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Dufour L, Grave C, Bonaldi C, Joly P, Andler R, Quatremere G, Nguyen-Thanh V, Olié V, Gabet A. Hemorrhagic Strokes Attributable to Chronic Alcohol Consumption and Heavy Episodic Drinking in France. Neurology 2024; 102:e209228. [PMID: 38527250 DOI: 10.1212/wnl.0000000000209228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/20/2023] [Indexed: 03/27/2024] Open
Abstract
OBJECTIVES To estimate the number of cases and deaths related to hemorrhagic stroke (HS) attributable to a chronic alcohol consumption and to heavy episodic drinking (HED) in France. METHODS A population-attributable fraction (PAF) estimation approach was used. Relative risks for HS with alcohol consumption were extracted from the INTERSTROKE study. Levels of alcohol consumption in the French population were collected from the 2017 Health Barometer. Data on HS morbidity and mortality were extracted from the French National Health Data System (SNDS). RESULTS We estimated that 7.2% (n = 2,100) and 6.6% (n = 1,900) of cases with HS were attributable to chronic alcohol consumption and HED, respectively. PAFs were higher in men than in women with 11.5% vs 2.6% for a chronic consumption and 10.7% vs 2.1% for HED, respectively. We estimated that 7.0% of HS deaths (n = 1,100) were attributable to chronic alcohol consumption and 5.1% attributable to HED (n = 800). Finally, 16.3% of patients with HS (n = 4,700) and 14.1% of HS deaths (n = 2,300) were attributable to overall chronic alcohol consumption or to monthly HED. DISCUSSION These results remind the importance of alcohol consumption in the occurrence of HS and the importance of implementing primary and secondary prevention measures, particularly among young people, where HED is most common.
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Affiliation(s)
- Lucas Dufour
- From the French Public Health Agency (L.D., C.G., C.B., P.J., R.A., G.Q., V.N.-T., V.O., A.G.), Saint-Maurice; and Univ. Bordeaux (P.J.), ISPED, INSERM, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | - Clémence Grave
- From the French Public Health Agency (L.D., C.G., C.B., P.J., R.A., G.Q., V.N.-T., V.O., A.G.), Saint-Maurice; and Univ. Bordeaux (P.J.), ISPED, INSERM, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | - Christophe Bonaldi
- From the French Public Health Agency (L.D., C.G., C.B., P.J., R.A., G.Q., V.N.-T., V.O., A.G.), Saint-Maurice; and Univ. Bordeaux (P.J.), ISPED, INSERM, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | - Pierre Joly
- From the French Public Health Agency (L.D., C.G., C.B., P.J., R.A., G.Q., V.N.-T., V.O., A.G.), Saint-Maurice; and Univ. Bordeaux (P.J.), ISPED, INSERM, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | - Raphaël Andler
- From the French Public Health Agency (L.D., C.G., C.B., P.J., R.A., G.Q., V.N.-T., V.O., A.G.), Saint-Maurice; and Univ. Bordeaux (P.J.), ISPED, INSERM, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | - Guillemette Quatremere
- From the French Public Health Agency (L.D., C.G., C.B., P.J., R.A., G.Q., V.N.-T., V.O., A.G.), Saint-Maurice; and Univ. Bordeaux (P.J.), ISPED, INSERM, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | - Viêt Nguyen-Thanh
- From the French Public Health Agency (L.D., C.G., C.B., P.J., R.A., G.Q., V.N.-T., V.O., A.G.), Saint-Maurice; and Univ. Bordeaux (P.J.), ISPED, INSERM, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | - Valérie Olié
- From the French Public Health Agency (L.D., C.G., C.B., P.J., R.A., G.Q., V.N.-T., V.O., A.G.), Saint-Maurice; and Univ. Bordeaux (P.J.), ISPED, INSERM, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | - Amélie Gabet
- From the French Public Health Agency (L.D., C.G., C.B., P.J., R.A., G.Q., V.N.-T., V.O., A.G.), Saint-Maurice; and Univ. Bordeaux (P.J.), ISPED, INSERM, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
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Lailler G, Grave C, Gabet A, Joly P, Regnault N, Deneux-Tharaux C, Tstsaris V, Plu-Bureau G, Kretz S, Blacher J, Olie V. Early Mortality, Cardiovascular, and Renal Diseases in Women's Lives Following Hypertensive Disorders of Pregnancy: The Prospective Nationwide Study CONCEPTION. J Am Heart Assoc 2024; 13:e033252. [PMID: 38563390 DOI: 10.1161/jaha.123.033252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/27/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND We aimed to evaluate the impact of hypertensive disorders of pregnancy occurrence, recurrence, onset time, and severity on mortality and on a wide range of cardiovascular outcomes in France. METHODS AND RESULTS CONCEPTION (Cohort of Cardiovascular Diseases in Pregnancy) is a French nationwide prospective cohort using data from the National Health Data System. We included all women in CONCEPTION with no history of a cardiovascular event who delivered in France for the first time between 2010 and 2018 (N=2 819 655). Hypertensive disorders of pregnancy and cardiovascular outcomes during the study follow-up were identified using algorithms combining International Classification of Diseases, Tenth Revision (ICD-10) coded diagnoses during hospitalization and purchases of medication between 2010 and 2021. We fitted Cox models with time-varying exposure to assess the associations of hypertensive disorders of pregnancy with mortality and cardiovascular events. Women with gestational hypertension had a 1.25- to 2-fold higher risk of stroke, acute coronary syndrome, peripheral arterial disease, pulmonary embolism, and chronic kidney disease, and a 2- to 4-fold higher risk of rhythm and conduction disorder and heart failure. Women with preeclampsia had a 1.35- to 2-fold higher risk of rhythm or conduction disorder and pulmonary embolism during follow-up; a 2- to 4-fold higher risk of stroke, acute coronary syndrome, and peripheral arterial disease; and a 7- to 9-fold higher risk of heart failure and chronic kidney disease. They were 1.8 times more likely to die and 4.4 times more likely to die of cardiovascular causes. CONCLUSIONS Hypertensive disorders of pregnancy drastically increase the risk of mortality, cardiovascular, and renal events early after pregnancy. Recurrent, severe, and early-onset preeclampsia further increases this risk.
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Affiliation(s)
- Grégory Lailler
- Santé Publique France Saint-Maurice France
- Université Paris Est Créteil France
| | | | | | - Pierre Joly
- Centre Inserm U1219-Bordeaux Population Health Université de Bordeaux-ISPED Bordeaux France
| | | | - Catherine Deneux-Tharaux
- Obstetrical Perinatal and Pediatric Epidemiology Research Team EPOPé, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), INSERM Paris France
- Université Paris Cité Paris France
| | - Vassilis Tstsaris
- Obstetrical Perinatal and Pediatric Epidemiology Research Team EPOPé, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), INSERM Paris France
- Maternité Port-Royal FHU PREMA, Assistance Publique Hôpitaux de Paris, Hôpital Cochin Paris France
| | - Geneviève Plu-Bureau
- Obstetrical Perinatal and Pediatric Epidemiology Research Team EPOPé, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), INSERM Paris France
- Université Paris Cité Paris France
- Unité de Gynécologie Médicale APHP, Hôpital Port-Royal Cochin Paris France
| | - Sandrine Kretz
- Centre de Diagnostic et de Thérapeutique Hôtel Dieu, AP-HP Paris France
| | - Jacques Blacher
- Université Paris Cité Paris France
- Centre de Diagnostic et de Thérapeutique Hôtel Dieu, AP-HP Paris France
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Grave C, Gabet A, Iliou MC, Cinaud A, Tuppin P, Blacher J, Olié V. Temporal trends in admission for cardiac rehabilitation after an acute coronary syndrome in France from 2009 to 2021: Persistent sex, age and social disparities. Arch Cardiovasc Dis 2024; 117:234-243. [PMID: 38458957 DOI: 10.1016/j.acvd.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/17/2023] [Accepted: 12/19/2023] [Indexed: 03/10/2024]
Abstract
BACKGROUND Cardiac rehabilitation after an acute coronary syndrome is recommended to decrease patient morbidity and mortality and to improve quality of life. AIMS To describe time trends in the rates of patients undergoing cardiac rehabilitation after an acute coronary syndrome in France from 2009 to 2021, and to identify possible disparities. METHODS All patients hospitalized for acute coronary syndrome in France between January 2009 and June 2021 were identified from the national health insurance database. Cardiac rehabilitation attendance was identified within 6 months of acute coronary syndrome hospital discharge. Age-standardized cardiac rehabilitation rates were computed and stratified for sex and acute coronary syndrome subtypes (ST-segment elevation and non-ST-segment elevation). Patient characteristics and outcomes were described and compared. Factors independently associated with cardiac rehabilitation attendance were identified. RESULTS In 2019, among 134,846 patients with an acute coronary syndrome, 22.3% underwent cardiac rehabilitation within 6 months of acute coronary syndrome hospital discharge. The mean age of patients receiving cardiac rehabilitation was 62 years. The median delay between acute coronary syndrome hospitalization and cardiac rehabilitation was 32 days, with about 60% receiving outpatient cardiac rehabilitation. Factors significantly associated with higher cardiac rehabilitation rates were male sex, younger age (35-64 years), least socially disadvantaged group, ST-segment elevation, percutaneous coronary intervention and coronary artery bypass graft. Between 2009 and 2019, cardiac rehabilitation rates increased by 40% from 15.9% to 22.3%. Despite greater upward trends in women, their cardiac rehabilitation rate was significantly lower than that for men (14.8% vs. 25.8%). In 2020, cardiac rehabilitation attendance dropped because of the coronavirus disease 2019 pandemic. CONCLUSIONS Despite the health benefits of cardiac rehabilitation, current cardiac rehabilitation attendance after acute coronary syndrome remains insufficient in France, particularly among the elderly, women and socially disadvantaged people.
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Affiliation(s)
- Clémence Grave
- Surveillance des maladies cardio-neuro-vasculaires, direction des maladies non transmissibles, Santé Publique France, 94415 Saint-Maurice, France.
| | - Amélie Gabet
- Surveillance des maladies cardio-neuro-vasculaires, direction des maladies non transmissibles, Santé Publique France, 94415 Saint-Maurice, France
| | | | - Alexandre Cinaud
- Centre de diagnostic et de thérapeutique, université Paris-Cité, Hôpital Hôtel-Dieu, AP-HP, 75004 Paris, France
| | - Philippe Tuppin
- Direction de la stratégie, des études et des statistiques, Caisse Nationale de l'Assurance Maladie, 75020 Paris, France
| | - Jacques Blacher
- Centre de diagnostic et de thérapeutique, université Paris-Cité, Hôpital Hôtel-Dieu, AP-HP, 75004 Paris, France
| | - Valérie Olié
- Surveillance des maladies cardio-neuro-vasculaires, direction des maladies non transmissibles, Santé Publique France, 94415 Saint-Maurice, France
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Grave C, Gabet A, Cinaud A, Tuppin P, Blacher J, Olié V. Nationwide time trends in patients hospitalized for acute coronary syndrome: a worrying generational and social effect among women. Eur J Prev Cardiol 2024; 31:116-127. [PMID: 37794752 DOI: 10.1093/eurjpc/zwad288] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 10/06/2023]
Abstract
AIMS To estimate the time trends in the annual incidence of patients hospitalized for acute coronary syndrome (ACS) in France from 2009 to 2021 and to analyse the current sex and social differences in ACS, management, and prognosis. METHODS AND RESULTS All patients hospitalized for ACS in France were selected from the comprehensive National Health Insurance database. Age-standardized rates were computed overall and according to age group (over or under 65 years), sex, proxy of socioeconomic status, and ACS subtype [ST-segment elevation (STSE) and non-ST-segment elevation]. Patient characteristics and outcomes were described for patients hospitalized in 2019. Differences in management (coronarography, revascularization), and prognosis were analysed by sex, adjusting for cofonders. In 2019, 143,670 patients were hospitalized for ACS, including 53,227 STSE-ACS (mean age = 68.8 years; 32% women). Higher standardized incidence rates among the most socially deprived people were observed. Women were less likely to receive coronarography and revascularization but had a higher excess in-hospital mortality. In 2019, the age-standardized rate for hospitalized ACS patients reached 210 per 100 000 person-year. Between 2009 and 2019, these rates decreased by 11.4% (men: -11.2%; women: -14.0%). Differences in trends of age-standardized incidence rate have been observed according to sex, age, and social status. Middle aged women (45-64 years) showing more unfavourable trends than in other age classes or in men. In addition, among women the temporal trends were more unfavourable as social deprivation increased. CONCLUSION Despite encouraging overall trends in patients hospitalized for ACS rates, the increasing trends observed among middle-aged women, especially socially deprived women, is worrying. Targeted cardiovascular prevention and close surveillance of this population should be encouraged.
