 y until September 2020. Three axes defined oral health conditions: 1) healthy, missing, filled, and decayed teeth; 2) masticatory capacity denoted by functional masticatory units; and 3) gingival inflammation and dental plaque. Hierarchical cluster analysis was performed with multivariate Cox proportional hazards regression models and adjusted for age, sex, smoking, body mass index, education, deprivation (EPICES score; Evaluation of Deprivation and Inequalities in Health Examination Centres), hypertension, type 2 diabetes, LDL and HDL serum cholesterol (low- and high-density lipoprotein), triglycerides, lipid-lowering medications, NT-proBNP and IL-6 serum level. A sample of 5,294 participants (age, 50 to 75 y; 37.10% women) were included in the study. Cluster analysis identified 3,688 (69.66%) participants with optimal oral health and preserved masticatory capacity (cluster 1), 1,356 (25.61%) with moderate oral health and moderately impaired masticatory capacity (cluster 2), and 250 (4.72%) with poor oral health and severely impaired masticatory capacity (cluster 3). After a median follow-up of 8.32 y (interquartile range, 8.00 to 10.05), 128 nonfatal incident CHD events occurred. As compared with cluster 1, the risk of CHD progressively increased from cluster 2 (hazard ratio, 1.45; 95% CI, 0.98 to 2.15) to cluster 3 (hazard ratio, 2.47; 95% CI, 1.34 to 4.57; P < 0.05 for trend). To conclude, middle-aged individuals with poor oral health and severely impaired masticatory capacity have more than twice the risk of incident CHD than those with optimal oral health and preserved masticatory capacity (ClinicalTrials.gov NCT00741728).

Body Silhouette Trajectories Over the Lifespan and Insomnia Symptoms: The Paris Prospective Study 3

Insomnia symptoms are highly prevalent and associated with several adverse medical conditions, but only few determinants, including non-modifiable ones, have been highlighted. We investigated associations between body silhouette trajectories over the lifespan and insomnia symptoms in adulthood. From a community-based study, 7 496 men and women aged 50–75 years recalled their body silhouette at age 8, 15, 25, 35 and 45, and rated the frequency of insomnia symptoms on a standardized sleep questionnaire. An Epworth Sleepiness Scale ≥11 defined excessive daytime sleepiness (EDS). Using a group-based trajectory modeling, we identified five body silhouette trajectories: a ‘lean-stable’ (32.7%), a ‘heavy-stable’ (8.1%), a ‘moderate-stable’ (32.5%), a ‘lean-increase’ (11%) and a ‘lean-marked increase’ (15.7%) trajectory. In multivariate logistic regression, compared to the ‘lean-stable’ trajectory, the ‘lean-marked increase’ and ‘heavy-stable’ trajectories were associated with a significant increased odd of having ≥1 insomnia symptoms as compared to none and of having a proxy for insomnia disorder (≥1 insomnia symptom and EDS). The association with the ‘lean-marked increase' trajectory’ was independent from body mass index measured at study recruitment. In conclusion, increasing body silhouette over the lifespan is associated with insomnia symptoms in adulthood, emphasizing the importance of weight gain prevention during the entire lifespan.

Cross-sectional analysis of deprivation and ideal cardiovascular health in the Paris Prospective Study 3

AIMS

We hypothesised that deprivation might represent a barrier to attain an ideal cardiovascular health (CVH) as defined by the American Heart Association (AHA).

METHODS AND RESULTS

The baseline data of 8916 participants of the Paris Prospective Study 3, an observational cohort on novel markers for future cardiovascular disease, were used. The AHA 7-item tool includes four health behaviours (smoking, body weight, physical activity and optimal diet) and three biological measures (blood cholesterol, blood glucose and blood pressure). A validated 11-item score of individual material and psychosocial deprivation, the Evaluation de la Précarité et des Inégalités dans les Centres d'Examens de Santé-Evaluation of Deprivation and Inequalities in Health Examination centres (EPICES) score was used. The mean age was 59.5 years (standard deviation 6.2), 61.2% were men and 9.98% had an ideal CVH. In sex-specific multivariable polytomous logistic regression, the odds ratio (OR) for ideal behavioural CVH progressively decreased with quartile of increasing deprivation, from 0.54 (95% CI 0.41 to 0.72) to 0.49 (0.37 to 0.65) in women and from 0.61 (0.50 to 0.76) to 0.57 (0.46 to 0.71) in men. Associations with ideal biological CVH were confined to the most deprived women (OR=0.60; 95% CI 0.37 to 0.99), whereas in men, greater deprivation was related to higher OR of intermediate biological CVH (OR=1.28; 95% CI 1.05 to 1.57 for the third quartile vs the first quartile).

