Aline Wagner

Physical Activity and Coronary Event Incidence in Northern Ireland and France The Prospective Epidemiological Study of Myocardial Infarction (PRIME)

Background—The influence of physical activity on the incidence of angina pectoris and hard coronary events (myocardial infarction and coronary deaths) was examined in Northern Ireland and France at contrasting risk for coronary heart disease (CHD) and with different physical activity patterns. Methods and Results—Participants of the Prospective Epidemiological Study of Myocardial Infarction (PRIME) (n=9758; age, 50 to 59 years), free of CHD at baseline, were followed up for 5 years: 167 hard CHD and 154 angina events were recorded. Net energy expenditure (EE) as the result of physical activity was assessed by means of the MONICA Optional Study of Physical Activity Questionnaire (MOSPA-Q). Leisure-time physical activity EE was calculated; subjects were also categorized as to whether they performed high-intensity leisure-time activities or walked or cycled to work. After multivariate adjustment, leisure-time physical activity EE was associated with a lower risk of hard CHD events (P <0.04), whereas walking or cycling to work was not independently related to hard CHD events. No interaction by country was found. The beneficial effect of leisure-time physical activity was also present among subjects who did not report high-intensity activities (P <0.04), with similar results in France and Northern Ireland. In contrast, an increasing level of leisure-time physical activity was associated with a higher risk of angina in both countries. Conclusions—These data indicate a beneficial effect of leisure-time physical activity EE on hard CHD incidence in middle-aged men, which could partly explain the unfavorable rate of CHD in Northern Ireland. The higher level of leisure-time activities in France could, in part, explain its lower rate of CHD.

High blood pressure prevalence and control in a middle-aged French population and their associated factors: the MONA LISA study.

Aims This work aims to assess high blood pressure (BP) prevalence and control and their associated factors in a population-based study conducted in three French areas: the Urban Community of Lille and the districts of Bas-Rhin and Haute-Garonne, between 2005 and 2007. Methods Participants were randomly recruited from electoral rolls after stratification on sex, 10-year age group (35–74 years) and town size. BP was measured by trained medical staff following standardized procedures. High BP was defined as BP at least 140/90 mmHg and/or taking antihypertensive drugs or following a specific diet. BP below 140/90 mmHg among treated individuals was considered adequately controlled (<130/80 mmHg among diabetics). Results Four thousand eight hundred and twenty-five participants were recruited (mean age 55.5 ± 11.3 years). The prevalence of high BP was greater in men (47%) than in women (35%). Antihypertensive treatment concerned 80% of the hypertensive individuals with most often a combination therapy. Control rates concerned only 38% of women and 22% of men and decreased with age. Metabolic risk factors and aging were independently associated with high BP prevalence as were low educational level and alcohol consumption. Diabetes and high cardiovascular risk were strong independent predictors of uncontrolled BP. The use of multiple drug treatment did not predict a better control. Conclusions Hypertension is frequent in France, particularly in the age group 55–74 years. Control rates remain low, particularly in high-risk, older and diabetic individuals. Intensified efforts are required to improve lifestyle, awareness of the condition, and use of appropriate and well tolerated combination therapy.

Effect of an FTO polymorphism on fat mass, obesity, and type 2 diabetes mellitus in the French MONICA Study

We investigated the association between the rs9939609 (T>A) polymorphism in the FTO (fat mass- and obesity-associated) gene and obesity- and type 2 diabetes mellitus-related phenotypes in the French Multinational MONItoring of Trends and Determinants in CArdiovascular Disease (MONICA) Study (n = 3367). In the study, TA or AA subjects had higher body mass index (BMI) (P = .017), waist circumference (P = .017), and hip (P = .01) circumference in an A allele dose-dependent manner. The A allele was also significantly associated with higher plasma insulin levels (P = .05), higher insulin resistance index (homeostasis model assessment) (P = .02), and higher systolic blood pressure (P = .003); but these associations disappeared after adjustment for BMI. In the study, 598 subjects were obese (BMI >or=30 kg/m(2)); and 2769 subjects were not obese (BMI <30 kg/m(2)). Subjects bearing the A allele of rs9939609 had a higher risk of obesity (adjusted odds ratio [95% confidence interval] = 1.29 [1.06-1.58], P = .01) compared with TT subjects. Moreover, the homozygous AA genotype of rs9939609 was associated with a higher risk of type 2 diabetes mellitus (odds ratio = 1.45 [1.05-1.99], P = .02, 283 subjects with and 2601 subjects without type 2 diabetes mellitus), independently of BMI. In conclusion, the role of the A allele of the FTO rs9939609 polymorphism on the risk of obesity and type 2 diabetes mellitus was confirmed in the French MONICA Study.