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Affiliation(s)
- Clémence Grave
- Surveillance des maladies cardio-neuro-vasculaires, Direction des maladies non transmissibles, Santé publique France, 12 rue du Val d'Osne, 94415 Saint-Maurice Cedex, France
| | - Amélie Gabet
- Surveillance des maladies cardio-neuro-vasculaires, Direction des maladies non transmissibles, Santé publique France, 12 rue du Val d'Osne, 94415 Saint-Maurice Cedex, France
| | - Alexandre Cinaud
- Centre de diagnostic et de thérapeutique, Hôpital Hôtel-Dieu AP-HP, Université Paris Cité, Paris, France
| | - Philippe Tuppin
- Direction de la stratégie, des études et des statistiques, Caisse Nationale de l'Assurance Maladie, Paris, France
| | - Jacques Blacher
- Centre de diagnostic et de thérapeutique, Hôpital Hôtel-Dieu AP-HP, Université Paris Cité, Paris, France
| | - Valérie Olié
- Surveillance des maladies cardio-neuro-vasculaires, Direction des maladies non transmissibles, Santé publique France, 12 rue du Val d'Osne, 94415 Saint-Maurice Cedex, France
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Béjot Y, Olié V, Lailler G, Grave C, Regnault N, Duloquin G, Blacher J, Gabet A. Comparison of Stroke Recurrence, Cardiovascular Events, and Death Among Patients With Pregnancy-Associated vs Non-Pregnancy-Associated Stroke. JAMA Netw Open 2023; 6:e2315235. [PMID: 37285159 DOI: 10.1001/jamanetworkopen.2023.15235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
Importance Women with pregnancy-associated stroke might have different risks of stroke recurrence, including during subsequent pregnancies, and other cardiovascular events due to pregnancy-specific stroke risk factors, such as gestational hypertension, preeclampsia, or gestational diabetes. Objective To estimate the rate of stroke recurrence, cardiovascular hospitalization, and death in women with pregnancy-associated stroke compared with women with non-pregnancy-associated stroke. Design, Setting, and Participants This cohort study included all women aged 15 to 49 years in France who were affiliated with the general scheme of French health care insurance (94% of women) and had a first hospitalization for stroke between January 1, 2010, and December 31, 2018. Women were followed up until December 31, 2020, with the registration of stroke recurrence, hospitalization for cardiovascular conditions, and death. Data were from the French health care database Système National des Données de Santé. Statistical analyses were conducted between December 2021 and September 2022. Exposure Pregnancy status at the time of stroke. Main Outcomes and Measures Poisson regressions were used to estimate incidence rates of these events with 95% CIs. We used Cox proportional hazards regression models to estimate the hazard ratios (HRs) of each event during the follow-up for women with a pregnancy-associated stroke vs women with a non-pregnancy-associated stroke. Results Among women aged between 15 and 49 years between 2010 and 2018 and living in France, 1204 had a pregnancy-associated stroke at a mean (SD) age of 31.5 (5.8) years, and 31 697 had a non-pregnancy-associated stroke at a mean age of 39.6 (8.2) years. Among the 1204 women with a pregnancy-associated stroke, the incidence rate was 11.4 (95% CI, 9.0-14.3) per 1000 person-years, with 2 recurrent events during a subsequent pregnancy. Compared with women with non-pregnancy-associated stroke, women with pregnancy-associated stroke had lower risks of ischemic stroke (adjusted HR, 0.53; 95% CI, 0.36-0.77), cardiovascular events (adjusted HR, 0.58; 95% CI, 0.49-0.69), and death (adjusted HR, 0.42; 95% CI, 0.22-0.79). In contrast, the risk of recurrent intracerebral hemorrhage and cerebral venous thrombosis did not differ significantly, whereas the risks of venous thromboembolism (HR, 2.02; 95% CI, 1.14-3.58) and acute coronary syndrome with ST-segment elevation (HR, 3.93; 95% CI, 1.10-14.0) were increased. Conclusions and Relevance In this cohort study, although the risks of ischemic stroke, overall cardiovascular events, and mortality were lower after a pregnancy-associated stroke than after a non-pregnancy-associated stroke, the risks of venous thromboembolism and acute coronary syndrome with ST-segment elevation were higher. Recurrent stroke during a subsequent pregnancy remained rare.
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Affiliation(s)
- Yannick Béjot
- Dijon Stroke Registry, University Hospital and Medical School of Dijon, University of Burgundy, Burgundy, France
| | | | | | | | | | - Gauthier Duloquin
- Dijon Stroke Registry, University Hospital and Medical School of Dijon, University of Burgundy, Burgundy, France
| | - Jacques Blacher
- Diagnosis and Therapeutic Center, Hotel Dieu, Assistance Publique-Hôpitaux de Paris, University Paris Descartes, Paris, France
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Soyer J, Gabet A, Grave C, Piffaretti C, Verdot C, Salanave B, Deschamps V, Fosse-Edorh S, Carcaillon-Bentata L, Olié V. Need for improvement of cardiovascular health: a clustering method to identify cardiovascular health profiles. Eur J Public Health 2023:7187096. [PMID: 37255383 PMCID: PMC10393485 DOI: 10.1093/eurpub/ckad048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND In France, the overall trend in the incidence of cardiovascular disease is unfavourable, especially in young subjects. This highlights the need to promote cardiovascular health by targeting the main risk factors. Social marketing campaigns to improve cardiovascular health should identify unhealthy behaviour and understand the target audience. The objective of this study was to identify poor cardiovascular health profiles in the French population using a clustering method. METHODS Subjects aged 18-74 years with no history of cardiovascular disease were included from the Esteban cross-sectional survey (2014-16). To evaluate cardiovascular health, seven items were considered as defined by the American Heart Association: blood glucose, blood cholesterol, blood pressure, body mass index, cigarette smoking, diet and physical activity. Cardiovascular health profiles were identified from these seven items by combining multiple correspondence analysis with hierarchical clustering and partitioning. RESULTS A total of 1673 subjects were included in the main analysis. Five cardiovascular health profiles were identified: two profiles corresponded to subjects with poor cardiovascular health (mainly older men with a low socioeconomic status), two to subjects with intermediate cardiovascular health (one mainly comprised of young women with a low socioeconomic status and the other of young subjects with a high socioeconomic status) and one to subjects with good cardiovascular health (mainly older women). CONCLUSION This description of cardiovascular health profiles, which led to the identification and characterization of target audiences for future population-based prevention campaigns, should be the starting point for improving cardiovascular health in the French population.
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Affiliation(s)
- Jessica Soyer
- Department of Non-Communicable Diseases and Trauma, Santé Publique France, Saint-Maurice, France
| | - Amélie Gabet
- Department of Non-Communicable Diseases and Trauma, Santé Publique France, Saint-Maurice, France
| | - Clémence Grave
- Department of Non-Communicable Diseases and Trauma, Santé Publique France, Saint-Maurice, France
| | - Clara Piffaretti
- Department of Non-Communicable Diseases and Trauma, Santé Publique France, Saint-Maurice, France
| | - Charlotte Verdot
- Department of Non-Communicable Diseases and Trauma, Santé Publique France, Saint-Maurice, France
| | - Benoit Salanave
- Department of Non-Communicable Diseases and Trauma, Santé Publique France, Saint-Maurice, France
| | - Valérie Deschamps
- Department of Non-Communicable Diseases and Trauma, Santé Publique France, Saint-Maurice, France
| | - Sandrine Fosse-Edorh
- Department of Non-Communicable Diseases and Trauma, Santé Publique France, Saint-Maurice, France
| | - Laura Carcaillon-Bentata
- Department of Non-Communicable Diseases and Trauma, Santé Publique France, Saint-Maurice, France
| | - Valérie Olié
- Department of Non-Communicable Diseases and Trauma, Santé Publique France, Saint-Maurice, France
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Lailler G, Grave C, Gabet A, Regnault N, Deneux-Tharaux C, Kretz S, Mounier-Vehier C, Tsatsaris V, Plu-Bureau G, Blacher J, Olié V. Adverse Maternal and Infant Outcomes in Women With Chronic Hypertension in France (2010-2018): The Nationwide CONCEPTION Study. J Am Heart Assoc 2023; 12:e027266. [PMID: 36847049 PMCID: PMC10111462 DOI: 10.1161/jaha.122.027266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Background It has been suggested that chronic hypertension is a risk factor for negative maternal and fetal outcomes during pregnancy and postpartum. We aimed to estimate the association of chronic hypertension on adverse maternal and infant outcomes and assess the impact of antihypertensive treatment and these outcomes. Methods and Results Using data from the French national health data system, we identified and included in the CONCEPTION cohort all women in France who delivered their first child between 2010 and 2018. Chronic hypertension before pregnancy was identified through antihypertensive medication purchases and by diagnosis during hospitalization. We assessed the incidence risk ratios (IRRs) of maternofetal outcomes using Poisson models. A total of 2 822 616 women were included, and 42 349 (1.5%) had chronic hypertension and 22 816 were treated during pregnancy. In Poisson models, the adjusted IRR (95% CI) of maternofetal outcomes for women with hypertension were as follows: 1.76 (1.54-2.01) for infant death, 1.73 (1.60-1.87) for small gestational age, 2.14 (1.89-2.43) for preterm birth, 4.58 (4.41-4.75) for preeclampsia, 1.33 (1.27-1.39) for cesarean delivery, 1.84 (1.47-2.31) for venous thromboembolism, 2.62 (1.71-4.01) for stroke or acute coronary syndrome, and 3.54 (2.11-5.93) for maternal death postpartum. In women with chronic hypertension, being treated with an antihypertensive drug during pregnancy was associated with a significantly lower risk of obstetric hemorrhage, stroke, and acute coronary syndrome during pregnancy and postpartum. Conclusions Chronic hypertension is a major risk factor of infant and maternal negative outcomes. In women with chronic hypertension, the risk of pregnancy and postpartum cardiovascular events may be decreased by antihypertensive treatment during pregnancy.
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Affiliation(s)
- Grégory Lailler
- Santé publique France Saint-Maurice France.,Department of Medicine Université Paris Est Créteil France
| | | | | | | | - Catherine Deneux-Tharaux
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), French National Institute for Health and Medical Research (INSERM) Paris France.,Department of Medicine Université Paris Cité Paris France
| | - Sandrine Kretz
- Centre de diagnostic et de thérapeutique, Assistance Publique Hôpitaux de Paris (AP-HP), Hôtel Dieu de Paris Paris France
| | | | - Vassilis Tsatsaris
- Department of Medicine Université Paris Cité Paris France.,Maternité Port-Royal, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Cochin Paris France
| | - Geneviève Plu-Bureau
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), French National Institute for Health and Medical Research (INSERM) Paris France.,Department of Medicine Université Paris Cité Paris France.,Unité de gynécologie médicale, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Port-Royal Cochin Paris France
| | - Jacques Blacher
- Department of Medicine Université Paris Cité Paris France.,Centre de diagnostic et de thérapeutique, Assistance Publique Hôpitaux de Paris (AP-HP), Hôtel Dieu de Paris Paris France
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Lailler G, Grave C, Gabet A, Regnault N, Deneux-Tharaux C, Kretz S, Tsatsaris V, Plu-Bureau G, Blacher J, Olie V. Aspirin for the Prevention of Early and Severe Pre-Eclampsia Recurrence: A Real-World Population-Based Study. Drugs 2023; 83:429-437. [PMID: 36867398 PMCID: PMC10042896 DOI: 10.1007/s40265-023-01842-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Many clinical trials have reported that low-dose aspirin decreases the risk of pre-eclampsia in women with prior pre-eclampsia. However, its impact in a real-world population has not been fully assessed. OBJECTIVES To assess the rates of low-dose aspirin initiation during pregnancy in women with a history of pre-eclampsia, and to evaluate the impact of low-dose aspirin in prevention of pre-eclampsia recurrence in a real-world population. STUDY DESIGN CONCEPTION is a French nationwide cohort study which uses data from the country's National Health Data System database. We included all women in France who gave birth at least twice between 2010-2018, and who had pre-eclampsia during their first pregnancy. Every dispensing of low-dose aspirin (75-300 mg) between the beginning of their second pregnancy and 36 weeks of gestation (WG) was identified. We used Poisson regression models to estimate the adjusted incidence rate ratios (aIRRs) of receiving aspirin at least once during their second pregnancy. In women who had early and/or severe pre-eclampsia during their first pregnancy, we estimated the IRRs of pre-eclampsia recurrence during their second pregnancy according to the aspirin therapy. RESULTS In 28,467 women who were included in the study, the aspirin initiation rate during the second pregnancy ranged from 27.8% for women in whose first pregnancy the pre-eclampsia was mild and late, to 79.9% for those women whose pre-eclampsia was severe and early. Just over half (54.3%) of those treated with aspirin-initiated treatment before 16 WG and adhered to treatment. Compared with women with mild and late pre-eclampsia, the aIRRs (95% CI) for receiving aspirin at least once during the second pregnancy were 1.94 (1.86-2.03) for women with severe and late pre-eclampsia, 2.34 (2.17-2.52) for those with early and mild pre-eclampsia, and 2.87 [2.74-3.01] for those with early and severe pre-eclampsia E. Social deprivation was associated with a lower initiation of aspirin (IRR = 0.74 [0.70-0.78]). Aspirin was not associated with a lower risk of mild and late pre-eclampsia, severe and late pre-eclampsia, or mild and early pre-eclampsia during the second pregnancy. The aIRRs for severe and early pre-eclampsia during the second pregnancy were 0.77 (0.62-0.95) for women who received prescribed aspirin at least once, 0.71 (0.5-0.89) for those who initiated aspirin therapy before 16 WG, and 0.60 (0.47-0.77) for those who adhered to aspirin treatment throughout their second pregnancy. The risk of severe and early pre-eclampsia was lower only when the prescribed mean daily dose was ≥ 100 mg/day. CONCLUSION In women with a history of pre-eclampsia, aspirin initiation during a second pregnancy and adherence to the prescribed dosage were largely insufficient, especially for women experiencing social deprivation. Aspirin initiated before 16 WG at a dose ≥ 100 mg/day was associated with a lower risk of severe and early pre-eclampsia.
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Affiliation(s)
- Grégory Lailler
- Santé publique France, Saint-Maurice, France.
