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Valensi P, Extramiana F, Lange C, Cailleau M, Haggui A, Maison Blanche P, Tichet J, Balkau B. Influence of blood glucose on heart rate and cardiac autonomic function. The DESIR study. Diabet Med 2011; 28:440-9. [PMID: 21204961 DOI: 10.1111/j.1464-5491.2010.03222.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To evaluate in a general population, the relationships between dysglycaemia, insulin resistance and metabolic variables, and heart rate, heart rate recovery and heart rate variability. METHODS Four hundred and forty-seven participants in the Data from an Epidemiological Study on the Insulin Resistance syndrome (DESIR) study were classified according to glycaemic status over the preceding 9 years. All were free of self-reported cardiac antecedents and were not taking drugs which alter heart rate. During five consecutive periods: rest, deep breathing, recovery, rest and lying to standing, heart rate and heart rate varability were evaluated and compared by ANCOVA and trend tests across glycaemic classes. Spearman correlation coefficients quantified the relations between cardio-metabolic risk factors, heart rate and heart rate varability. RESULTS Heart rate differed between glycaemic groups, except during deep breathing. Between rest and deep-breathing periods, patients with diabetes had a lower increase in heart rate than others (P(trend) < 0.01); between deep breathing and recovery, the heart rate of patients with diabetes continued to increase, for others, heart rate decreased (P(trend) < 0.009). Heart rate was correlated with capillary glucose and triglycerides during the five test periods. Heart rate variability differed according to glycaemic status, especially during the recovery period. After age, sex and BMI adjustment, heart rate variability was correlated with triglycerides at two test periods. Change in heart rate between recovery and deep breathing was negatively correlated with heart rate variability at rest, (r=-0.113, P < 0.05): lower resting heart rate variability was associated with heart rate acceleration. CONCLUSIONS Heart rate, but not heart rate variability, was associated with glycaemic status and capillary glucose. After deep breathing, heart rate recovery was altered in patients with known diabetes and was associated with reduced heart rate variability. Being overweight was a major correlate of heart rate variability.
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Affiliation(s)
- P Valensi
- Department of Endocrinology-Diabetology-Nutrition, Paris-Nord University, Jean Verdier Hospital, Bondy, France
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Massin P, Lange C, Tichet J, Vol S, Erginay A, Cailleau M, Eschwège E, Balkau B. Hemoglobin A1c and fasting plasma glucose levels as predictors of retinopathy at 10 years: the French DESIR study. ACTA ACUST UNITED AC 2011; 129:188-95. [PMID: 21320965 DOI: 10.1001/archophthalmol.2010.353] [Citation(s) in RCA: 32] [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] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To evaluate the predictive values of hemoglobin A(1c) (HbA(1c)) and fasting plasma glucose (FPG) for retinopathy 10 years after the baseline examination. METHODS Seven hundred men and women from the DESIR (Data From an Epidemiological Study on the Insulin Resistance Syndrome) Study underwent evaluation for retinopathy using a nonmydriatic digital camera. During the preceding 9 years, 235 had diabetes mellitus (treated or FPG level of ≥126 mg/dL at least once), 227 had an impaired FPG level (110-125 mg/dL) at least once, and 238 always had glucose levels within reference limits (<110 mg/dL). RESULTS Compared with those without retinopathy, the 44 participants with retinopathy at 10 years had higher baseline mean (SD) levels of FPG (130 [49] vs 106 [22] mg/dL) and HbA(1c) (6.4% [1.6%] vs 5.7% [0.7%]) (both, P < .001). The frequency of retinopathy at 10 years, standardized according to the distribution of glycemia across the entire DESIR population, was 3.6%. In our population, FPG levels of 108 and 116 mg/dL had positive predictive values of 8.4% and 14.0%, respectively, for retinopathy at 10 years; HbA(1c) levels of 6.0% and 6.5% had positive predictive values of 6.0% and 14.8%, respectively. After 10 years of follow-up, retinopathy was equally frequent in participants with impaired FPG levels and in those who became diabetic during the study (8.6% and 6.7%, respectively), lower than in those with diabetes at baseline (13.9%). CONCLUSION Because the positive predictive values for retinopathy increase sharply from 108 mg/dL for FPG and from 6.0% for HbA(1c) levels, these thresholds are proposed to identify those at risk of retinopathy 10 years later.
