[The metabolic syndrome: marker of cardiovascular risk in hypertensive patients? The importance of definition]. / Le Syndrome métabolique: marqueur de risque chez l'hypertendu? Importance de la définition utilisée.

INTRODUCTION: Metabolic syndrome (MetS) was defined by association of abdominal obesity, hypertension, glucose intolerance and/or dyslipidemia. The objective of this study was to compare the new International Diabetes Federation (IDF) definition and the National Cholesterol Education Program Adult Treatment Panel III (NCEP) definition and their association with cardio-vascular disease in hypertensive patients. POPULATION AND METHOD: Two hundred and thirty hypertensive patients were hospitalized successively for cardio-vascular disease exploration and hs-CRP measurement. The stratification of cardio-vascular risk was made according to the French recommendations. The IDF definition and the NCEP definition were compared according frequency of resistant hypertension and cardio-vascular disease extension. RESULTS: In our study, high cardio-vascular risk hypertension represented 68.5% of patients. Diabetes was present in 23.5% of them and obesity in 45.5%. Patients with cardio-vascular disease represented 60% of our study population. Prevalence of MetS was 38.5% according to the NCEP definition and 59% according to the IDF definition. The NCEP definition was allowed to select subjects with widespread vascular disease and resistant hypertension whereas the IDF definition did not. These results could be explained by lower waist circumference and glycaemia cuts offs according to the IDF criteria. When diabetic's patients were excluded, MetS was not associated with increase of resistant hypertension frequency. Moreover, hs-CRP was independently associated to the extension of the cardiovascular disease and smoking remained the most powerfully factor associated to the cardio-vascular disease extension. CONCLUSION: In hypertensive patients, the NCEP definition seems more adapted to the diagnosis of MetS than the IDF one. Abdominal obesity could be the indispensable element to the MetS diagnosis but according to the NCEP waist circumference cut off. The use of this syndrome seems to be relevant to select the patients presenting an intermediate cardio-vascular risk in order to adapt treatment.

[Benefits of a healthcare network in the management of cardiovascular disease: HTA Vasc, an innovation in the Nord Pas de Calais region]. / Apport d'un réseau de santé dans la prise en charge des maladies cardiovasculaires: HTA Vasc, une innovation dans la région Nord-Pas-de-Calais.

Created in 2004, the HTA vasc healthcare network intensified detection, multi-disciplinary management and follow up of atheromatous cardiovascular disease and complicated hypertension in the Nord Pas de Calais region. The participating doctors gave their patients a Patient Dossier, as a function of predefined inclusion criteria (patients at elevated cardiovascular risk, as defined by the Haute Autorité de Santé (Higher Authority of Health) stratification. The dossier was presented in the form of a file containing all the information needed to optimise multi-disciplinary management, while at the same time reinforcing therapeutic compliance by patients. Therapeutic education workshops were organised, in order to complement the existing service. In parallel, HTA vasc set up a pilot medical education programme for vascular rehabilitation in six hospitals in the region. HTA vasc also established partnerships with other healthcare networks in the region. A patients' association 'Notre Coeur, Nos Artères', (Our Hearts, Our Arteries) was created in September 2006. About 250 healthcare professionals had joined the network by the end of January 2006, an increase of almost 40% over the year. More than two thirds were independent doctors, and they included cardiologists, neurologists, nephrologists, diabetologists, general practitioners, radiologists, cardiovascular surgeons, rehabilitation doctors, paramedics and pharmacists. More than 260 patients received a follow up dossier. The results of a survey carried out in May 2006 showed a high level of satisfaction: 82% of patients considered the Patient Dossier to be useful and appropriate; 78% of the healthcare professionals stated that the network was of help in the management of patients. HTA vasc received the scientific support of the Sociétés Françaises de Médecine Vasculaire, d' Hypertension Artérielle (French Societies of Vascular Medicine and Hypertension), and the Vascular Group of the Société Française de Cardiologie, with an external audit of the tools and activities undertaken in the region.

[The use of the RESCUE thromboaspiration system in acute coronary syndrome]. / Thromboaspiration dans les syndromes coronaires aigus par le système RESCUE.

Interventional procedures associated with acute coronary syndromes or performed on saphenous bypass grafts frequently lead to embolic complications, resulting in no-reflow phenomenon, side-branch occlusion, or peri-procedural infarction. The RESCUE thrombo-aspiration system was used in 19 percutaneous coronary interventions. After initial use of the aspiration device, 81% of procedures were followed by stent deployment. TIMI flow 2 or higher was present in 42% at the beginning of the procedure and in 95% at the end. In-hospital MACE rate was 4.76%. This relatively user-friendly technique appears rapid and efficacious in the case of visible intracoronary thrombus.

[Restenosis and vascular response after angioplasty: physiopathological data]. / Resténose et réponse de la paroi vasculaire après angioplastie: aspects physiopathologiques.

Our purpose is to review the different mechanisms involved in the vascular response following percutaneous coronary revascularization, and their role in thrombotic complications and in restenosis. Specificities related to the various techniques of percutaneous coronary revascularization (balloon angioplasty, coronary stents, brachytherapy, drug eluting stents) are discussed.