- Université Paris Est, Créteil, France.
| | | | | | | | - Catherine Deneux-Tharaux
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), INSERM, Paris, France
- Université Paris Cité, Paris, France
| | - Sandrine Kretz
- Centre de diagnostic et de thérapeutique, Hôtel Dieu, AP-HP, Paris, France
| | - Vassilis Tsatsaris
- Université Paris Cité, Paris, France
- Maternité Port-Royal, FHU PREMA, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - Geneviève Plu-Bureau
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), INSERM, Paris, France
- Université Paris Cité, Paris, France
- Unité de gynécologie médicale, APHP, Hôpital Port-Royal Cochin, Paris, France
| | - Jacques Blacher
- Université Paris Cité, Paris, France
- Centre de diagnostic et de thérapeutique, Hôtel Dieu, AP-HP, Paris, France
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Lailler G, Grave C, Regnault N, Deneux-Tharaux C, Kretz S, Tsatsaris V, Plu-Bureau G, Blacher J, Gabet A, Olié V. Prévention des récidives de pré-éclampsie par aspirine: une étude en population réelle. Rev Epidemiol Sante Publique 2023. [DOI: 10.1016/j.respe.2023.101436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
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10
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Lailler G, Grave C, Gabet A, Regnault N, Deneux-Tharaux C, Kretz S, Tsatsaris V, Plu-Bureau G, Blacher J, Olié V. Recurrence of hypertensive disorders of pregnancy: results from a nationwide prospective cohort study (CONCEPTION). BJOG 2023. [PMID: 36802131 DOI: 10.1111/1471-0528.17424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 01/24/2023] [Accepted: 02/07/2023] [Indexed: 02/20/2023]
Abstract
OBJECTIVE To assess the risk of gestational hypertension (GH) and pre-eclampsia (PE) during a second pregnancy after occurrence during a first pregnancy. DESIGN Prospective cohort study. SETTING CONCEPTION is a French nationwide cohort study that used data from the National Health Data System (SNDS) database. METHODS We included all women who gave birth for the first time in France in 2010-2018 and who subsequently gave birth. We identified GH and PE through hospital diagnoses and the dispensing of anti-hypertensive drugs. The incidence rate ratios (IRR) of all hypertensive disorder of pregnancy (HDP) during the second pregnancy were estimated using Poisson models adjusted for confounding. MAIN OUTCOME MEASURES Incidence rate ratios of HDP during the second pregnancy. RESULTS Of the 2 829 274 women included, 238 506 (8.4%) were diagnosed with HDP during their first pregnancy. In women with GH during their first pregnancy, 11.3% (IRR 4.5, 95% confidence interval [CI] 4.4-4.7) and 3.4% (IRR 5.0, 95% CI 4.8-5.3) developed GH and PE during their second pregnancy, respectively. In women with PE during their first pregnancy, 7.4% (IRR 2.6, 95% CI 2.5-2.7) and 14.7% (IRR 14.3, 95% CI 13.6-15.0) developed GH and PE during their second pregnancy, respectively. The more severe and earlier the PE during the first pregnancy, the stronger the likelihood of having PE during the second pregnancy. Maternal age, social deprivation, obesity, diabetes and chronic hypertension were all associated with PE recurrence. CONCLUSION These results can guide policymaking that focuses on improving counselling for women who wish to become pregnant more than once, by identifying those who would benefit more from tailored management of modifiable risk factors, and heightened surveillance during post-first pregnancies.
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Affiliation(s)
- G Lailler
- Santé Publique France, Saint-Maurice, France.,Université Paris Est, Créteil, France
| | - C Grave
- Santé Publique France, Saint-Maurice, France
| | - A Gabet
- Santé Publique France, Saint-Maurice, France
| | - N Regnault
- Santé Publique France, Saint-Maurice, France
| | - C Deneux-Tharaux
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), INSERM, Paris, France.,Université Paris Cité, Paris, France
| | - S Kretz
- Centre de Diagnostic et de Thérapeutique, Paris, France
| | - V Tsatsaris
- Université Paris Cité, Paris, France.,Maternité Port-Royal, FHU PREMA, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - G Plu-Bureau
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), INSERM, Paris, France.,Université Paris Cité, Paris, France.,Unité de Gynécologie Médicale, APHP, Hôpital Port-Royal Cochin, Paris, France
| | - J Blacher
- Université Paris Cité, Paris, France.,Centre de Diagnostic et de Thérapeutique, Paris, France
| | - V Olié
- Santé Publique France, Saint-Maurice, France
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11
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Béjot Y, Olié V, Lailler G, Grave C, Regnault N, Blacher J, Duloquin G, Gabet A. Acute revascularization therapy for ischemic stroke during pregnancy and post-partum in France. Eur Stroke J 2023; 8:467-474. [DOI: 10.1177/23969873231156208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
Introduction: Intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) in women with ischemic stroke (IS) during pregnancy/post-partum is challenging, and recent guidelines claimed for additional information to better argue its effectiveness and safety. This observational national study aimed to describe characteristics, rates and outcomes of pregnant/post-partum women receiving acute revascularization therapy for IS compared to their non-pregnant counterparts, and pregnant women with IS not receiving such therapy. Patients and methods: In this cross-sectional study, all women aged 15–49 years hospitalized in France for IS between 2012 and 2018 were retrieved from the French hospital discharge databases. Pregnant or post-partum (⩽6 weeks after delivery) women were identified. Data about patients’ characteristics, risk factors, revascularization therapy, delivery, post-stroke survival, and recurrent vascular events during follow-up were recorded. Results: Over the study period, 382 women with pregnancy-related IS were registered. Among them, 7.3% ( n = 28) received a revascularization therapy, including nine cases during pregnancy, one the same day as delivery, and 18 during the post-partum period, compared with 8.5% ( n = 1285) in women with non-pregnancy-related IS ( n = 15,084). Treated pregnant/post-partum women had more severe IS than not-treated pregnant/post-partum. Compared with treated not-pregnant women, they were younger, but did not differ regarding other characteristics including stroke severity. There were no differences in systemic or intracranial hemorrhages or in the length of hospital stay between pregnant/post-partum women compared with treated not-pregnant women. All women receiving revascularization during pregnancy had a live baby. After a mean follow-up of 4.3 years, all pregnant/post-partum women were alive, one had recurrent IS and none had other vascular events. Discussion and conclusion: Only a few women with pregnancy-related IS were treated with acute revascularization therapy, but this was proportionately similar to their non-pregnant counterparts, from whom they did not differed regarding characteristics, survival, and risk of recurrent events. These findings suggest that stroke physicians applied treatment strategies of IS in a similar way regardless of pregnancy in France, and this attitude was an anticipation but consistent with the recently published guidelines on the topic.
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Affiliation(s)
- Yannick Béjot
- Dijon Stroke Registry, Department of Neurology, University Hospital of Dijon, EA7460, Pathophysiology and Epidemiology of Cardio-Cerebrovascular Disease (PEC2), University of Burgundy, Dijon, France
| | - Valérie Olié
- French Public Health Agency, Saint-Maurice, France
| | | | | | | | - Jacques Blacher
- Diagnosis and Therapeutic Center, Hotel Dieu, AP-HP, University Paris Descartes, Paris, France
| | - Gauthier Duloquin
- Dijon Stroke Registry, Department of Neurology, University Hospital of Dijon, EA7460, Pathophysiology and Epidemiology of Cardio-Cerebrovascular Disease (PEC2), University of Burgundy, Dijon, France
| | - Amélie Gabet
- French Public Health Agency, Saint-Maurice, France
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12
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Lailler G, Grave C, Gabet A, Regnault N, Deneux-Tharaux C, Kretz S, Tsatsaris V, Plu Bureau G, Blacher J, Olié V. Aspirin for the prevention of pre-eclampsia recurrence: A real-life nationwide study. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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13
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Grave C, Gabet A, Cinaud A, Iliou MC, Tuppin P, Blacher J, Olié V. Cardiac rehabilitation after an acute coronary syndrome in France: Latest estimates and temporal trends 2009–2021. An overall improvement but persistent regional and sex disparities. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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14
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Lailler G, Gabet A, Grave C, Regnault N, Plu Bureau G, Tsatsaris V, Deneux-Tharaux C, Kretz S, Blacher J, Olié V. Recurrence of hypertensive disorders of pregnancy: The nationwide CONCEPTION study. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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15
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Olié V, Lailler G, Bejot Y, Martin A, Gabet A, Grave C, Regnault N, Chatignoux E, Kretz S, Tsatsaris V, Plu Bureau G, Deneux-Tharaux C, Blacher J. Cardiovascular diseases in pregnancy: Incidence, temporal trends and characteristics of women, the nationwide CONCEPTION study. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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16
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Olié V, Chatignoux E, Bonaldi C, Grave C, Gabet A, Blacher J. How to avoid overestimating the burden of hypertension in epidemiological studies? A new methodology to account for within-person variability of blood pressure. Int J Epidemiol 2022; 51:1824-1834. [PMID: 35904461 DOI: 10.1093/ije/dyac152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 07/08/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Hypertension (HT) is a major modifiable risk factor for cardiovascular and renal diseases. HT is diagnosed as blood pressure (BP) exceeding a certain threshold. Because of the high within-person variability of BP, the estimation of HT in epidemiological studies based on single visit measurements tends to overestimate HT prevalence. Our study aimed to determine the correction factors to correct the bias in the estimation of HT prevalence in epidemiological studies. METHODS We used data from the National Health and Nutrition Examination Survey study in which BP was measured at three visits. A Bayesian hierarchical model was used to estimate the different components of BP variability (between individuals, between visits or between measures) by age and sex. These components allowed us to calculate the correction factors necessary to correct HT prevalence in epidemiological studies with single BP measurement. The method was then applied to data from the French Esteban study in which three standardized BP measurements were performed at a single clinical examination. RESULTS The components of BP variability varied with age and sex, with different patterns observed for systolic and diastolic BP. Between-visit and between-individual variations drove BP variability, with between-measure variability being much lower. The uncorrected prevalence of HT in the Esteban study overestimated the burden of HT by 12.6% in the French population, with more than one in five untreated individuals being misclassified. The overestimation was higher in younger adults and women. CONCLUSION Taking into account within-person BP variability in epidemiological studies could avoid a substantial overestimation of the burden of HT.
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Affiliation(s)
| | | | | | | | | | - Jacques Blacher
- Université Paris Cité; Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu University Hospital, AP-HP, Paris, France
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Blacher J, Lelong H, Grave C, Gabet A, Tuppin P, Olié V. Tell me how much you make, I'll tell you what illnesses you'll have - The scandal of socioeconomic inequalities in health. J Med Vasc 2022; 47:215-217. [PMID: 36464414 DOI: 10.1016/j.jdmv.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- J Blacher
- Centre de diagnostic et de thérapeutique, Hôtel-Dieu, AP-HP, Université Paris Cité, 1, parvis Notre-Dame, 75004 Paris, France.
| | - H Lelong
- Centre de diagnostic et de thérapeutique, Hôtel-Dieu, AP-HP, Université Paris Cité, 1, parvis Notre-Dame, 75004 Paris, France
| | - C Grave
- Santé Publique France, Saint-Maurice, France
| | - A Gabet
- Santé Publique France, Saint-Maurice, France
| | - P Tuppin
- Caisse Nationale d'Assurance Maladie des travailleurs salariés, Paris, France
| | - V Olié
- Santé Publique France, Saint-Maurice, France
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18
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Vay-Demouy J, Lelong H, Neudorff P, Gabet A, Grave C, Blacher J, Olié V. Underuse of lifestyle recommendations in hypertension management in France: The Esteban study. J Clin Hypertens (Greenwich) 2022; 24:1266-1275. [PMID: 36177966 PMCID: PMC9581092 DOI: 10.1111/jch.14576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/23/2022] [Accepted: 08/29/2022] [Indexed: 11/29/2022]
Abstract
Lifestyle recommendations are first‐line elements in the management of arterial hypertension. This cross‐sectional study aimed to analyze the level to which lifestyle recommendations are used in hypertension management in France, using data from the Esteban study, which was implemented by Santé Publique France, France's public health agency, from 2014 to 2016 on a representative sample of the French population. The study sample comprised 440 adult Esteban participants who were aware they had hypertension and were aged 18–74 years old. The main outcomes were the proportion of participants who received lifestyle recommendations in their hypertension management plan, and the proportion of recommendations according to the three following dimensions: physical activity, weight loss, and changes in diet. Over half (57.0%) of the 440 participants declared they did not receive lifestyle recommendations as part of their hypertension management plan in the year preceding the study. Of these, 39.0% did not receive pharmacological treatment either. Physical activity was recommended to 31.8% of sedentary participants and weight loss to 26.8% of participants with overweight or obesity. One‐fifth of the study sample (20.1%) received dietary recommendations. Of these, 69% and 10.7% were advised to limit their salt and alcohol intake, respectively. Lifestyle interventions are too rarely recommended in hypertension management plans in France. Adherence to lifestyle recommendations needs in‐depth discussion not only at the time of diagnosis but also throughout follow‐up.
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Affiliation(s)
- Juliette Vay-Demouy
- Diagnosis and Therapeutic Center, Hôtel-Dieu University Hospital, Assistance Publique-Hôpitaux de Paris, Paris University, Paris, France
| | - Hélène Lelong
- Diagnosis and Therapeutic Center, Hôtel-Dieu University Hospital, Assistance Publique-Hôpitaux de Paris, Paris University, Paris, France
| | - Pauline Neudorff
- Diagnosis and Therapeutic Center, Hôtel-Dieu University Hospital, Assistance Publique-Hôpitaux de Paris, Paris University, Paris, France
| | - Amélie Gabet
- French Public Health Agency, Saint-Maurice, France
| | | | - Jacques Blacher
- Diagnosis and Therapeutic Center, Hôtel-Dieu University Hospital, Assistance Publique-Hôpitaux de Paris, Paris University, Paris, France
| | - Valérie Olié
- French Public Health Agency, Saint-Maurice, France
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Martin A, Lailler G, Pr YB, Gabet A, Grave C, Regnault N, Chatignoux E, Moutengou E, Deneux-Tharaux C, Kretz S, Mounier-Vehier C, Tsatsaris V, Plu-Bureau G, Blacher J, Olié V. Incidence and Time Trends of Pregnancy-Related Stroke Between 2010 and 2018: The Nationwide CONCEPTION Study. Neurology 2022; 99:e1598-e1608. [PMID: 36038274 DOI: 10.1212/wnl.0000000000200944] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 05/20/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES - Despite the potentially devastating effects of pregnancy-related stroke, few studies have examined its incidence by type of stroke. We aimed to study the nationwide incidence rates and recent temporal trends for all types of pregnancy-related stroke and to compare these incidence with stroke incidence in nonpregnant women. METHODS - We conducted a study of 6 297 698 women aged 15 to 49 years who gave birth in France between 2010 and 2018 with no history of stroke before pregnancy by collecting data from the French National Health Insurance Information System database. Poisson regression were used to estimate incidence by types of stroke for the different pregnancy periods and the incidence rate ratio of stroke in pregnant versus nonpregnant French women. RESULTS - Among the 6 297 698 women, 1261 (24.0 per 100,000 person-years) experienced a first ever stroke during , antepartum peripartum, or the first 6 weeks of postpartum. Of the pregnancy-related strokes, 42.9% were ischemic (IS), 41.9% were hemorrhagic (with similar proportion of intracerebral and subarachnoid hemorrhage) and 17.4% were cerebral venous thrombosis (CVT). Compared with nonpregnant women, incidence rates of stroke were similar during pregnancy for IS (aIRR=0.9(0.8-1.1), slightly higher for all hemorrhagic strokes (IRR=1.4(1.2-1.8), and considerably increased for CVT (IRR=8.1(6.5-10.1). Pregnancy-related stroke incidence rose between 2010 and 2018 for ischemic and hemorrhagic stroke but was stable for CVT. DISCUSSION - The risk of pregnancy related CVT was more than eight-fold higher than that observed in nonpregnant women.The incidence of pregnancy-related ischemic and hemorrhagic stroke is increasing over time, and efforts should be made in terms of prevention considering treatable cardiovascular risk factors and hypertensive disorders in pregnant women.