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Affiliation(s)
- Pascale Massin
- Ophthalmology Department, Assistance Publique Hôpitaux de Paris, Hôpital Lariboisière, Paris, France
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Meslier N, Vol S, Balkau B, Gagnadoux F, Cailleau M, Petrella A, Racineux JL, Tichet J. Prévalence des symptômes du syndrome d’apnées du sommeil. Étude dans une population française d’âge moyen. Rev Mal Respir 2007; 24:305-13. [PMID: 17417168 DOI: 10.1016/s0761-8425(07)91062-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To study the prevalence of symptoms of sleep apnoea syndrome (SAS) in a large French middle-aged population and to establish what proportion have symptoms that justify further investigation with a sleep study. METHODS We performed a cross-sectional study of 2,195 men and 2,247 women, 33 to 69 year old (DESIR. cohort) recording responses to a self-administered "sleep" questionnaire and a general questionnaire including socio-economic characteristics and lifestyle factors. RESULTS The prevalence of symptoms in men and women were respectively: snoring frequently (28%, 14%), frequent daytime sleepiness (14%, 18%) and frequent apnoeas (5%, 2%). Overall, 8.5% of men and 6.3% of women reported a pattern of symptoms suggestive of OSA, as they snored and had daytime sleepiness and/or apnoeas. This pattern was associated, for both sexes, with age, body mass index and after adjustment on these two factors, to a mediocre self-reported health status and treatment with benzodiazepines or other sedatives. For men only, the OSA pattern of symptoms was also associated with, hypertension, alcohol consumption and smoking. CONCLUSION Snoring, daytime hypersomnolence and witnessed apnoeas are symptoms frequently observed in the general population. Subjects with a combination of these abnormalities suggesting a high probability of sleep apnoea syndrome and in whom a sleep study is warranted represent 7.5% of the adult population.
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Affiliation(s)
- N Meslier
- Département de Pneumologie, CHU Angers, France.
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Balkau B, Sapinho D, Petrella A, Mhamdi L, Cailleau M, Arondel D, Charles MA. Prescreening tools for diabetes and obesity-associated dyslipidaemia: comparing BMI, waist and waist hip ratio. The D.E.S.I.R. Study. Eur J Clin Nutr 2006; 60:295-304. [PMID: 16278693 PMCID: PMC2065791 DOI: 10.1038/sj.ejcn.1602308] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare the sensitivities of BMI, waist circumference and waist hip ratio (WHR) in identifying subjects who should be screened for diabetes and/or for obesity-associated dyslipidaemia. DESIGN Cross-sectional study. SETTING Central-western France. PARTICIPANTS More than 3000 men and women, aged 40-64 years, from the French study: data from an epidemiological study on the insulin resistance syndrome (D.E.S.I.R.). MAIN OUTCOME MEASURES Sensitivity and specificity for screened diabetes (fasting plasma glucose>or=7.0 mmol/l) and screened dyslipidaemia (triglycerides>or=2.3 mmol/l and/or HDL-cholesterol <0.9/1.1 mmol/l (men/women)) according to BMI, waist circumference and WHR. RESULTS Sensitivities increased as more corpulent subjects were screened, but they increased slowly after screening the top 30%: body mass index (BMI)>or=27/26 kg/m(2) (men/women) or waist >or=96/83 cm or WHR>or=0.96/0.83. These values were chosen as thresholds. In men, BMI had a nonsignificantly higher sensitivity than waist or WHR for both diabetes and dyslipidaemia (77 vs 74 and 66% P<0.3, 0.09; 56 vs 54 and 49% P<0.5, 0.16). For women, waist had a slightly higher sensitivity than BMI or WHR (82 vs 77 and 77% P<0.8, 0.7) for diabetes; for dyslipidaemia, waist and WHR had similar sensitivities, higher than for BMI (65 and 67 vs 54% P<0.16, 0.13). CONCLUSIONS We propose that for screening in a French population 40-64 years of age, the more obese 30% of the population, identified either by BMI, waist or WHR be screened for diabetes and obesity-associated dyslipidaemia.
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Affiliation(s)
- B Balkau
- INSERM, U258, Villejuif, France.