Anthropometric assessment of abdominal obesity and coronary heart disease risk in men: the PRIME study

Objective: Waist-to-height ratio is an anthropometric indicator of abdominal obesity that accounts for stature. Earlier studies have reported marked associations between the waist-to-height ratio and cardiovascular risk factors. The goal of this study was to compare the associations of waist-to-height ratio, waist girth, waist-to-hip ratio or body mass index (BMI) with incidence of coronary events. Design: Prospective study with 10 602 men, aged 50–59 years, recruited between 1991 and 1993 in three centres in France and one centre in Northern Ireland. Clinical and biological data were obtained at interview by trained staff. During the 10 years of follow-up 659 incident coronary events (CHD) were recorded. The relations between anthropometric markers and coronary events were estimated by Cox proportional hazards models. Results: Waist circumference, waist-to-hip ratio, waist-to-height ratios and BMI were positively associated with blood pressure (p<0.0001), diabetes (p<0.0001), low-density lipoprotein (LDL)-cholesterol (p<0.0001), triglycerides (p<0.0001) and inversely correlated to high-density lipoprotein (HDL)-cholesterol (p<0.0001). There was a linear association between waist circumference, waist-to-hip ratio, waist-to-height ratio, BMI and CHD events. The age-adjusted and centre-adjusted relative risks (95% CI) for CHD were 1.57 (1.22 to 2.01), 1.75 (1.34 to 2.87), 2.3 (1.79 to 2.99) and 1.99 (1.54 to 2.56) in the 5th quintile vs the first quintile of waist circumference, waist-to-hip ratio, waist-to-height ratio and BMI distribution, respectively. After further adjustment for school duration, physical activity, tobacco and alcohol consumption, hypertension, diabetes, HDL-cholesterol and triglycerides, the relative risks for CHD were 0.99 (0.76 to 1.30) for waist circumference (p = 0.5), 1.22 (0.93 to 1.60) for waist-to-hip ratio (p = 0.1), 1.53 (1.16 to 2.01) for waist-to-height ratio (p = 0.03) and 1.30 (0.99 to 1.71) for BMI (p = 0.06). Conclusion: In middle-aged European men, waist-to-height ratio identifies coronary risk more strongly than waist circumference, waist-to-hip ratio or BMI, though the difference is marginal.

Impact of Age and Gender on the Prevalence and Prognostic Importance of the Metabolic Syndrome and Its Components in Europeans. The MORGAM Prospective Cohort Project

Objective To investigate the influence of age and gender on the prevalence and cardiovascular disease (CVD) risk in Europeans presenting with the Metabolic Syndrome (MetS). Methods Using 36 cohorts from the MORGAM-Project with baseline between 1982–1997, 69094 men and women aged 19–78 years, without known CVD, were included. During 12.2 years of follow-up, 3.7%/2.1% of men/women died due to CVD. The corresponding percentages for fatal and nonfatal coronary heart disease (CHD) and stroke were 8.3/3.8 and 3.1/2.5. Results The prevalence of MetS, according to modified definitions of the International Diabetes Federation (IDF) and the revised National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATPIII), increased across age groups for both genders (P<0.0001); with a 5-fold increase in women from ages 19–39 years to 60–78 years (7.4%/7.6% to 35.4%/37.6% for IDF/NCEP-ATPIII) and a 2-fold increase in men (5.3%/10.5% to 11.5%/21.8%). Using multivariate-adjusted Cox regressions, the associations between MetS and all three CVD events were significant (P<0.0001). For IDF/NCEP-ATPIII in men and women, hazard ratio (HR) for CHD was 1.60/1.62 and 1.93/2.03, for CVD mortality 1.73/1.65 and 1.77/2.06, and for stroke 1.51/1.53 and 1.58/1.77. Whereas in men the HRs for CVD events were independent of age (MetS*age, P>0.05), in women the HRs for CHD declined with age (HRs 3.23/3.98 to 1.55/1.56; MetS*age, P = 0.01/P = 0.001 for IDF/NCEP-ATPIII) while the HRs for stroke tended to increase (HRs 1.31/1.25 to 1.55/1.83; MetS*age, P>0.05). Conclusion In Europeans, both age and gender influenced the prevalence of MetS and its prognostic significance. The present results emphasise the importance of being critical of MetS in its current form as a marker of CVD especially in women, and advocate for a redefinition of MetS taking into account age especially in women.