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Affiliation(s)
- Alice Martin
- French Public Health Agency, Saint-Maurice, France
| | | | - Yannick Béjot Pr
- Dijon Stroke Registry, University Hospital and Medical School of Dijon, University of Burgundy, France
| | - Amélie Gabet
- French Public Health Agency, Saint-Maurice, France
| | | | | | | | | | - Catherine Deneux-Tharaux
- Inserm U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Research Center for Epidemiology and Biostatistics Sorbonne Paris Cité (CRESS), France.,Paris-Descartes university, Paris, France
| | - Sandrine Kretz
- Diagnosis and Therapeutic Center, Hotel Dieu; AP-HP; University Paris Descartes, Paris, France
| | - Claire Mounier-Vehier
- Vascular medecine and hypertension center, EA 2694 - Santé Publique- University Lille, France
| | - Vassilis Tsatsaris
- Paris-Descartes university, Paris, France.,Department of Obstetrics and Gynecology, APHP, Port-Royal Maternity, University Hospital Center Cochin Broca Hôtel Dieu, Groupe Hospitalier Universitaire Ouest, Paris, France
| | - Genevieve Plu-Bureau
- Inserm U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Research Center for Epidemiology and Biostatistics Sorbonne Paris Cité (CRESS), France.,Paris-Descartes university, Paris, France.,Division of Gynaecology, APHP, Hôpital Cochin, Paris, France
| | - Jacques Blacher
- Paris-Descartes university, Paris, France.,Diagnosis and Therapeutic Center, Hotel Dieu; AP-HP; University Paris Descartes, Paris, France
| | - Valérie Olié
- French Public Health Agency, Saint-Maurice, France;
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20
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Gabet A, Grave C, Tuppin P, Lesuffleur T, Guenancia C, Nguyen-Thanh V, Guignard R, Blacher J, Olié V. Nationwide Initiation of Cardiovascular Risk Treatments During the COVID-19 Pandemic in France: Women on a Slippery Slope? Front Cardiovasc Med 2022; 9:856689. [PMID: 35548431 PMCID: PMC9081923 DOI: 10.3389/fcvm.2022.856689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/28/2022] [Indexed: 11/28/2022] Open
Abstract
Objectives This study examines the initiation of prescribed medication treatments for cardiovascular risk (antihypertensives, lipid-lowering drugs, oral anticoagulants in atrial fibrillation, and smoking cessation medications) during the COVID-19 pandemic in the French population. Methods For each year between 2017 and 2021, we used the French National Insurance Database to identify the number of people with at least one reimbursement for these medications but no reimbursement in the previous 12 months. We computed incidence rate ratios (IRRs) between 2017–2019 and, respectively 2020 and 2021 using Poisson regression adjusted for age and 2017–2019 time trends. We recorded the number of lipid profile blood tests, Holter electrocardiograms, and consultations with family physicians or cardiologists. Results In 2020, IRR significantly decreased for initiations of antihypertensives (−11.1%[CI95%, −11.4%;−10.8%]), lipid-lowering drugs (−5.2%[CI95%, −5.5%;−4.8%]), oral anticoagulants in atrial fibrillation (−8.6%[CI95%, −9.1%;−8.0%]), and smoking cessation medications (−50.9%[CI95%, −51.1%;−50.7%]) compared to 2017–2019. Larger decreases were found in women compared to men except for smoking cessation medications, with the sex difference increasing with age. Similar analyses comparing 2021 to 2017–2019 showed an increase in the initiation of lipid-lowering drugs (+ 11.6%[CI95%, 10.7%;12.5%]) but even lower rates for the other medications, particularly in women. In addition, the 2020 number of people visiting a family physician or cardiologist decreased by 8.4 and 7.4%. A higher decrease in these visits was observed in those over 65 years of age compared to those under 65 years of age. A greater use of teleconsultation was found in women. Conclusion The COVID-19 pandemic heavily impacted the initiation of medication treatments for cardiovascular risk in France, particularly in women and people over 65 years.
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Affiliation(s)
- Amélie Gabet
- Santé Publique France, Paris, France
- *Correspondence: Amélie Gabet,
| | | | | | | | | | | | | | - Jacques Blacher
- Centre de Diagnostic et de Thérapeutique, Hôtel-Dieu, AP-HP, Université de Paris, Paris, France
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21
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Olié V, Grave C, Tuppin P, Duloquin G, Béjot Y, Gabet A. Patients Hospitalized for Ischemic Stroke and Intracerebral Hemorrhage in France: Time Trends (2008-2019), In-Hospital Outcomes, Age and Sex Differences. J Clin Med 2022; 11:jcm11061669. [PMID: 35329995 PMCID: PMC8949281 DOI: 10.3390/jcm11061669] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/12/2022] [Accepted: 03/15/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Rates of patients hospitalized for stroke increased among people aged under 65 years in France, as has been found in other countries. Methods: To analyze time trends in the rates of patients hospitalized for ischemic stroke (IS) and intracerebral hemorrhage (ICH) in France between 2008 and 2019 and determine related short-term outcomes mainly, we selected all patients hospitalized for stroke using the French national hospital database. Results: The average annual percentage change in the rates of patients hospitalized for IS increased significantly in men and women aged 50–64 years (+2.0%) and in men aged 18–34 years (+1.5%) and 35–44 years (+2.2%). A decrease in the average annual percentage change was observed for IS among people aged over 75 years and among those over 50 years for ICH. After adjustment on confounding factors, women were less likely to die in hospital. Case fatality rates decreased overtime in all age groups for both sexes, with a more pronounced decrease for IS than ICH. Conclusions: The increasing trend of IS among adults under 65 years is ongoing, highlighting the urgent need for stroke prevention programs in that age. For the first time, we recorded a decrease in the rates of patients hospitalized for ICH among the population over 50 years.
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Affiliation(s)
- Valérie Olié
- Department of Non-Communicable Diseases, Santé Publique France, 94410 Saint-Maurice, France; (V.O.); (C.G.)
| | - Clémence Grave
- Department of Non-Communicable Diseases, Santé Publique France, 94410 Saint-Maurice, France; (V.O.); (C.G.)
| | - Philippe Tuppin
- Department of Health Studies and Statistics, Caisse Nationale de l’Assurance Maladie, 75020 Paris, France;
| | - Gauthier Duloquin
- Dijon Stroke Registry, University Hospital of Burgundy, 21000 Dijon, France; (G.D.); (Y.B.)
| | - Yannick Béjot
- Dijon Stroke Registry, University Hospital of Burgundy, 21000 Dijon, France; (G.D.); (Y.B.)
| | - Amélie Gabet
- Department of Non-Communicable Diseases, Santé Publique France, 94410 Saint-Maurice, France; (V.O.); (C.G.)
- Correspondence:
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22
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Gabet A, Grave C, Tuppin P, Olié V, Emmerich J. One Year Prevalence of Venous Thromboembolism in Hospitalized COVID-19 Patients in France: Patients' Characteristics, Time Trends, and Outcomes. Thromb Haemost 2022; 122:1532-1541. [PMID: 35288889 DOI: 10.1055/s-0042-1743475] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Patients hospitalized with coronavirus disease-2019 (COVID-19) are at high risk of deep venous thrombosis (DVT) and pulmonary embolism (PE). OBJECTIVES The aims were to provide time trends in the 2020 nation-wide prevalence of venous thromboembolism (VTE) in patients hospitalized with a COVID-19 diagnosis in France, and to describe in-hospital and up to 30-day postdischarge death. METHODS All patients hospitalized in France with a COVID-19 diagnosis in 2020 were selected. Crude and age-adjusted prevalence of VTE and PE was computed by 4-week intervals and for the overall study period using Poisson regression. Time trends in in-hospital and 30-day postdischarge case-fatality rates were evaluated by comparing each 4-week intervals to weeks 10 to 14 corresponding to the first part of the first lockdown using logistic regression models. RESULTS Among the 287,638 patients hospitalized with a COVID-19 diagnosis in 2020 in France, 14,985 (5.2%) had a concomitant VTE, with 10,453 (3.6%) having PE and 4,532 (1.6%) having DVT. In patients admitted to intensive care units, the crude prevalence of VTE and PE reached 16.1 and 11.0% respectively during the first lockdown. After adjustment, the prevalence of VTE and PE decreased during the year 2020 but a rebound was observed during the second lockdown. In-hospital case-fatality rates among hospitalized COVID-19 patients with PE globally decreased between the first and the second epidemic waves. CONCLUSION Our study showed a decrease in the incidence of symptomatic VTE and PE in hospitalized COVID-19 patients, and a decreased time trend of outcomes during the second wave compared with the first one.
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Affiliation(s)
- Amélie Gabet
- Cardiovascular Division, Department of Non-Communicable Diseases, Santé Publique France, Saint-Maurice (94), France
| | - Clémence Grave
- Cardiovascular Division, Department of Non-Communicable Diseases, Santé Publique France, Saint-Maurice (94), France
| | - Philippe Tuppin
- Department of Studies Strategy and Statistics, Caisse Nationale d'Assurance Maladie, Paris, France
| | - Valérie Olié
- Cardiovascular Division, Department of Non-Communicable Diseases, Santé Publique France, Saint-Maurice (94), France
| | - Joseph Emmerich
- Department of Vascular Medicine, Groupe Hospitalier Paris Saint-Joseph, Université de Paris, INSERM CRESS 1153, Paris, France
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Gabet A, Grave C, Tuppin P, Lesuffleur T, Blacher J, Olié V. Initiation d'un traitement du risque cardiovasculaire au cours de la pandémie de COVID-19 en France. Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.01.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Kuhn J, Olié V, Grave C, Le Strat Y, Bonaldi C, Joly P. Estimating the Future Burden of Myocardial Infarction in France Until 2035: An Illness-Death Model-Based Approach. Clin Epidemiol 2022; 14:255-264. [PMID: 35281209 PMCID: PMC8906821 DOI: 10.2147/clep.s340031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/17/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose In France, myocardial infarction (MI) was the second leading cause of years of life lost in 2019. Estimating the burden of MI in future years could help policymakers and other actors anticipate care and prevention needs and guide them in public health decision-making. Materials and Methods Using data from the French hospital discharge database from 2007 to 2015 (n = 519,400), demographic data, and an illness-death model, we projected incidence, prevalence, number of prevalent cases and mean age of incident MI cases in France. The methodology took into account the age-cohort effect on MI incidence, mortality of healthy and diseased subjects, and the time since disease onset. Results Projections highlighted an increase in MI prevalence in men between 2015 and 2035 from 2.52% (95% uncertainty interval (UI): [2.48–2.56]) in 2015 to 4.02% ([3.92–4.12]) in 2035, and from 0.85% ([0.83–0.87]) to 1.44% ([1.38–1.50]) in women. This corresponds to an increase of 365,000 cases between 2015 and 2035 (+81.1%) for men and 146,000 cases for women (+88.0%). The difference in the mean age of incident cases between men and women decreased from 9.52 in 2015 to 5.49 years in 2035. Conclusion Our projections forecast an increase in MI prevalence between 2015 and 2035 in men and women, especially in relatively younger women. Using statistical models such as ours can help assess the impact of prevention campaigns for the main cardiovascular disease risk factors on the future MI prevalence.
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Affiliation(s)
- Johann Kuhn
- Department of Support, Data Processing and Analysis, French National Public Health Agency, Saint-Maurice, France
- Correspondence: Johann Kuhn, Department of Support, Data Processing and Analysis, French National Public Health Agency, 12 rue du Val d’Osne, Saint-Maurice, 94410, France, Tel/Fax +33 1 71 80 15 44, Email
| | - Valérie Olié
- Department of Chronic Diseases and Injuries, French National Public Health Agency, Saint-Maurice, France
| | - Clémence Grave
- Department of Chronic Diseases and Injuries, French National Public Health Agency, Saint-Maurice, France
| | - Yann Le Strat
- Department of Support, Data Processing and Analysis, French National Public Health Agency, Saint-Maurice, France
| | - Christophe Bonaldi
- Department of Support, Data Processing and Analysis, French National Public Health Agency, Saint-Maurice, France
| | - Pierre Joly
- Centre Inserm U1219 – Bordeaux Population Health, Université de Bordeaux - ISPED, Bordeaux, France
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Grave C, Gabet A, Puymirat E, Empana JP, Tuppin P, Danchin N, Olié V. Les infarctus du myocarde pendant un an de pandémie de COVID-19 - Étude nationale française des taux d'hospitalisation, du pronostic et de la mortalité à 90 jours. Rev Epidemiol Sante Publique 2022. [PMCID: PMC8907803 DOI: 10.1016/j.respe.2022.01.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction Au début de la pandémie de COVID-19, plusieurs études ont signalé une diminution des séjours hospitaliers hors COVID-19. L'objectif de cette étude était de décrire les tendances nationales des admissions pour infarctus du myocarde (IDM) à l'hôpital en 2020 et comparer les caractéristiques, le pronostic hospitalier et la mortalité à 90 jours des patients admis en 2020, à ceux des patients admis en 2017-19. Méthodes Tous les patients hospitalisés pour IDM en France entre 2017 et 2020 ont été inclus à partir du PMSI-MCO. Les analyses ont comparé les tendances temporelles d'admissions pour IDM, les taux de complications cardiaques hospitalières, la réadmission et la mortalité hospitalière et à 90 jours en 2020 versus 2017-19 ; puis ont été stratifiées par période d'admission, type d'IDM, sexe, âge et régions. Résultats En 2020, 94 747 patients ont été hospitalisés pour IDM, correspondant à une diminution de 6 % des admissions pour IDM par rapport à 2017-2019. Cette diminution était plus importante durant le premier confinement (-24 %, p<0,0001) que pendant le deuxième (-8 %, p<0,0001), et a atteint -40 % en semaine 13. Les diminutions d'hospitalisation pour IDM étaient plus élevées et ont persisté plus longtemps pour les NSTEMI, pour les personnes âgées et pour les femmes. Une augmentation des hospitalisations pour STEMI a été observée entre les confinements (+4 %, p=0,0005). Globalement et après ajustement sur l’âge, le sexe et l'effet temporel, les taux de mortalité hospitalière et dans les 90 jours qui suivaient la sortie d'hospitalisation ne différaient pas entre 2020 et 2017-2019 (IRRaj-hosp =1,03[0,98 ; 1,08], p=0,19 - IRRaj 90j-post-sortie=1,06[0,98 ; 1,13], p=0,14). Discussion/Conclusion En 2020, une diminution significative des hospitalisations pour IDM a été observée et était particulièrement importante au début de l'année. L'impact de la crise du COVID-19 sur les complications aiguës et le pronostic à trois mois des patients admis apparaît limité. Néanmoins, la surveillance des complications chroniques de l'IDM et de l'impact sur les personnes non hospitalisées devra être poursuivie.