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Hillier TA, Rousseau A, Lange C, Lépinay P, Cailleau M, Novak M, Calliez E, Ducimetière P, Balkau B. Practical way to assess metabolic syndrome using a continuous score obtained from principal components analysis. Diabetologia 2006; 49:1528-35. [PMID: 16752171 PMCID: PMC3505191 DOI: 10.1007/s00125-006-0266-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [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: 12/12/2005] [Accepted: 03/20/2006] [Indexed: 11/24/2022]
Abstract
AIMS/HYPOTHESIS We devised a practical continuous score to assess the metabolic syndrome, and assessed whether this syndrome score predicts incident diabetes and cardiovascular disease. SUBJECTS AND METHODS Among 5,024 participants of the Data from an Epidemiological Study on the Insulin Resistance Syndrome (D.E.S.I.R.) cohort, we defined a metabolic syndrome score by the first principal component (PC1), using only the correlations between continuous metabolic syndrome measures (glucose, waist circumference, triglycerides, and systolic blood pressure). This metabolic syndrome score was highly correlated with a similar score also including insulin and HDL cholesterol (r ( s )=0.94). Over 9 years of follow-up, incident diabetes and cardiovascular disease (CVD) were predicted by logistic regression using the simpler metabolic syndrome score. RESULTS The means of the metabolic syndrome measures differed between men and women. Nevertheless, as the degree of variance explained and the PC1 coefficients were remarkably similar, we used a common metabolic syndrome score. The metabolic syndrome score explained 50% of the variance of the metabolic syndrome measures, and waist circumference had the highest correlation (0.59) with this score. Each standard deviation increase in the metabolic syndrome score was associated with a markedly increased age-adjusted risk of developing diabetes (odds ratios: men 3.4 [95% CI 2.6-4.4]; women 5.1 [3.6-7.2]) and with increased incident CVD of 1.7 (1.4-2.1) in men and 1.7 (1.0-2.7) in women. CONCLUSIONS/INTERPRETATION Our results, which should be confirmed in other populations, suggest that it is possible to evaluate the risk of the metabolic syndrome in a pragmatic fashion with a continuous score, obtained from principal components analysis of the basic, continuous syndrome measures.
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Affiliation(s)
- Teresa A. Hillier
- Epidémiologie cardiovasculaire et métabolique
INSERM : U258INSERM : IFR69Université Paris XI - Paris Sud16, Avenue Paul Vaillant-Couturier 94807 Villejuif Cedex,FR
- Center for Health Research Northwest/Hawaii
Kaiser PermanentePortland,US
| | - A. Rousseau
- Epidémiologie cardiovasculaire et métabolique
INSERM : U258INSERM : IFR69Université Paris XI - Paris Sud16, Avenue Paul Vaillant-Couturier 94807 Villejuif Cedex,FR
| | - Céline Lange
- Epidémiologie cardiovasculaire et métabolique
INSERM : U258INSERM : IFR69Université Paris XI - Paris Sud16, Avenue Paul Vaillant-Couturier 94807 Villejuif Cedex,FR
| | - P. Lépinay
- Centre d'examen de santé
Institut inter-régional pour la santé IRSAOrléans,FR
| | | | - M. Novak
- Centre d'examen de santé
Institut inter-régional pour la santé IRSAChateauroux,FR
| | - Etienne Calliez
- Centre d'examen de santé
Institut inter-régional pour la santé IRSAAngers,FR
| | - Pierre Ducimetière
- Epidémiologie cardiovasculaire et métabolique
INSERM : U258INSERM : IFR69Université Paris XI - Paris Sud16, Avenue Paul Vaillant-Couturier 94807 Villejuif Cedex,FR
| | - Beverley Balkau
- Epidémiologie cardiovasculaire et métabolique
INSERM : U258INSERM : IFR69Université Paris XI - Paris Sud16, Avenue Paul Vaillant-Couturier 94807 Villejuif Cedex,FR
- * Correspondence should be addressed to: Beverley Balkau
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Tapp RJ, Balkau B, Shaw JE, Valensi P, Cailleau M, Eschwege E. Association of glucose metabolism, smoking and cardiovascular risk factors with incident peripheral arterial disease: the DESIR study. Atherosclerosis 2006; 190:84-9. [PMID: 16674960 DOI: 10.1016/j.atherosclerosis.2006.02.017] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2005] [Revised: 02/01/2006] [Accepted: 02/02/2006] [Indexed: 11/30/2022]
Abstract