CONCLUSIONS

Higher material and psychosocial deprivation may represent a barrier to reach an ideal CVH.

TRIAL REGISTRATION NUMBER

NCT00741728.

High level of depressive symptoms as a barrier to reach an ideal cardiovascular health. The Paris Prospective Study III

We hypothesized that depression might represent a barrier to reach an ideal cardiovascular health (CVH) as estimated by the 7-item tool proposed by the American Heart Association. Between 2008 and 2012, 9,417 subjects 50-75 years of age were examined in a large health center and enrolled in the Paris Prospective Study III (PPS3). Participants with 0-2, 3-4 and 5-7 health metrics at the ideal level were categorized as having poor, intermediate and ideal CVH, respectively. Participants with a score ≥ 7 on the 13-item Questionnaire of Depression 2nd version, Abridged or who were on antidepressants were referred as having high level of depressive symptoms (HLDS). The mean age of the 9417 study participants was 59.57 (SD 6.28) years and 61.16% were males. A total of 9.55% had HLDS. Poor, intermediate and ideal CVH was present in 40.38%, 49.52% and 10.10% of the participants. In multivariate polytomous logistic regression analysis, HLDS was inversely associated with ideal CVH (odds ratio = 0.70; 95% CI: 0.55;0.90). This was driven by an association with the behavioural component of the CVH. Participants with HLDS had a substantial reduced chance of reaching an ideal CVH.

Overall and cause specific long term mortality following childhood cancer: The role of cancer treatment

9520

Background: A multi-centre French cohort study was performed to evaluate the role of treatment in the long-term overall and cause-specific mortality among childhood cancer survivors. Methods: This study cohort included 3,057 patients treated for a solid tumours before the age of 17 between 1942–1986, in 5 French centres and who survived at least 5 years from diagnosis. Detailed clinical and therapeutic data were extracted for each patients from medical records. For 2,081of the 2,178 patients who received radiotherapy, radiation doses were estimated at 188 anatomical sites, including heart (7 sites) and lungs (10 sites). 98% of patients were identified in French National Registry of Physical Persons (RNIPP) and we obtained the death causes of 95% of dead patients. Overall and cause-specific mortality standardized ratios (SMR), absolute excess risk (AER) of death were studied using Poisson regression. Results: 50% of patients were treated by chemotherapy (CT) plus radiotherapy (RT), 22% by CT alone and 21% by RT alone. During an average follow-up of 25 years, 465 patients dead. The overall SMR was 7.3 (95% CI: 6.7–8.0) and AER was 6 deaths per 1,000 person-years. SMR for death due to cancer other than the 1st cancer (SC) was 16.1 (95%, CI 13.5–18.9). SMRs were significantly elevated for non-cancer overall mortality, infectious and parasitic diseases, diseases of the circulatory, nervous and respiratory system, congenital anomalies, symptoms, signs and ill- defined conditions’ (SMRs of 2.6, 15.7, 6.4, 8.5, 4.6, 3.2, respectively). RT was associated an increase in the risk for overall and SC related deaths (RR = 2.0; 95% CI: 1.5–2.7; RR = 1.8; 95% CI: 1.1–2.9; respectively). CT was associated with an increased risk for overall, SC and non- cancer related deaths (RR = 1.6; 95% CI: 1.3–2.0; RR = 1.9; 95% CI: 1.2–3.0; RR = 1.8; 95% CI: 1.1–2.9 respectively). We were not able to find any evidence for an interaction between CT and RT, whatever the end point considered. Among the 26 circulatory deaths, 24 received RT, the mean radiation dose of the heart (P=0.0006) and treatment with spindle inhibitors (P=0.009) were significantly associated to death by cardiac disease. Conclusions: In the future, death due to cardiac pathologies could be an important issue for long term survivors of childhood cancer.

No significant financial relationships to disclose.