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Calas L, Subiros M, Ruello M, Hassani Y, Gabet A, Angue M, Pointeau O, Olié V, Grave C. Hypertension prevalence, awareness, treatment and control in 2019 in the adult population of Mayotte. Eur J Public Health 2022; 32:408-414. [PMID: 35195255 PMCID: PMC9159308 DOI: 10.1093/eurpub/ckac015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Mayotte is a French overseas territory with significant socio-economic and health challenges. This study updates the prevalence of hypertension in Mayotte to estimate the awareness, treatment and control of this disease and identify any associated factors. METHODS Data were taken from the cross-sectional Unono Wa Maore survey conducted in Mayotte in 2019. Analyses were based on the adult population aged 18-69 years who underwent a clinical examination with at least two blood pressure measurements (n = 2620). RESULTS In 2019, the prevalence of hypertension was estimated at 38.4% (36.1-40.7%) in the Mayotte population aged 18-69 years. The prevalence was similar in men (38.5%) and women (38.3%; P = 0.95). The prevalence of certain risk factors was high, with 75% of hypertensives being overweight or obese, 13% reporting diabetes and 69% being occupationally inactive. Among the hypertensives, 48% was aware of their diagnosis, with women more likely to be aware than men (P < 0.0001). Of those who were aware, 45% were treated pharmacologically and 49% reported engaging in physical activity to lower their blood pressure. The control rate was 30.2% among pharmacologically treated hypertensives. Overall, 80% of hypertensive patients had too high blood pressure during the survey's clinical examination. CONCLUSION The prevalence of hypertension remains high in Mayotte, where certain risk factors like obesity are particularly common in the population. Awareness, treatment and control remain insufficient. Primary prevention measures, access to a healthy food, and screening and treatment of hypertension should be encouraged by targeting the most affected populations.
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Affiliation(s)
- Lucinda Calas
- Santé Publique France, French Public Health Agency, Saint-Maurice, France
| | - Marion Subiros
- Santé Publique France, French Public Health Agency, Saint-Maurice, France
| | - Marc Ruello
- Santé Publique France, French Public Health Agency, Saint-Maurice, France
| | - Youssouf Hassani
- Santé Publique France, French Public Health Agency, Saint-Maurice, France
| | - Amélie Gabet
- Santé Publique France, French Public Health Agency, Saint-Maurice, France
| | - Marion Angue
- Department of Cardiology, Centre Hospitalier de Mayotte, Mamoudzou, France
| | - Odile Pointeau
- Department of Cardiology, Centre Hospitalier de Mayotte, Mamoudzou, France
| | - Valérie Olié
- Santé Publique France, French Public Health Agency, Saint-Maurice, France
| | - Clémence Grave
- Santé Publique France, French Public Health Agency, Saint-Maurice, France
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Olié V, Grave C, Gabet A. Impact of lowering low-density lipoprotein cholesterol thresholds on the proportion of adults requiring an intervention: Application of the 2019 ESC/EAS guidelines for the management of dyslipidaemia to the French population. Arch Cardiovasc Dis 2022; 115:106-108. [DOI: 10.1016/j.acvd.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/23/2021] [Accepted: 12/02/2021] [Indexed: 11/30/2022]
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Grave C, Gabet A, Empana J, Puymirat E, Tuppin P, Danchin N, Olié V. Care management and 90-day mortality in patients hospitalized for myocardial infarction and COVID-19 in France. Archives of Cardiovascular Diseases Supplements 2022. [PMCID: PMC8710960 DOI: 10.1016/j.acvdsp.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background Concomitant COVID-19 in patients with myocardial infarction (MI) may lead to difficulties in acute care management and may impair prognosis. To date, studies have involved a limited number of patients. Purpose To estimate and compare the characteristics, care management and 90-day outcomes of patients hospitalized for MI who didn’t have Covid-19, with those having concomitant hospital diagnosis of Covid-19 from the French National Health Data System, an exhaustive and nationwide database. Methods All patients hospitalised for MI in France between 30 December 2019 and 4 October 2020 were included. Patients with a previous hospitalization with Covid-19 were excluded (n = 135). Patients’ characteristics were compared according to Covid-19 status. 90-day mortality rates and follow-up outcomes were estimated and adjusted on age, sex and comorbidities. Results Among the 55,389 patients hospitalized for MI, 329 had concomitant Covid-19 (21% asymptomatic). MI patients with concomitant Covid-19 were more comorbid than patients without Covid-19. They had longer hospital stays, more admissions to resuscitation unit, underwent less percutaneous coronary intervention, and discharged more often to rehabilitation units than patients without Covid-19. The in-hospital and 90-day-out-of hospital mortality rates of MI patients with Covid-19 were 11.9% and 6.2%, respectively, compared to 3.5% and 2.8% in MI patients without Covid-19. The risk of in-hospital and out-of-hospital death remained increased after adjustment on comorbidities (ORajin-hosp = 3.31[2.32;4.72], ORajout-of-hosp = 1.79 [1.02;3.15]). Conclusions The prognosis of patients hospitalized for MI who had concomitant Covid-19 was impaired in the short term but also in the medium term. These results underline the need of an urgent protection of the population at cardiovascular risk from Covid-19, as well as a systematized and rapid management despite the pandemic context, and then a close follow-up of these patients.
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Grave C, Gabet A, Puymirat E, Empana J, Tuppin P, Danchin N, Olié V. One year of Covid-19: French nationwide study of hospitalisation, 90-day readmission and mortality rates from myocardial infarction. Archives of Cardiovascular Diseases Supplements 2022. [PMCID: PMC8711011 DOI: 10.1016/j.acvdsp.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Studies reported a decrease in hospital admissions for myocardial infarction (MI) in early 2020 due to Covid19 crisis, but these were restricted to the early weeks of the pandemic. Purpose To describe patient characteristics, in-hospital management and 90-day mortality of MI patients throughout the year 2020, in particular during periods of lockdowns. Methods All patients hospitalised for MI in France from 2017 to 2020 were selected from the national hospital discharge database. Incidence rate ratios were computed to analyze time trends in MI admissions and mortality rates and stratified by type of MI, sex, age, and period of admission. Characteristics and management of patients in 2020 were described and compared to 2017-19 (OR adjusted on temporality, sex, age) Results In 2020, 94,747 patients were hospitalized for MI corresponding to a 6% decrease in MI admissions compared to 2017-19. This decrease was more significant during the first lockdown (−24%, P < 0.0001), in particular in week 13 (−40%) than during the second lockdown (−8%). Decreases in MI admissions were more pronounced and longer for NSTEMI, older people and for women. An increase in the rate of STEMI admissions was observed between the two 2020 lockdowns (+4%, P = 0.0005). Admission to a resuscitation unit and complications rates did not differ between 2017-19 and 2020. In early 2020, there was also a decrease in 90-days readmission. In 2020, the in-hospital and 90-days-out-of hospital mortality rates were 5.5% and 3.8%, compared to 5.7% and 3.6% in reference years. Globally and after adjustment, mortality rates did not differ in 2020 vs. 2017-19 (IRRin-hosp = 1.03[0.98;1.08], P = 0.19 - IRRout-hosp = 1.04[0.97;1.27], P = 0.21). Conclusions This nationwide study showed significant decrease in MI hospitalization during 2020, in particular during the first lockdown, with a slight STEMI increase during the summer. However, these trends were not associated with more cardiac complications or mortality.
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Grave C, Gabet A, Empana JP, Puymirat E, Tuppin P, Danchin N, Olié V. Care management and 90-day post discharge mortality in patients hospitalized for myocardial infarction and COVID-19: A French nationwide observational study. Arch Cardiovasc Dis 2022; 115:37-47. [PMID: 34952827 PMCID: PMC8666304 DOI: 10.1016/j.acvd.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 11/09/2021] [Accepted: 11/15/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Concomitant or cured coronavirus disease 2019 (COVID-19) in patients with myocardial infarction (MI) may lead to difficulties in acute care management and impair prognosis. AIMS To describe and compare the characteristics, care management and 90-day post discharge outcomes of patients hospitalized for MI who did not have COVID-19 with those of patients with concomitant or previous hospital-diagnosed COVID-19. METHODS This population-based French study included all patients hospitalized for MI in France (30 December 2019 to 04 October 2020) from the French National Health Data System. Outcomes were described for each COVID-19 group and compared using adjusted logistic regression analysis. RESULTS Among 55,524 patients hospitalized for MI, 135 had previous hospital-diagnosed COVID-19 and 329 had concomitant COVID-19. Patients with previous hospital-diagnosed COVID-19 had more personal history of cardiovascular diseases than those without concomitant/previous confirmed COVID-19. In-hospital and 90-day post discharge mortality rates of patients with previous COVID-19 were 8.1% and 4.0%, respectively, compared with 3.5% and 3.0% in patients without concomitant/previous confirmed COVID-19 (odds ratio [OR]adjin-hospital 1.83, 95% confidence interval [CI] 0.97-3.46; ORadjpostdischarge 0.77, 95% CI 0.28-2.13). Patients with concomitant COVID-19 had more personal history of cardiovascular diseases, but also a poorer prognosis than their no concomitant/no previous confirmed COVID-19 counterparts; they presented excess cardiac complications during hospitalization (ORadj 1.62, 95% CI 1.29-2.04), in-hospital mortality (ORadj 3.31, 95% CI 2.32-4.72) and 90-day post discharge mortality (ORadj 2.09, 95% CI 1.24-3.51). CONCLUSIONS In-hospital and 90-day post discharge mortality of patients hospitalized for MI who had previous hospital-diagnosed COVID-19 did not seem to differ from those hospitalized for MI alone. Conversely, concomitant COVID-19 and MI carried a poorer prognosis extending beyond the hospital stay. Special attention should be given to patients with simultaneous COVID-19 and MI, in terms of acute care and secondary prevention.
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Affiliation(s)
- Clémence Grave
- Santé Publique France (French Public Health Agency), 94415 Saint-Maurice, France,Corresponding author. Santé Publique France (French Public Health Agency), 12, rue du Val d’Osne, 94415 Saint-Maurice cedex, France
| | - Amélie Gabet
- Santé Publique France (French Public Health Agency), 94415 Saint-Maurice, France
| | - Jean-Philippe Empana
- Inserm, UMR-S970, department of epidemiology, Paris Cardiovascular Research Centre, université Paris Descartes, 75015 Paris, France
| | - Etienne Puymirat
- Department of cardiology, hôpital Européen Georges-Pompidou, université Paris-Descartes, AP–HP, 75015 Paris, France
| | - Philippe Tuppin
- Caisse Nationale de l’Assurance Maladie (French National Health Insurance), 75020 Paris, France
| | - Nicolas Danchin
- Department of cardiology, hôpital Européen Georges-Pompidou, université Paris-Descartes, AP–HP, 75015 Paris, France
| | - Valérie Olié
- Santé Publique France (French Public Health Agency), 94415 Saint-Maurice, France
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Lailler G, Boucheron P, Regnault N, Gabet A, Deneux-Tharaux C, Kretz S, Grave C, Mounier-Vehier C, Tsatsaris V, Plu-Bureau G, Blacher J, Olié V. Impact of type and duration of hypertensive disorders of pregnancy on the onset of permanent hypertension in France (2010–2018): The nationwide CONCEPTION study. Archives of Cardiovascular Diseases Supplements 2022. [DOI: 10.1016/j.acvdsp.2021.09.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Grave C, Gabet A, Puymirat E, Empana JP, Tuppin P, Danchin N, Olié V. Myocardial infarction throughout 1 year of the COVID-19 pandemic: French nationwide study of hospitalization rates, prognosis and 90-day mortality rates. Arch Cardiovasc Dis 2021; 114:768-780. [PMID: 34840126 PMCID: PMC8600551 DOI: 10.1016/j.acvd.2021.10.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 10/08/2021] [Accepted: 10/12/2021] [Indexed: 11/16/2022]
Abstract
Background Studies reported a decrease in hospital admissions for myocardial infarction (MI) in early 2020 as a result of the coronavirus disease 2019 (COVID-19) crisis, mainly restricted to the beginning of the pandemic. Aims To describe national trends in hospital admissions for MI in 2020, and to compare patient characteristics, in-hospital prognosis and 90-day mortality between patients who had an MI in 2020 and those admitted in 2017–2019. Methods All patients hospitalized for MI in France from 2017 to 2020 were selected from the national hospital discharge database. Analyses compared temporal trends in MI admissions, in-hospital cardiac complications and mortality rates in 2020 versus 2017–2019. Results In 2020, 94,747 patients were hospitalized for MI, corresponding to a 6% decrease in MI admissions compared with 2017–19. This decrease was larger during the first lockdown (–24%; P < 0.0001) than during the second lockdown (–8%; P < 0.0001). Reductions in MI admissions were more pronounced and longer among patients with non-ST-segment elevation MI, older people and women. An increase in ST-segment elevation MI admissions was observed between lockdowns (+4%; P = 0.0005). Globally, and after adjustment for age, sex and calendar year, in-hospital and 90-day post-discharge mortality rates did not differ in 2020 versus 2017–19: incidence rate ratio (IRR)adjin-hospital 1.03, 95% confidence interval (CI) (0.98–1.08); IRRadj90-daypost-discharge 1.06, 95% CI (0.98–1.13). Conclusions In 2020, a significant decrease in MI admissions was observed, and was marked at the beginning of the year. This highlights the need to disseminate public information on the importance of maintaining care and regular medical follow-up. The effect of the COVID-19 crisis on acute and 3-month outcomes of patients hospitalized for MI appears limited. Nevertheless, monitoring of chronic MI complications and the impact on non-hospitalized patients should continue.