AIMS We determined the 6-year incidence of peripheral arterial disease (PAD) in a French population and assessed the association of glucose metabolism, smoking, cardiovascular risk factors and physical activity with incident PAD. METHODS Participants from the French Data from a Epidemiological Study on the Insulin Resistance Syndrome (DESIR) were studied. Participants analysed were 30-65 years (at baseline) and had complete data (n=3805) after 6 years of follow-up. Diabetes was diagnosed according to the 1999 WHO criteria on the basis of fasting plasma glucose results or previous diagnosis of diabetes mellitus. The ankle brachial pressure index (ABPI) and a claudication question were used to classify PAD. RESULTS The 6-year incidence of PAD (defined by ABPI<0.9 and or claudication present) among those with normal fasting glucose (NFG) and free of PAD at baseline was 5.1%. Among those with impaired fasting glucose (IFG) at baseline the incidence of PAD was 4.9% and among those with diabetes mellitus at baseline the incidence of PAD was 9.8%. The incidence of PAD among those who maintained NFG over 6 years was 4.7% and among those who progressed to diabetes over 6 years was 10.2%. Those who progressed from NFG or IFG to diabetes over 6 years were twice as likely to develop PAD compared to those who maintained NFG over 6 years, after adjustment for age and sex (OR (95% CI), 2.22 (1.12-4.42)). Independent risk factors for incident PAD using baseline population characteristics were diabetes (OR (95% CI) 2.11 (1.25-3.55)), systolic BP 122-135mmHg 1.06 (0.70-1.60), >135mmHg 1.54 (1.04-2.27) and current smoking 1.60 (1.10-2.34) after multivariate adjustment for age, sex, cholesterol, triglycerides and waist circumference. CONCLUSIONS This French study shows that those who progress to diabetes are twice as likely to develop PAD, compared to those who maintain NFG. Peripheral arterial disease is a treatable condition and more aggressive management of atherosclerotic risk factors could reduce the numbers of people who develop PAD.
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Affiliation(s)
- Robyn J Tapp
- INSERM Unite 258-IFR69, University Paris XI, Villejuif, France; Department of Epidemiology and Preventive Medicine, Monash University, Australia.
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Hillier TA, Fagot-Campagna A, Eschwège E, Vol S, Cailleau M, Balkau B. Weight change and changes in the metabolic syndrome as the French population moves towards overweight: the D.E.S.I.R. cohort. Int J Epidemiol 2005; 35:190-6. [PMID: 16373378 PMCID: PMC2062519 DOI: 10.1093/ije/dyi281] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND How weight change affects the metabolic syndrome (MS) and its parameters is unknown, particularly, in a leaner European population such as the French prospective D.E.S.I.R. cohort. METHODS In 3770 D.E.S.I.R. participants (sex ratio=1) averaging 47.5 years (range 30-64), with measured weight and MS parameters at baseline (D0) and at 6 year follow-up (D6), we assessed this relationship across five weight-change classes, using stable weight as the referent group (-2 to +2 kg). We used analysis-of-covariance to assess changes in each MS parameter and logistic regression to assess incident MS, according to the National Cholesterol Education Program (NCEP). We also assessed weight-change effect on MS status between D0 and D6. RESULTS At D0, average weight was 68.4 kg (SD 12.3); BMI was 24.8 kg/m2 (SD 3.5). From D0-D6, the cohort gained a mean 2.1 kg (median 2.0; SD 4.4). After adjustment for age and D0 weight, there was a strong linear relationship with weight change and worsening of the following MS parameters at D6: fasting insulin, waist girth, fasting glucose, fasting triglycerides, HDL cholesterol, and systolic and diastolic blood pressure (P<0.0001). After age adjustment, for every kilogram gained over 6 years, risk of developing the NCEP Syndrome increased 22% (OR 1.22; 95% CI 1.18-1.25). NCEP-MS was incident in 3% of those with stable weight compared with 21% among those gaining >9 kg; 10% of those who lost >2 kg reverted to non-NCEP-MS. CONCLUSIONS All continuous MS measures are linearly related to weight change, and MS can resolve with modest weight loss, underscoring the importance of maintaining lifelong normal weight.