Treatment-adjusted predisposition to second malignant neoplasms after a solid cancer in childhood: A case-control study

21031

Background: Previous therapy, genetic susceptibility and the type of the first cancer are known to be associated with the risk of a second malignant neoplasm (SMN) among patients treated for a childhood cancer. The aim of this study was to investigate the independent role of the type of first malignant neoplasm in the onset of any SMN taking into account treatment and family cancer syndromes. Methods: A case-control study nested in a European cohort of 4,581 patients, treated for a solid cancer during childhood was conducted. 146 cases with a SMN and 417 controls were matched according to sex, age at first cancer, chemotherapy, radiotherapy, the local radiation dose received at the site of the SMN for the case and at the same site for the matched controls and follow- up. Results: A significantly increased risk of developing any SMN was observed after Hodgkin's lymphoma, retinoblastoma, soft tissue sarcoma orand a malignant bone tumor as the first malignant neoplasm (FMN), independently of initial treatment and family cancer syndromes. A significantly increased risk of developing a sarcoma was observed among patients who had developed a retinoblastoma, OR=5.9 (95%CI : 1.0–34) a malignant bone tumor, OR=11.9 (95%CI : 1.5–95), or a soft tissue sarcoma, OR=5.1 (95%CI : 1.4–19) compared to patients with a Wilm's tumor as the FMN. Conclusions: Survivors of Hodgkin's lymphoma, retinoblastoma, soft tissue sarcoma or a malignant bone tumor are at increased risk of any SMN independently of initial treatment and genetic susceptibility.

No significant financial relationships to disclose.

[Development of a bio-library in the cohort survey: E3N-EPIC]

Since data from biological material banks are now considered as complementary to epidemiological data, most cohort studies have now integrated them. However, their constitution raises numerous logistical problems. The present paper describes the experience of investigators of an on-going prospective study in France: the E3N study. It reviews several constraints that this team had to face, E3N being a study with no individual benefit for the volunteers.

[Serological identification of an antigen associated with acute lymphoid leukemia]

Using as references a lymphoblastoid cell line established from the pleural effusion of a lymphosarcoma patient and the corresponding autochtonous reactive serum, absorption typing assays resulted in the identification of a cell surface antigen associated with acute lymphoid leukaemia. This antigen, provisionally termed PON, may also be demonstrated on the cells of some acute myelomonocytic leukaemias and lymphosarcomas.

[Cytotoxic antibodies to leukemia cells in normal human sera]

Antibodies cytotoxic for human leukemia cells were demonstrated in 7 parents of leukemia children and in 2 normal donors whose blood had induced a partial remission in leukemia and lymphoma patients. None of these sera were cytotoxic to remission cells nor to normal lymphocytes. These sera appear to be relatively specific for acute lymphoblastic leukemia cells; however, several antigenic specificities appear to be detected by these sera.

Cytotoxic antibodies to human leukaemia cells in normal human sera

Antibodies cytotoxic for human leukaemia cells were demonstrated in the serum of normal individuals: two of them being the fathers of leukaemia children, the third one being a normal unrelated donor. One of these sera (obtained from the father of an eight years old girl with acute myeloblastic leukaemia) appears to react widely with cells from acute leukaemias, both lymphoid and myeloid. On the other hand, the serum obtained from the normal blood donor appears to react almost exclusively with cells from acute lymphoblastic leukaemias, and more especially with those which do not form rosettes with sheep red cells.

[Antigens associated with human leukemia]

Several clinical observations, such as spontaneous remissions, or transfusion induced remissions and the results obtained by active immunotherapy, suggest that human leukaemia cells may possess tumour specific antigens. In vitro studies have provided evidence for immune reactions to leukaemia in man. However, the antigens involved in such reactions are far from being fully identified. Serological studies of the human leukaemia associated antigens have been developed with xenoantisera raised in a variety of animal species, and with human sera obtained either from patients or from some normal individuals. It appears that the xenoantisera and the few human sera yet obtained do not detect the same antigenic structures. Schematically, one can assume that the rabbit antisera react with antigen(s) common to acute leukaemias or even to the four main leukaemia types; primate antisera react with the lymphoid leukaemias (both acute and chronic) or with the myeloid leukaemias. On the other hand, human sera appear to react in a different way, and several antigenic specificities may thus be detected on the cells of acute lymphoblastic leukaemias. However, these human sera are yet rather rare and do not cover all the varieties of leukaemias. Cross-reactivity with antigens of animal oncornaviruses or of animal leukaemias has been shown with some of the antisera used. The serological identification of human leukaemia associated antigens aims at two different goals: a better control of the promizing immunotherapy attempts as well as a new insight in the etiology of human leukaemias.