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Affiliation(s)
- Clémence Grave
- Santé Publique France (French Public Health Agency), 94415 Saint-Maurice, France.
| | - Amélie Gabet
- Santé Publique France (French Public Health Agency), 94415 Saint-Maurice, France
| | - Etienne Puymirat
- Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris-Descartes, 75015 Paris, France
| | - Jean-Philippe Empana
- Université de Paris, INSERM, UMR-S970, Integrative Epidemiology of Cardiovascular Disease Team, Paris Cardiovascular Research Centre, 75015 Paris, France
| | - Philippe Tuppin
- Caisse Nationale de l'Assurance Maladie (French National Health Insurance), 75020 Paris, France
| | - Nicolas Danchin
- Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris-Descartes, 75015 Paris, France
| | - Valérie Olié
- Santé Publique France (French Public Health Agency), 94415 Saint-Maurice, France
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Gabet A, Grave C, Tuppin P, Emmerich J, Olié V. Changes in the epidemiology of patients hospitalized in France with deep venous thrombosis and pulmonary embolism during the COVID-19 pandemic. Thromb Res 2021; 207:67-74. [PMID: 34562677 PMCID: PMC9753774 DOI: 10.1016/j.thromres.2021.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/07/2021] [Accepted: 09/13/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The onset of the COVID-19 pandemic and the first national lockdown implemented might have disrupted the epidemiology of deep venous thrombosis (DVT) and pulmonary embolism (PE). This study aimed to analyze time trends in patients hospitalized for DVT and PE in France and related in-patient and 90-day post-admission mortality rates. MATERIALS AND METHODS All patients hospitalized in France for DVT or PE between January and September (weeks 1-40) for each year from 2017 to 2020, were selected. Weekly incidence rate ratios (IRR) were computed to compare the rates of patients hospitalized in 2020 with those hospitalized in 2017-2019. RESULTS Compared with the 2017-2019 study period, the rates of patients hospitalized with a primary diagnosis (PD) of DVT or PE in 2020 were significantly (50 and 40%, respectively) lower during weeks 12-13. The rate of patients hospitalized with an associated diagnosis (AD) of PE during weeks 12-19 of 2020 was twice as high as in the same period in 2017-2019. The prevalence of COVID-19 in patients hospitalized with a PD of DVT and PE, and in those hospitalized with an AD of DVT and PE reached respectively 4.0, 9.6, 17.2 and 44.6 during the country's first lockdown. Inpatients case-fatality rates in patients hospitalized with an AD of PE increased significantly during weeks 12-13. CONCLUSIONS Epidemiology of VT and PE was seriously impacted by the COVID-19 pandemic in 2020 in France, with a significant decrease in the rate of patients hospitalized for PE and a threefold increase in the related in-patient mortality rate. This highlight the need to inform the general population about the symptoms of PE and about the need to immediately seek medical care, particularly those infected with SARS-CoV-2.
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Affiliation(s)
- Amélie Gabet
- Santé Publique France, Saint-Maurice 94, France.
| | | | | | - Joseph Emmerich
- Department of Vascular Medicine, Hôpital Saint-Joseph, Université de Paris, INSERM CRESS 1153, Paris, France
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Haneef R, Constantinou P, Rachas A, Ghosn W, Kudjawu Y, Grave C, Torres M, Fayad M, Ung A, Bonaldi C. Quantifying the burden of premature mortality at national level in France in 2016. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Efforts to accurately measure premature mortality are important to monitor the impact of diseases and injuries on population health and to set policy priorities. This is an ongoing study with a strong collaboration between Santé Publique France and the French National Health Insurance, whose main objective is to provide the first national estimates of Years of Life Lost (YLLs) for all causes of death in France.
Methods
The French national health data system (SNDS) contains detailed nationwide causes of death data, reported using ICD-10 codes. We used the underlying cause, as defined by the Center for Epidemiology on Medical Causes of deaths, of all deaths for year 2016 (the last year available). For this preliminary study without redistribution of ill-defined deaths (IDDs), national sex-specific life expectancy tables were used to estimate YLLs by age class, sex, and cause of death categories at national level. We identified and quantified IDDs and also compared YLLs to crude mortality.
Results
In 2016, we estimated approximately 7.3 million YLLs (586,519 registered deaths), of which 35.1% were due to neoplasms, 17.8% to cardiovascular diseases (respectively 34.5% and 17.3% in men; 35.8% and 18.4% in women) and 10.3% to injuries (4.9% among people aged 65 or more at time of death; 34.5% among people aged 25-44). Approximately 27% of the deaths registered were IDDs, representing approximately 1.8 million YLLs.
Conclusions
These preliminary results confirm the importance of YLLs as a metric to target preventive strategies according to age. Moreover, by quantifying IDDs, we highlight that data gaps are important even in settings with highly developed health information systems. Next steps include applying an IDD redistribution methodology, aspirational life table and computing subnational YLLs. The French collaborative initiative should address those gaps and propose national and subnational burden metrics in the following months.
Key messages
Methodological and data requirements to compute YLLs constitute a challenge even in settings with developed health information systems, highlighting the need of national institutional collaborations. Highlight data gaps in terms of ill-defined deaths in mortality database.
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Affiliation(s)
- R Haneef
- Non-Communicable Diseases and Injuries, Santé Publique France, Saint-Maurice, France
| | - P Constantinou
- Department of Strategy, Studies and Statistics, French National Health Insurance, Paris, France
| | - A Rachas
- Department of Strategy, Studies and Statistics, French National Health Insurance, Paris, France
| | - W Ghosn
- INSERM, CépiDc, Epidemiological Center of Medical Causes of Death, Le Kremlin-Bicêtre, France
| | - Y Kudjawu
- Non-Communicable Diseases and Injuries, Santé Publique France, Saint-Maurice, France
| | - C Grave
- Non-Communicable Diseases and Injuries, Santé Publique France, Saint-Maurice, France
| | - M Torres
- Non-Communicable Diseases and Injuries, Santé Publique France, Saint-Maurice, France
| | - M Fayad
- Department of Strategy, Studies and Statistics, Santé Publique France, Saint-Maurice, France
| | - A Ung
- Non-Communicable Diseases and Injuries, Santé Publique France, Saint-Maurice, France
| | - C Bonaldi
- Department of Strategy, Studies and Statistics, Santé Publique France, Saint-Maurice, France
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Boucheron P, Lailler G, Moutengou E, Regnault N, Gabet A, Deneux-Tharaux C, Kretz S, Grave C, Mounier-Vehier C, Tsatsaris V, Plu-Bureau G, Blacher J, Olié V. Hypertensive disorders of pregnancy and onset of chronic hypertension in France: the nationwide CONCEPTION study. Eur Heart J 2021; 43:3352-3361. [PMID: 34643681 DOI: 10.1093/eurheartj/ehab686] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/23/2021] [Accepted: 09/14/2021] [Indexed: 12/20/2022] Open
Abstract
AIMS Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal and foetal morbidity and mortality. We aimed to estimate the impact of HDP on the onset of chronic hypertension in primiparous women in the first years following childbirth. METHODS AND RESULTS This nationwide cohort study used data from the French National Health Data System (SNDS). All eligible primiparous women without pre-existing chronic hypertension who delivered between 2010 and 2018 were included. Women were followed up from six weeks post-partum until onset of hypertension, a cardiovascular event, death, or the study end date (31 December 2018). The main outcome was a diagnosis of chronic hypertension. We used Cox models to estimate hazard ratios (HRs) of chronic hypertension for all types of HDP. Overall, 2 663 573 women were included with a mean follow-up time of 3.0 years. Among them, 180 063 (6.73%) had an HDP. Specifically 66 260 (2.16%) had pre-eclampsia (PE) and 113 803 (4.27%) had gestational hypertension (GH). Compared with women who had no HDP, the fully adjusted HRs of chronic hypertension were 6.03 [95% confidence interval (CI) 5.89-6.17] for GH, 8.10 (95% CI 7.88-8.33) for PE (all sorts), 12.95 (95% CI 12.29-13.65) for early PE, 9.90 (95% CI 9.53-10.28) for severe PE, and 13.17 (95% CI 12.74-13.60) for PE following GH. Hypertensive disorders of pregnancy exposure duration was an additional risk factor of chronic hypertension for all PE subgroups. Women with HDP consulted a general practitioner or cardiologist more frequently and earlier. CONCLUSION Hypertensive disorders of pregnancy exposure greatly increased the risk of chronic hypertension in the first years following delivery.
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Affiliation(s)
- Pauline Boucheron
- Santé publique France, 12 Rue du Val d'Osne, Saint-Maurice 94410, France
| | - Grégory Lailler
- Santé publique France, 12 Rue du Val d'Osne, Saint-Maurice 94410, France
| | - Elodie Moutengou
- Santé publique France, 12 Rue du Val d'Osne, Saint-Maurice 94410, France
| | - Nolwenn Regnault
- Santé publique France, 12 Rue du Val d'Osne, Saint-Maurice 94410, France
| | - Amélie Gabet
- Santé publique France, 12 Rue du Val d'Osne, Saint-Maurice 94410, France
| | - Catherine Deneux-Tharaux
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), INSERM, Paris, France.,Université de Paris, Paris, France
| | - Sandrine Kretz
- Centre de diagnostic et de thérapeutique, Hôtel Dieu, AP-HP, 1 Parvis Notre-Dame, Paris 75004, France
| | - Clémence Grave
- Santé publique France, 12 Rue du Val d'Osne, Saint-Maurice 94410, France
| | - Claire Mounier-Vehier
- CHU Lille, Institut Cœur-Poumon, Médecine Vasculaire et HTA, 2 Av. Oscar Lambret, Lille 59000, France
| | - Vassilis Tsatsaris
- Université de Paris, Paris, France.,Maternité Port-Royal, FHU PREMA, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, 27 Rue du Faubourg Saint-Jacques, Paris 75014, France
| | - Geneviève Plu-Bureau
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), INSERM, Paris, France.,Université de Paris, Paris, France.,Unité de gynécologie médicale, APHP, Hôpital Port-Royal Cochin, 27 Rue du Faubourg Saint-Jacques, Paris 75014, France
| | - Jacques Blacher
- Université de Paris, Paris, France.,Centre de diagnostic et de thérapeutique, Hôtel Dieu, AP-HP, 1 Parvis Notre-Dame, Paris 75004, France
| | - Valérie Olié
- Santé publique France, 12 Rue du Val d'Osne, Saint-Maurice 94410, France
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Gabet A, Grave C, Chatignoux E, Tuppin P, Béjot Y, Olié V. Characteristics, Management, and Case-Fatality of Patients Hospitalized for Stroke with a Diagnosis of COVID-19 in France. Neuroepidemiology 2021; 55:323-330. [PMID: 34167111 PMCID: PMC8339027 DOI: 10.1159/000516670] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 04/18/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction COVID-19 was found to be associated with an increased risk of stroke. This study aimed to compare characteristics, management, and outcomes of hospitalized stroke patients with or without a hospital diagnosis of COVID-19 at a nationwide scale. Methods This is a cross-sectional study on all French hospitals covering the entire French population using the French national hospital discharge databases (Programme de Médicalisation des Systèmes d'Information, included in the Système National des Données de Santé). All patients hospitalized for stroke between 1 January and 14 June 2020 in France were selected. A diagnosis of COVID-19 was searched for during the index hospitalization for stroke or in a prior hospitalization that had occurred after 1 January 2020. Results Among the 56,195 patients hospitalized for stroke, 800 (1.4%) had a concomitant COVID-19 diagnosis. Inhospital case-fatality rates were higher in stroke patients with COVID-19, particularly for patients with a primary diagnosis of COVID-19 (33.2%), as compared to patients hospitalized for stroke without COVID-19 diagnosis (14.1%). Similar findings were observed for 3-month case-fatality rates adjusted for age and sex that reached 41.7% in patients hospitalized for stroke with a concomitant primary diagnosis of COVID-19 versus 20.0% in strokes without COVID-19. Conclusion Patients hospitalized for stroke with a concomitant COVID-19 diagnosis had a higher inhospital and 3 months case-fatality rates compared to patients hospitalized for stroke without a COVID-19 diagnosis. Further research is needed to better understand the excess of mortality related to these cases.