Measures of Abdominal Adiposity and the Risk of Stroke The MOnica Risk, Genetics, Archiving and Monograph (MORGAM) Study

Background and Purpose— Excess fat accumulates in the subcutaneous and visceral adipose tissue compartments. We tested the hypothesis that indicators of visceral adiposity, namely, waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR), are better predictors of stroke risk than body mass index (BMI). Methods– The association of BMI, WC, WHR, and WHtR with stroke was assessed in 31 201 men and 23 516 women, free of vascular disease at baseline, from the MOnica Risk, Genetics, Archiving and Monograph (MORGAM) study. During a mean follow-up of 11 years, 1130 strokes were recorded. Relative risks (95% CI) were calculated by Cox regression after stratification for center and adjustment for age, smoking, educational level, alcohol consumption, hypertension, diabetes, total cholesterol, high-density lipoprotein cholesterol, and BMI and model fit was assessed using log-likelihoods. Results— BMI, WC, WHR, and WHtR were associated with the risk of stroke in men. After full adjustment including BMI, the relative risks for stroke remained significant for WC (1.19 [1.02 to 1.34] per 1 SD increase in WC), WHR (1.14 [1.03 to 1.26]), and WHtR (1.50 [1.28 to 1.77]). Among women, the extent of the associations with stroke risk was similar for WHtR (1.31 [1.04 to 1.65]), WC (1.19 [0.96 to 1.47]), and WHR (1.08 [0.97 to 1.22]). Further analyses by World Health Organization obesity categories showed that WC, WHR, and WHtR were associated with the risk of stroke also in lean men and women (BMI <25 kg/m2), independently of confounders, cardiovascular risk factors, and BMI. Conclusions— Indicators of abdominal adiposity, especially WHtR, are more strongly associated with stroke risk than BMI. These results emphasize the importance of measuring abdominal adiposity, especially in lean subjects.

Physical activity patterns in 50-59 year men in France and Northern Ireland. Associations with socio-economic status and health behaviour

Background: This study aimed to compare physical activity patterns and their associations with socio-economic status (SES) and health behaviour in two countries at contrasting risk for coronary heart disease (CHD). Methods: This paper is a cross-sectional analysis of 7359 French and 2398 Northern Irish 50–59 year men of the PRIME cohort. Net energy expenditure due to physical activity (PAE) was assessed by means of the MOSPA-Q taking high-intensity recreational activities into account. SES was evaluated by educational attainment and material conditions. Different behavioural factors (smoking, alcohol intake and healthy eating patterns) were considered. Results: The prevalence of walking or cycling to work was greater in Northern Ireland (p < 10−5) whereas leisure PAE (p < 10−5) and high-intensity leisure-time activity (p < 10−5) were higher in France. Education was positively associated with leisure-time PAE in Northern Ireland but negatively in France. However education in both countries and material conditions in France were favourably associated with the regular practice of high-intensity recreational activities. Alcohol consumption was positively associated with leisure PAE in France only (p < 10−3). A weak negative association was also observed between smoking and leisure-time activities while healthy eating patterns were associated with greater physical activity in both countries. Conclusions: Physical activity patterns and their relationships with SES and alcohol consumption differ in France and in Northern Ireland. Our results underline the need to focus on low socio-economic groups for health promotion but, also, to adapt strategies to promote physical activity according to cultural differences between countries. Our results also show that healthy behaviours tend to cluster in middle-aged men.

