[The genetics of multifactorial cardiovascular disease. How significant for the cardiologist?]. / La génétique des maladies cardiovasculaires multifactorielles. Quel intérêt pour le cardiologue?

Cardiovascular disease represents the prime cause of mortality and morbidity in many countries. The occurrence is affected by pre-existing risk factors of which the best known at the moment are the environmental risk factors. However, for the same level of environmental risk, two individuals do not necessarily have the same probabilities of developing a cardiovascular event. In effect, the constitutional component, accounted for by details in everyone's genetic makeup, can significantly alter this risk. The characterisation and identification of the mutations responsible for this variation in individual susceptibility are complex in the case of multifactorial diseases such as cardiovascular disease. Several studies now allow a glimpse at the expected benefits of understanding this genetic component, as far as diagnosis, prognosis and pharmacogenetics are concerned. The current explosion in high capacity genome techniques will herald new therapeutic approaches likely to further improve the survival and quality of life for our patients.

[Causes of uncontrolled hypertension. DUO-HTA survey]. / Causes de non-contrôle de l'hypertension artérielle. Enquête DUO-HTA.

OBJECTIVES: To identify the socio-demographic, clinical, psycho-behavioural and therapeutic factors explaining uncontrolled blood pressure in a population of hypertensives in ambulatory practice. METHODS: The DUO-HTA survey is a national, cross-sectional, mirrored, observational study, from a representative sample of 347 general practitioners (MG) and 210 cardiologists, and a population of 2022 hypertensive patients followed by these doctors. The data were collected by means of questionnaires completed by the hypertensives and their doctors. RESULTS: The factors significantly discriminating patients for whom BP was controlled (C) from those patients whose BP was not controlled (NC) were an age less than 65 years, smoking, obesity, alcohol consumption, sedentary lifestyle and multiple anti-hypertensive treatment. On the psycho-behavioural front, the NC patients were more often anxious and irritable, claiming to lead a stressful life and for whom hypertension was often perceived as a "foreign entity" and a source of frustration and multiple deprivations. The factors discriminating the NC doctors from the C doctors were essentially psycho-behavioural, with the NC doctors considering the management of hypertension as being less gratifying, and hypertension as a condition with fluctuating progression, poorly understood and dramatized by patients. CONCLUSION: The DUO-HTA survey underlines the weight of reciprocal representation systems in hypertension for patients and their doctors, as well as the quality of the doctor-patient relationship in blood pressure control. It prompts the development of sensitisation actions for practitioners centered on improving the doctor-patient relationship.

[Medical cost of cardiovascular risk factors prevention in France]. / Coût de la prise en charge médicamenteuse des facteurs de risque cardiovasculaire en France.

AIM: To assess the cost of the preventive measures against hypertension and dyslipidemia in French subjects aged 35-64 years. METHODS: Cross-sectional study conducted in 433 men and 424 women from the three French centres participating in the WHO-MONICA Project and receiving antihypertensive and/or hypolipidemic drug therapy. RESULTS: In both genders, beta-blockers and ACE inhibitors were the most frequently prescribed antihypertensive drugs, and half of treated hypertensive subjects still had blood pressure levels beyond the normal limits, this percentage being lower in men and in Bas-Rhin. Daily cost of antihypertensive treatment ranged between 0.58 (minimum) and 1.72 [symbol: see text] (maximum) in men and between 0.54 and 1.46 [symbol: see text] in women, with no differences between centers. Fibrates were the most frequently prescribed hypolipidemic drug, and daily cost of treatment ranged between 0.33 and 1.33 [symbol: see text] in men and between 0.36 and 1.26 [symbol: see text] in women; in men, costs were lower in the Communauté Urbaine de Lille. Slightly more than half of the hyperlipidemic subjects had their LDL levels within normal values; no differences were found between centers or genders. Finally, the daily cost of "therapeutic inefficiency" for hypertension and dyslipidemia for age group 35-64 years in France was estimated to be over one million [symbol: see text]. CONCLUSION: The cost of the antihypertensive and hypolipidemic drug treatment is high and efforts should be undertaken in order to increase the efficiency of prevention.