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Affiliation(s)
- Amélie Gabet
- Department of Non-Communicable Diseases, Cardiovascular Diseases and Stroke Program, Santé Publique France, Saint-Maurice, France
| | - Clémence Grave
- Department of Non-Communicable Diseases, Cardiovascular Diseases and Stroke Program, Santé Publique France, Saint-Maurice, France
| | - Edouard Chatignoux
- Department of Non-Communicable Diseases, Cardiovascular Diseases and Stroke Program, Santé Publique France, Saint-Maurice, France
| | - Philippe Tuppin
- Department of strategy and statistical studies, Caisse Nationale d'Assurance Maladie, Paris, France
| | - Yannick Béjot
- Neurology Department, Dijon University Hospital, Dijon, France
| | - Valérie Olié
- Department of Non-Communicable Diseases, Cardiovascular Diseases and Stroke Program, Santé Publique France, Saint-Maurice, France
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Olié V, Moutengou E, Grave C, Deneux-Tharaux C, Regnault N, Kretz S, Gabet A, Mounier-Vehier C, Tsatsaris V, Plu-Bureau G, Blacher J. Prevalence of hypertensive disorders during pregnancy in France (2010-2018): The Nationwide CONCEPTION Study. J Clin Hypertens (Greenwich) 2021; 23:1344-1353. [PMID: 34042277 PMCID: PMC8678732 DOI: 10.1111/jch.14254] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/10/2021] [Accepted: 03/28/2021] [Indexed: 01/19/2023]
Abstract
Hypertensive disorders of pregnancy (HDP) are one of the leading causes of maternal and fetal morbidity and mortality. We aimed to estimate the prevalence of each HDP in France and to study their associations. All pregnant women who delivered in France between 2010 and 2018 were included in a cohort and followed during their pregnancy and 6 weeks of postpartum. Each HDP occurring during the follow-up was identified. Prevalence of each HDP and cumulative incidence by gestational age were estimated. Incidence rate ratio (IRR) and 95% confidence interval (CI) for preeclampsia among women with preexisting or gestational hypertension (GH) were estimated using Poisson regression and adjusted for age were estimated. Between 2010 and 2018, 6 302 810 deliveries were included. HDP complicated 7.4% of pregnancies. Preeclampsia and GH complicated 2.0% and 4.2% of pregnancies, respectively. Most of preeclampsia cases occurred without a prior HDP. HELLP syndrome represented 10.4% of preeclampsia cases. Compared to nulliparous pregnancies without HDP prior preeclampsia, the age-adjusted IRR of preeclampsia was 6.2 [95% CI: 6.1-6.4] in nulliparous pregnancies with preexisting hypertension and 2.9 [95% CI: 2.8-3.0] in nulliparous pregnancies with GH. In France, HDP occurred in 7.4% of all pregnancies. Women with preexisting chronic hypertension are at high risk to present preeclampsia during pregnancy. Preeclampsia complicated 2.0% of pregnancies in France. Tailoring management of women according to the HDP is a major challenge to avoid complications related to these disorders.
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Affiliation(s)
- Valérie Olié
- Santé publique France, the French Public Health Agency, Saint-Maurice, France
| | - Elodie Moutengou
- Santé publique France, the French Public Health Agency, Saint-Maurice, France
| | - Clémence Grave
- Santé publique France, the French Public Health Agency, Saint-Maurice, France
| | - Catherine Deneux-Tharaux
- Inserm U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Research Center for Epidemiology and Biostatistics Sorbonne Paris Cité (CRESS), France.,Paris-Descartes University, Paris, France
| | - Nolwenn Regnault
- Santé publique France, the French Public Health Agency, Saint-Maurice, France
| | - Sandrine Kretz
- Diagnosis and Therapeutic Center, AP-HP, University Paris Descartes, Paris, France
| | - Amélie Gabet
- Santé publique France, the French Public Health Agency, Saint-Maurice, France
| | - Claire Mounier-Vehier
- Vascular Medicine and Hypertension Center, EA 2694 - Santé Publique- University Lille, Lille, France
| | - Vassilis Tsatsaris
- Paris-Descartes University, Paris, France.,Department of Obstetrics and Gynecology, APHP, Port-Royal Maternity, University Hospital Center Cochin Broca Hôtel Dieu, Groupe Hospitalier Universitaire Ouest, Paris, France
| | - Geneviève Plu-Bureau
- Inserm U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Research Center for Epidemiology and Biostatistics Sorbonne Paris Cité (CRESS), France.,Paris-Descartes University, Paris, France.,Division of Gynaecology, APHP, Hôpital Cochin, Paris, France
| | - Jacques Blacher
- Paris-Descartes University, Paris, France.,Diagnosis and Therapeutic Center, AP-HP, University Paris Descartes, Paris, France
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Gabet A, Grave C, Tuppin P, Chatignoux E, Béjot Y, Olié V. Impact of the COVID-19 pandemic and a national lockdown on hospitalizations for stroke and related 30-day mortality in France: A nationwide observational study. Eur J Neurol 2021; 28:3279-3288. [PMID: 33738913 PMCID: PMC8251122 DOI: 10.1111/ene.14831] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/02/2021] [Accepted: 03/11/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this nationwide study was to assess the impact of the COVID-19 pandemic on stroke hospitalization rates, patient characteristics and 30-day case fatality rates. METHODS All hospitalizations for stroke from January to June of each year from 2017 to 2020 were selected using International Classification of Diseases, 10th revision, codes I60 to I64 in the national hospital discharge database. Patient characteristics and management were described according to three time periods: pre-lockdown, lockdown, and post-lockdown. Weekly incidence rate ratios (IRRs) were computed to compare time trends in the rates of patients hospitalized for stroke as well as in-hospital and 30-day case fatality rates between the years 2017-2019 and 2020. RESULTS In 2020, between weeks 1 and 24, 55,308 patients were hospitalized for stroke in France. IRRs decreased by up to 30% for all age groups, sex, and stroke types during the lockdown compared to the period 2017-2019. Patients hospitalized during the second and third weeks of the lockdown had higher in-hospital case fatality rates compared to 2017-2019. In-hospital case fatality rates increased by almost 60% in patients aged under 65 years. Out-of-hospital 30-day case fatality rates increased between weeks 11 and 15 among patients who returned home after their hospitalization. Important changes in care management were found, including fewer stroke patients admitted to resuscitation units, more admitted to stroke care units, and a shorter mean length of hospitalization. CONCLUSIONS During the first weeks of the lockdown, rates of patients hospitalized for stroke fell by 30% and there were substantial increases of both in-hospital and out-of-hospital 30-day case fatality rates.
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Gabet A, Chatignoux E, Grave C, Vallée A, Tuppin P, Béjot Y, Olié V. Stroke Incidence and Death in Atrial Fibrillation Patients Newly Treated with Direct Oral Anticoagulants. Clin Epidemiol 2021; 13:131-140. [PMID: 33642879 PMCID: PMC7903960 DOI: 10.2147/clep.s290707] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/08/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The objectives were to analyse the determinants of stroke incidence and mortality as a competing event in AF patients newly treated with DOAC and to assess the impact of non-adherence to DOAC treatment. Methods It is a population-based retrospective cohort study using the French national healthcare data system. AF patients aged >20 years were affiliated to the general health insurance scheme (66% of the French population) and newly treated with DOAC between 2012 and 2015 were included and followed for 2 years. Results Overall 76,795 AF patients were newly treated with DOAC in 2015. Stroke incidence reached 10.1 (95% CI: 9.6–10.6) per 1000 person-year and death 39.7 (95% CI: 38.6–40.8) as a competitive risk. Female sex was associated with a lower risk of death but not of stroke. Non-adherence to DOAC treatment increased the risk of both stroke (42%) and death (38%). Acute coronary syndrome was associated with an increased risk of stroke alone, whereas heart failure decompensation, social deprivation, and haemorrhage were associated with an increased risk of death alone. Conclusion Both stroke and death risks remain non-negligible in AF patients treated with DOAC. Non-adherence was associated with an increased risk of stroke and death.
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Affiliation(s)
- Amélie Gabet
- French Public Health Agency, Saint-Maurice, France
| | | | | | - Alexandre Vallée
- Diagnosis and Therapeutic Center, Hotel Dieu, AP-HP, University Paris Descartes, Paris, France
| | - Philippe Tuppin
- General Health Insurance Scheme (Caisse Nationale d'Assurance Maladie), Paris, France
| | - Yannick Béjot
- Dijon Stroke Registry, EA4184, University Hospital and Medical School of Dijon, University of Burgundy, Dijon, France
| | - Valérie Olié
- French Public Health Agency, Saint-Maurice, France
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Vallée A, Grave C, Gabet A, Blacher J, Olié V. Treatment and adherence to antihypertensive therapy in France: the roles of socioeconomic factors and primary care medicine in the ESTEBAN survey. Hypertens Res 2021; 44:550-560. [PMID: 33442029 DOI: 10.1038/s41440-020-00603-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 12/18/2022]
Abstract
Antihypertensive drugs remain one of the main beneficial strategies for cardiovascular disease prevention. The objective of our study was to investigate the associations of different clinical and socioeconomic (SES) factors, and the use of primary care medicine with treatment and adherence (proportion of days covered (PDC) by treatment) to hypertension management in French participants aware of their hypertension. Cross-sectional analyses of treatment for hypertension and adherence to treatment were performed using data from 396 participants from the ESTEBAN survey, a representative sample of the French population. Logistic regression analyses were performed to investigate associations between SES factors (age, sex, education, income, civil status), clinical factors, health care (general practitioner (GP) visits, cardiologist visits, number of consultations, home blood pressure measurement (HBPM)), treatment and adherence. A total of 265 of the 396 hypertensive patients were treated. Antihypertensive drug use was more common among elderly individuals (OR: 2.73 [1.14; 4.32), diabetic patients (OR: 4.18 [1.92; 6.44] and overweight hypertensive patients (OR = 3.04 [1.09; 4.99]). GP consultations and HBPM were associated with increased treatment (OR: 1.03 [1.01; 1.05]; OR: 1.97 [1.06; 2.61], respectively). The PDC was higher among men (p = 0.045) and couples living together (p = 0.018) but lower among diabetic patients (p = 0.012) and patients visiting a cardiologist (p = 0.008). Education and income levels were not associated with either treatment or the PDC. In France, SES factors seemed to have little impact on treatment and adherence to antihypertensive drug regimens. However, treatment administered by GPs and HBPM may play key roles in hypertension management. Although the PDC was quite low, both the number of GP consultations and HBPM were positively associated with pharmacological treatment.
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Affiliation(s)
- Alexandre Vallée
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, Paris-Descartes University, AP-HP, Paris, France
| | - Clémence Grave
- Santé Publique France, The French Public Health Agency, Saint-Maurice, France
| | - Amélie Gabet
- Santé Publique France, The French Public Health Agency, Saint-Maurice, France
| | - Jacques Blacher
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, Paris-Descartes University, AP-HP, Paris, France.
| | - Valérie Olié
- Santé Publique France, The French Public Health Agency, Saint-Maurice, France
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Gabet A, Guenancia C, Duloquin G, Grave C, Olié V, Béjot Y. Ischemic stroke with Atrial Fibrillation, characteristics and time-trends over 12-year period 2006-2017 in the Dijon Stroke Registry. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Olié V, Chatignoux E, Bonaldi C, Gabet A, Grave C, Ducimetière P, Blacher J. What are the real prevalence of hypertension in France? Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gabet A, Houot M, Mas J, Gourtay E, Gautier A, Grave C, Olié V. Stroke perception and knowledge of its symptoms in a sample of the general French population. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Calas L, Ruello M, Hassani Y, Richard J, Gabet A, Olié V, Grave C. Hypertension prevalence, awareness, treatment and control in 2019 in the adult population of Mayotte. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Grave C, Juillière Y, Tuppin P, Weill A, Gabet A, Tribouilloy C, Olié V. Epidemiological Features of Aortic Stenosis in a French Nationwide Study: 10-Year Trends and New Challenges. J Am Heart Assoc 2020; 9:e017588. [PMID: 33222585 PMCID: PMC7763773 DOI: 10.1161/jaha.120.017588] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background Aortic stenosis (AS) is one of the most common forms of valvular heart disease. Our aim was to estimate the burden of AS in the hospital in France, describe patient characteristics, and evaluate the mortality rate and temporal trends. Methods and Results All patients hospitalized for AS in France between 2006 and 2016 were identified from the national hospital discharge database. Patients’ sociodemographic, medical, and surgical characteristics and temporal trends were described. All AS‐related deaths between 2000 and 2014 were identified using death certificates. In 2016, 26 071 patients were hospitalized for AS: 56.5% were men with an average age of 77 years. The all‐cause mortality rate at 1 year postindex stay was 11%. The rate of patients hospitalized for AS increased by 59% between 2006 and 2016, reaching 38.7/100 000 person‐years in 2016. This increase was most pronounced in patients aged >75 years. The number of transcatheter aortic valve implantations increased following their introduction in 2010. In 2016, 44% of patients were treated with aortic valve surgery during the index hospital stay or following year (mean age, 71.5 years), and 34% were treated with transcatheter aortic valve implantation (mean age, 83.0 years). In 2014, 6186 deaths caused by AS were identified in death certificates: 41.6% were men with an average age of 87 years. The age‐standardized mortality rate increased by 5% between 2000 and 2014, reaching 8.5/100 000 person‐years in 2014. Conclusions The rate of patients hospitalized for AS increased in recent years in line with the higher life expectancy and introduction of transcatheter aortic valve implantation. Mortality increased more moderately.
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Affiliation(s)
- Clémence Grave
- Santé Publique France French Public Health Agency Saint-Maurice France
| | - Yves Juillière
- Department of Cardiology Nancy University Hospital Vandoeuvre-lès-Nancy France
| | - Philippe Tuppin
- Caisse Nationale de l'Assurance Maladie French National Health Insurance Paris Cedex 20 France
| | - Alain Weill
- Caisse Nationale de l'Assurance Maladie French National Health Insurance Paris Cedex 20 France
| | - Amélie Gabet
- Santé Publique France French Public Health Agency Saint-Maurice France
| | | | - Valérie Olié
- Santé Publique France French Public Health Agency Saint-Maurice France
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Vallée A, Gabet A, Grave C, Lelong H, Blacher J, Olié V. Home blood pressure monitoring in France: Device possession rate and associated determinants, the Esteban study. J Clin Hypertens (Greenwich) 2020; 22:2204-2213. [PMID: 32966691 DOI: 10.1111/jch.14055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/24/2020] [Accepted: 09/04/2020] [Indexed: 11/28/2022]
Abstract
Home blood pressure monitoring (HBPM) is increasingly being promoted in hypertension guidelines to improve hypertension management. Possessing a HBPM device could improve blood pressure (BP) control and prognostic impact. The aims of this study were to estimate the possession rate of HBPM devices in the French population and in hypertensive adults, and to investigate the determinants of possessing such devices at home. Cross-sectional analyses were performed using data from the Esteban survey, which comprised a representative sample of the French population. Among the 2,054 study participants, 673 had hypertension. Of these, 385 were aware they had it. Weighted logistic regressions were performed to investigate the factors (socioeconomic, clinical, drug treatment, and healthcare visits) associated with possessing a HBPM device. 20.9% of the study sample, 42.1% of those with hypertension, and 54% of those aware of their hypertension, possessed a HBPM device. Female gender (OR = 2.03, 95%CI [1.46; 2.60]), smoking (OR = 2.33, 95%CI [1.51; 3.15]), antihypertensive drugs (OR = 1.75, 95%CI [1.06; 2.44]), general practitioner (GP) visits (OR = 3.28, 95%CI [1.84; 4.68]), and diabetes (OR = 0.41 95% CI [0.14; 0.68]) were associated with possessing a HBPM device among those aware of their hypertension. Over 20% of the study population possessed a HBPM device at home. This proportion rose to one in two in those aware or their hypertension. Among the latter, possessing a device was positively associated with female gender, GP visits, and antihypertensive drug use. Increasing possession of HBPM devices in the hypertensive population could foster better management of the condition.