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Affiliation(s)
- Teresa A. Hillier
- Epidémiologie cardiovasculaire et métabolique
INSERM : U258 INSERM : IFR69Université Paris Sud - Paris XIHôpital Paul Brousse
16, Avenue Paul Vaillant-Couturier
94807 VILLEJUIF CEDEX,FR
- Center for Health Research Northwest/Hawaii,Kaiser Permanente,
Portland, OR, USA
| | | | - Eveline Eschwège
- Epidémiologie cardiovasculaire et métabolique
INSERM : U258 INSERM : IFR69Université Paris Sud - Paris XIHôpital Paul Brousse
16, Avenue Paul Vaillant-Couturier
94807 VILLEJUIF CEDEX,FR
| | - S. Vol
- Institut Inter Régional pour la Santé
Institut Inter Regional pour la SanteTours,FR
| | - Martine Cailleau
- Institut Inter Régional pour la Santé
Institut Inter Regional pour la SanteTours,FR
| | - Beverley Balkau
- Epidémiologie cardiovasculaire et métabolique
INSERM : U258 INSERM : IFR69Université Paris Sud - Paris XIHôpital Paul Brousse
16, Avenue Paul Vaillant-Couturier
94807 VILLEJUIF CEDEX,FR
- * Correspondence should be adressed to: Beverley Balkau
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Cogneau J, Warck R, Tichet J, Royer B, Cailleau M, Balkau B. [Study of the motivation of physicians participating in public health research]. Sante Publique 2002; 14:191-9. [PMID: 12375524] [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] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
In order to explore practitioners' motivations to participate in epidemiological research, a study was conducted among doctors who had been requested to provide clinical information on their patients included in the group study DESIR in the Inde and Loire regions of France. Six semi-structured individual interviews were carried out by two sociologists, and were then followed-up by 216 questionnaires, 80 of which were completed and analysed. Finally, 18 telephone interviews were conducted to complete the data collected. Reasons given for participating in epidemiological studies are mainly the perceived scientific interest, relevance for public health and the feeling of being a partner in the research. The obstacles seem to be the vague image of the promoter, ignorance of the DESIR study's objectives, lack of direct contact for communicating information, and the mixture and confusion between filling out the study's questionnaire and handling administrative constraints in general. Therefore, better communication, centred on the concept of partnership between research and practical medicine, informing on the usefulness of knowledge from epidemiological studies for the practice of medicine, and clarifying the promoter's role, could improve the level of participation from general practitioners.
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Affiliation(s)
- J Cogneau
- IRMG 9, av. de Beaugaillard, 37550 Saint-Avertin
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Mennen LI, Balkau B, Royer B, Caradec A, Marre M, Balkau B, Eschwège E, Alhenc-Gelas F, Bechetoille A, Gallois Y, Girault A, Marre M, Brochier M, Chesnier MC, Gasnier M, Le Mauff JM, Caradec A, Arondel D, Novak M, Petrella A, D'Hour A, Lépinay P, Royer B, Verstraete N, Aubourg P, Cogneau J, Rougeron C, Diquero V, Cacès E, Cailleau M, Jacquelin JM, Moreau JG, Rakotozafy F, Tichet J, Vol S. Microalbuminuria and markers of the atherosclerotic process: the D.E. S.I.R. study. Atherosclerosis 2001; 154:163-9. [PMID: 11137096 DOI: 10.1016/s0021-9150(00)00451-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The relationship between microalbuminuria and tissue-type plasminogen activator antigen (tPA-ag) and fibrinogen was evaluated in non-diabetic subjects. Subjects were participants of the D.E.S.I. R. (Data from an Epidemiological Study on the Insulin Resistance syndrome) Study. Analyses were carried out on 2248 women and 2402 men for fibrinogen and on 272 women and 284 men for tPA-ag. Microalbuminuria was defined as urinary albumin concentration greater than 20 mg/l. Men with microalbuminuria had a 6% higher fibrinogen concentration than those without (3.07 g/l (95% confidence interval: 2.99,3.15) vs. 2.89 g/l (2.87,2.91), adjusted for age and smoking). This relationship existed in hypertensive as well as non-hypertensive subjects. The association between microalbuminuria and tPA-ag existed only in hypertensive men, those with microalbuminuria having a 21% higher tPA-ag than those without (4.39 ng/ml (3.70,5.08) vs. 3.63 ng/ml (3.32,3.94), adjusted for age and smoking). Adjustment for other risk markers for cardiovascular disease did not change the results. There was no relationship between microalbuminuria and these haemostatic factors in women. The results of this study suggest that in non-diabetic men, microalbuminuria is associated with fibrinogen, but with tPA-ag only when concomitant with hypertension.
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Affiliation(s)
- L I Mennen
- INSERM, Unit 258, and the Faculty of Medicine Paris-Sud, Villejuif, France.
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