Associations between classical cardiovascular risk factors and coronary artery disease in two countries at contrasting risk for myocardial infarction: the PRIME study.

PURPOSE: In two countries with contrasting risk for coronary artery disease (CAD)-Northern Ireland and France-a case-control study was performed on baseline data within a cohort study to compare the strength of the associations between CAD prevalence and classical risk factors. METHOD AND RESULTS: A sample of 9561 men, aged 50-60 years, was studied: 382 had had myocardial infarction or angina, and 9179 were controls. In both countries, variables associated with CAD were age, body mass index, hypertension, diabetes, family history of myocardial infarction (MI), tobacco consumption, triglycerides, HDL-cholesterol, apolipoprotein A-I and B levels. Logistic regression analyses were conducted using standardized odds ratios. The strength of the associations with CAD was rather similar in the two countries (Northern Ireland versus France) for age [1.26 (1.10-1. 45) vs. 1.41 (1.17-1.69)], family history of MI [1.50 (1.04-2.15) vs. 1.83 (0.99-3.37)], hypertension [1.49 (1.13-1.97) vs. 1.67 (1.14-2. 44)], diabetes [5.42 (2.53-11.60) vs. 2.24 (1.06-4.73)], tobacco consumption [1.43 (1.27-1.60) vs. 1.39 (1.22-1.58)], HDL-cholesterol [0.80 (0.68-0.94) vs. 0.86 (0.70-1.06)] and triglyceride levels [1. 17 (1.01-1.36) vs. 1.10 (0.91-1.32)]. Discrepancies concerned lipoprotein(a) [1.22 (1.06-1.40) vs. 0.96 (0.81-1.15), P<0.01], with stronger associations in Northern Ireland than in France. CONCLUSION: It is concluded that the higher prevalence of CAD in Northern Ireland cannot be explained by major differences in the susceptibility to classical risk factors; the difference in risk of CAD appears mainly related in Northern Ireland to other risk factors including a worse lipid profile and genetic/environmental interactions.

[Prevalence and management of major risk factors in 500 men with stable coronary disease]. / Prévalence et prise en charge des facteurs de risque majeurs chez 500 hommes présentant une maladie coronaire stable.

Management of major risk factors (smoking, hypercholesterolaemia, hypertension), in the context of secondary prevention, has an impact on recurrence and life expectancy. However, there is a delay between the publication of therapeutic trials and their diffusion within the medical community. The objective of this study was to evaluate the prevalence and management of the main risk factors in a sample of 500 men, with a mean age of 55.1 +/- 7.5 years, presenting with stable coronary artery disease. 11% of subjects had a family history of premature myocardial infarction. Smoking was frequent: 21% of smokers, 60% of ex-smokers. Hypercholesterolaemia (LDL-C > 3.4 mmole/l or treatment) was present in 82% of subjects. Only 45% of treated subjects had an LDL-C < 3.4 mmole/l. Hypertension (systolic blood pressure > or = 140 mmHg or diastolic blood pressure > or = 90 mmHg or treatment) was present in 61% of subjects. Only 33% of treated subjects were controlled. Non-insulin-dependent diabetes mellitus (blood glucose > or = 7.7 mmole/l or treatment) was present in 21% of subjects. Only 43% of treated subjects were controlled. Calculation of the distribution of major risk factors (smoking, pathological obesity, hypercholesterolaemia, hypertension, diabetes) showed that 90% of coronary patients presented at least two risk factors. Overall, the prevalence and management of risk factors in patients with stable coronary artery disease is far from optimal.

[Long-term effects of prescription drugs in 174 patients treated for myocardial infarction, followed up from 4 to 5 years (the DEVENIR study)]. / Evolution à long terme de la prescription médicamenteuse chez 174 patients atteints d'infarctus du myocarde suivis pendant 4,5 ans (étude DEVENIR).

The aim of this study was to document changes in drug prescription after myocardial infarction. One hundred and seventy four men with typical myocardial infarction recensed by the Toulouse MONICA centre between 1989 and 1990 were followed up for 4.5 years. A copy of their drug prescription was obtained during the acute phase of infarction, at the time of discharge from hospital or clinic, after 6 months, and finally, after 4.5 years after infarction. During the acute phase, the majority of patients received nitrate derivatives, platelet antiaggregants, calcium antagonists, betablockers and antiarrhythmics. Between hospital discharge and the sixth month, the prescription of lipid lowering drugs quadrupled (from 8 to 33%; p < 0.00001) and those of platelet anti-aggregants decreased (from 82 to 70%; p < 0.01). The prescriptions of other drugs remained relatively stable. Between the 6th month and the 4th year of follow-up the only prescription to increase significantly was that of ACE inhibitors (from 14 to 23%; p < 0.03). The other prescriptions were maintained: platelet anti-aggregants (70% at 6 months vs 75% at 4.5 years), nitrate derivatives (59 vs 51%), betablockers (51 vs 52%), calcium antagonists (51 vs 48%), lipid lowering drugs (33 vs 42%), diuretics (3 vs 6%) and inotropic agents (2 vs 2%). Overall analysis showed an increase in the prescriptions of lipid-lowering agents (p < 0.00001) and ACE inhibitors (p < 0.002). On the other hand, the prescriptions of calcium antagonists and nitrate derivatives tended to decrease. These results show that the treatment of patients with coronary artery disease is based on drugs of proven efficacy, reflecting the impact of large scale therapeutic trials on everyday medical practice.

[Amiodarone-induced pleuropneumopathies: experience 1983-1993 in a drug vigilance Regional Center]. / Pleuro-pneumopathies à l'amiodarone: expérience 1983-1993 d'un Centre régional de Pharmacovigilance.

The authors present the results of a ten year retrospective analysis about amiodarone-induced pulmonary toxicity. Only cases without any etiology (after complete explorations made in hospital), and judged probably imputable to amiodarone treatment were kept. This work finds all characteristics usually described with amiodarone pulmonary toxicity: dyspnea, cough, weight loss, restrictive lung disease and interstitial infiltration in the chest roentgenogram. It shows three another points: pulmonary disease is more frequent during first and fourth years of amiodarone treatment, pneumopathy occurs more rapidly in patients with a previous history of pulmonary disease, and patients with amiodarone lung toxicity may have elevation in lactate dehydrogenase activity.

[Drug vigilance: opinion survey among residents of a university hospital]. / Pharmacovigilance: enquête d'opinion auprès des internes d'un centre hospitalier universitaire.

To approach perception of drug safety by young practitioners, a nine item questionnaire has been mailed to the 263 residents from Toulouse Hospital. The analysis of the 116 returned questionnaires shows that pharmacovigilance centres are still badly known in France. The level of under-reporting of adverse drug reactions is 44%. However, it decreases when the Regional Pharmacovigilance Centre sends informations to the prescribers. In the University Hospital, the regional pharmacovigilance centre is the more used source of drug information by residents. However, 66% of the residents do not know that spontaneous reporting is compulsory in France and 75% are unable to find the address of the Regional Pharmacovigilance Centre.