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Affiliation(s)
- Alexandre Vallée
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, AP-HP, University of Paris, Paris, France
| | - Amélie Gabet
- Santé Publique France, The French Public Health Agency, Saint-Maurice, France
| | - Clémence Grave
- Santé Publique France, The French Public Health Agency, Saint-Maurice, France
| | - Hélène Lelong
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, AP-HP, University of Paris, Paris, France
| | - Jacques Blacher
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, AP-HP, University of Paris, Paris, France
| | - Valérie Olié
- Santé Publique France, The French Public Health Agency, Saint-Maurice, France
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Vallée A, Gabet A, Grave C, Blacher J, Olié V. Associations between urinary cadmium levels, blood pressure, and hypertension: the ESTEBAN survey. Environ Sci Pollut Res Int 2020; 27:10748-10756. [PMID: 31950414 DOI: 10.1007/s11356-019-07249-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/02/2019] [Indexed: 06/10/2023]
Abstract
Cadmium is inconsistently associated with blood pressure (BP) and hypertension. Our study focuses to understand the association between urinary cadmium levels, blood pressure, and hypertension in a French representative sample. Our study included 2015 subjects from the ESTEBAN survey (2014-2015) with measured urinary cadmium. Associations between natural logarithm-transformed cadmium levels and BP (systolic (SBP) and diastolic blood pressure (DBP)) were performed by adjusted linear regression models. Associations between cadmium and hypertension were performed by adjusted logistic regression models. Models were stratified by gender, smoking habits, body mass index (BMI), and kidney function categories. Men present higher SBP (131.7 vs. 121.5 mmHg, p < 0.0001) and DBP (78.9 vs. 74.7 mmHg, p < 0.0001) in comparison to women. Creatinine-adjusted urinary cadmium levels (0.48 vs. 0.39 μg/L, p < 0.0001) were higher in hypertensive subjects. Nevertheless, no difference was observed after adjustment for age, gender, and smoking habits. No correlation between urinary cadmium, BP, and hypertension was observed in overall population. Stratified models showed inverse correlations between urinary cadmium and hypertension among obese (OR = 0.39, 95% CI [0.21-0.57], p = 0.0009), chronic kidney function (OR = 0.68 95%CI [0.75-0.97], p = 0.003), and current smokers (OR = 0.78, 95% CI [0.64-0.92], p = 0.04). A correlation between urinary cadmium levels, BP, and hypertension is observed in subpopulations. Nevertheless, directions and significance of these associations differs by gender, BMI, smoking, and kidney function categories.
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Affiliation(s)
- Alexandre Vallée
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, Paris Descartes University, 1 place du Parvis de Notre-Dame AP-HP, Paris, France.
| | - Amélie Gabet
- Santé Publique France, The French Public Health Agency, Saint-Maurice, France
| | - Clémence Grave
- Santé Publique France, The French Public Health Agency, Saint-Maurice, France
| | - Jacques Blacher
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, Paris Descartes University, 1 place du Parvis de Notre-Dame AP-HP, Paris, France
| | - Valérie Olié
- Santé Publique France, The French Public Health Agency, Saint-Maurice, France
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Grave C, Boucheron P, Rudant J, Mikaeloff Y, Tubert-Bitter P, Escolano S, Hocine MN, Coste J, Weill A. Seasonal influenza vaccine and Guillain-Barré syndrome: A self-controlled case series study. Neurology 2020; 94:e2168-e2179. [PMID: 32098853 DOI: 10.1212/wnl.0000000000009180] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 11/22/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the risk of Guillain-Barré syndrome (GBS) following seasonal influenza vaccination based on French nationwide data. METHODS All cases of GBS occurring in metropolitan France between September 1 and March 31 from 2010 to 2014 were identified from the French national health data system. Data were analyzed according to the self-controlled case series method. The risk period started 1 day after the patient received vaccine (D1) until 42 days after vaccination (D42). The incidence of GBS during this risk period was compared to that of the control period (D43-March 31). The incidence rate ratio (IRR) was estimated after adjusting for seasonality and presence or not of acute infections. RESULTS Between September and March, of the 2010/2011 to 2013/2014 influenza vaccination seasons, 3,523 cases of GBS occurred in metropolitan France and were included in the study. Among them, 15% (527 patients) had received influenza vaccination. A total of 140 patients developed GBS during the 42 days following influenza vaccination. The crude risk of developing GBS was not significantly increased during the 42 days following influenza vaccination (IRR, 1.02; 95% confidence interval [CI], 0.83-1.25; p = 0.85). This result remained nonsignificant after adjustment for calendar months and the incidence of acute gastrointestinal and respiratory tract infections (IRR, 1.10; 95% CI, 0.89-1.37; p = 0.38). In contrast, the risk of GBS was fourfold higher after acute respiratory tract infection (IRR, 3.89; 95% CI, 3.52-4.30; p < 0.0001) or gastrointestinal infection (IRR, 3.64; 95% CI, 3.01-4.40; p < 0.0001). CONCLUSIONS No association between seasonal influenza vaccination and GBS was shown during the 42 days following vaccination.
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Affiliation(s)
- Clémence Grave
- From the Department of Studies in Public Health (C.G., P.B., J.R., J.C., A.W.), French National Health Insurance, Paris; Assistance Publique-Hôpitaux de Paris (Y.M.), Unité de Rééducation Neurologique Infantile, Hôpital Bicêtre; CESP, Faculté de Médecine-Université Paris-Sud (Y.M.), Faculté de Médecine-UVSQ, INSERM, Université Paris-Saclay, Villejuif; Biostatistics and Pharmacoepidemiology (P.T.-B., S.E.), Inserm U1181 (B2PHI), UVSQ, University Paris Saclay, Institut Pasteur; and Laboratoire Modélisation (M.N.H.), Epidémiologie et Surveillance des Risques Sanitaires, Conservatoire National des Arts et Métiers, Paris, France.
| | - Pauline Boucheron
- From the Department of Studies in Public Health (C.G., P.B., J.R., J.C., A.W.), French National Health Insurance, Paris; Assistance Publique-Hôpitaux de Paris (Y.M.), Unité de Rééducation Neurologique Infantile, Hôpital Bicêtre; CESP, Faculté de Médecine-Université Paris-Sud (Y.M.), Faculté de Médecine-UVSQ, INSERM, Université Paris-Saclay, Villejuif; Biostatistics and Pharmacoepidemiology (P.T.-B., S.E.), Inserm U1181 (B2PHI), UVSQ, University Paris Saclay, Institut Pasteur; and Laboratoire Modélisation (M.N.H.), Epidémiologie et Surveillance des Risques Sanitaires, Conservatoire National des Arts et Métiers, Paris, France
| | - Jérémie Rudant
- From the Department of Studies in Public Health (C.G., P.B., J.R., J.C., A.W.), French National Health Insurance, Paris; Assistance Publique-Hôpitaux de Paris (Y.M.), Unité de Rééducation Neurologique Infantile, Hôpital Bicêtre; CESP, Faculté de Médecine-Université Paris-Sud (Y.M.), Faculté de Médecine-UVSQ, INSERM, Université Paris-Saclay, Villejuif; Biostatistics and Pharmacoepidemiology (P.T.-B., S.E.), Inserm U1181 (B2PHI), UVSQ, University Paris Saclay, Institut Pasteur; and Laboratoire Modélisation (M.N.H.), Epidémiologie et Surveillance des Risques Sanitaires, Conservatoire National des Arts et Métiers, Paris, France
| | - Yann Mikaeloff
- From the Department of Studies in Public Health (C.G., P.B., J.R., J.C., A.W.), French National Health Insurance, Paris; Assistance Publique-Hôpitaux de Paris (Y.M.), Unité de Rééducation Neurologique Infantile, Hôpital Bicêtre; CESP, Faculté de Médecine-Université Paris-Sud (Y.M.), Faculté de Médecine-UVSQ, INSERM, Université Paris-Saclay, Villejuif; Biostatistics and Pharmacoepidemiology (P.T.-B., S.E.), Inserm U1181 (B2PHI), UVSQ, University Paris Saclay, Institut Pasteur; and Laboratoire Modélisation (M.N.H.), Epidémiologie et Surveillance des Risques Sanitaires, Conservatoire National des Arts et Métiers, Paris, France
| | - Pascale Tubert-Bitter
- From the Department of Studies in Public Health (C.G., P.B., J.R., J.C., A.W.), French National Health Insurance, Paris; Assistance Publique-Hôpitaux de Paris (Y.M.), Unité de Rééducation Neurologique Infantile, Hôpital Bicêtre; CESP, Faculté de Médecine-Université Paris-Sud (Y.M.), Faculté de Médecine-UVSQ, INSERM, Université Paris-Saclay, Villejuif; Biostatistics and Pharmacoepidemiology (P.T.-B., S.E.), Inserm U1181 (B2PHI), UVSQ, University Paris Saclay, Institut Pasteur; and Laboratoire Modélisation (M.N.H.), Epidémiologie et Surveillance des Risques Sanitaires, Conservatoire National des Arts et Métiers, Paris, France
| | - Sylvie Escolano
- From the Department of Studies in Public Health (C.G., P.B., J.R., J.C., A.W.), French National Health Insurance, Paris; Assistance Publique-Hôpitaux de Paris (Y.M.), Unité de Rééducation Neurologique Infantile, Hôpital Bicêtre; CESP, Faculté de Médecine-Université Paris-Sud (Y.M.), Faculté de Médecine-UVSQ, INSERM, Université Paris-Saclay, Villejuif; Biostatistics and Pharmacoepidemiology (P.T.-B., S.E.), Inserm U1181 (B2PHI), UVSQ, University Paris Saclay, Institut Pasteur; and Laboratoire Modélisation (M.N.H.), Epidémiologie et Surveillance des Risques Sanitaires, Conservatoire National des Arts et Métiers, Paris, France
| | - Mounia N Hocine
- From the Department of Studies in Public Health (C.G., P.B., J.R., J.C., A.W.), French National Health Insurance, Paris; Assistance Publique-Hôpitaux de Paris (Y.M.), Unité de Rééducation Neurologique Infantile, Hôpital Bicêtre; CESP, Faculté de Médecine-Université Paris-Sud (Y.M.), Faculté de Médecine-UVSQ, INSERM, Université Paris-Saclay, Villejuif; Biostatistics and Pharmacoepidemiology (P.T.-B., S.E.), Inserm U1181 (B2PHI), UVSQ, University Paris Saclay, Institut Pasteur; and Laboratoire Modélisation (M.N.H.), Epidémiologie et Surveillance des Risques Sanitaires, Conservatoire National des Arts et Métiers, Paris, France
| | - Joël Coste
- From the Department of Studies in Public Health (C.G., P.B., J.R., J.C., A.W.), French National Health Insurance, Paris; Assistance Publique-Hôpitaux de Paris (Y.M.), Unité de Rééducation Neurologique Infantile, Hôpital Bicêtre; CESP, Faculté de Médecine-Université Paris-Sud (Y.M.), Faculté de Médecine-UVSQ, INSERM, Université Paris-Saclay, Villejuif; Biostatistics and Pharmacoepidemiology (P.T.-B., S.E.), Inserm U1181 (B2PHI), UVSQ, University Paris Saclay, Institut Pasteur; and Laboratoire Modélisation (M.N.H.), Epidémiologie et Surveillance des Risques Sanitaires, Conservatoire National des Arts et Métiers, Paris, France
| | - Alain Weill
- From the Department of Studies in Public Health (C.G., P.B., J.R., J.C., A.W.), French National Health Insurance, Paris; Assistance Publique-Hôpitaux de Paris (Y.M.), Unité de Rééducation Neurologique Infantile, Hôpital Bicêtre; CESP, Faculté de Médecine-Université Paris-Sud (Y.M.), Faculté de Médecine-UVSQ, INSERM, Université Paris-Saclay, Villejuif; Biostatistics and Pharmacoepidemiology (P.T.-B., S.E.), Inserm U1181 (B2PHI), UVSQ, University Paris Saclay, Institut Pasteur; and Laboratoire Modélisation (M.N.H.), Epidémiologie et Surveillance des Risques Sanitaires, Conservatoire National des Arts et Métiers, Paris, France
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Vallée A, Gabet A, Grave C, Sorbets E, Blacher J, Olié V. Patterns of hypertension management in France in 2015: The ESTEBAN survey. J Clin Hypertens (Greenwich) 2020; 22:663-672. [DOI: 10.1111/jch.13834] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/21/2020] [Accepted: 02/06/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Alexandre Vallée
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit AP‐HP Hôtel‐Dieu Hospital Paris‐Descartes University Paris France
| | - Amélie Gabet
- Santé Publique France, The French Public Health Agency Saint‐Maurice France
| | - Clémence Grave
- Santé Publique France, The French Public Health Agency Saint‐Maurice France
| | - Emmanuel Sorbets
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit AP‐HP Hôtel‐Dieu Hospital Paris‐Descartes University Paris France
| | - Jacques Blacher
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit AP‐HP Hôtel‐Dieu Hospital Paris‐Descartes University Paris France
| | - Valérie Olié
- Santé Publique France, The French Public Health Agency Saint‐Maurice France
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Grave C, Tribouilloy C, Juillière Y, Tuppin P, Weill A, Olié V. Nationwide incidence of patients hospitalized for a mitral regurgitation: Patient characteristics and temporal trends in France 2006–2016. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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