The APOA5 Trp19 allele is associated with metabolic syndrome via its association with plasma triglycerides

BackgroundThe goal of the present study was to assess the effect of genetic variability at the APOA5/A4/C3/A1 cluster locus on the risk of metabolic syndrome.MethodsThe APOA5 Ser19Trp, APOA5 -12,238T>C, APOA4 Thr347Ser, APOC3 -482C>T and APOC3 3238C>G (SstI) polymorphisms were analyzed in a representative population sample of 3138 men and women from France, including 932 individuals with metabolic syndrome and 2206 without metabolic syndrome, as defined by the NCEP criteria.ResultsCompared with homozygotes for the common allele, the odds ratio (OR) [95% CI] for metabolic syndrome was 1.30 [1.03–1.66] (p = 0.03) for APOA5 Trp19 carriers, 0.81 [0.69–0.95] (p = 0.01) for APOA5 -12,238C carriers and 0.84 [0.70–0.99] (p = 0.04) for APOA4 Ser347 carriers. Adjustment for plasma triglycerides, (but not for waist girth, HDL, blood pressure or glycemia – the other components of metabolic syndrome) abolished these associations and suggests that triglyceride levels explain the association with metabolic syndrome. There was no association between the APOC3 -482C>T or APOC3 3238C>G polymorphisms and metabolic syndrome. The decreased risk of metabolic syndrome observed in APOA5 -12,238C and APOA4 Ser347 carriers merely reflected the fact that the APOA5 Trp19 allele was in negative linkage disequilibrium with the common alleles of APOA5 -12,238T>C and APOA4 Thr347Ser polymorphisms.ConclusionThe APOA5 Trp19 allele increased susceptibility to metabolic syndrome via its impact on plasma triglyceride levels.

Trends in coronary heart disease in France during the second half of the 1990s

Background Data on the recent evolution in coronary heart disease (CHD) mortality and incidence rates are lacking in France. This paper aims to investigate whether the declining trends observed from 1985–1993 still persist in the second half of the 1990s. Methods Population registers of acute CHD have been implemented in three specific geographical areas, first as part of the MONICA Project (1985–1993) and, since 1997, according to a simplified registration procedure. Weighted Poisson regressions have been used to investigate time trends in CHD events in men and women aged 35–64 after correction for registration differences. Results Data obtained from 1997–2000 showed that the north-to-south gradient of decreasing frequency of CHD events in France was still present. Besides, they revealed no specific trend in CHD morbidity by centre and gender, except in Lille (in the north of France) where events tended to increase in women. Coronary heart disease mortality rates in recent years were decreasing in men, particularly in the north and east of France, but were stable in women with, even, a rising tendency in the north. Conclusion The decreasing trend in CHD events in France observed from the mid 1980s to the early 1990s seemed to markedly slow down in the second half of the 1990s.

The North-East-South gradient of coronary heart disease mortality and case fatality rates in France is consistent with a similar gradient in risk factor clusters

In France, the mortality and case fatality rates of coronary heart disease follow a decreasing North–East–South gradient. The aim of the study was to evaluate the contribution of major cardiovascular risk factors to this gradient. To this end, the results of the third population survey of the WHO–MONICA Project conducted in three French geographically contrasted regions (the Urban Community of Lille in the North, the district of Bas-Rhin in the East and the district of Haute-Garonne in the South) are presented. One thousand seven hundred seventy-eight men and 1730 women aged 35–64years were randomly selected from the electoral rolls. Major coronary heart disease risk factors (hypertension, hypercholesterolemia, low high-density lipoprotein (HDL)-cholesterol, obesity, smoking, physical inactivity, diabetes) were studied. The results show that the distribution of major coronary heart disease risk factors is heterogeneous among geographical areas in France. However, the proportion of subjects with more than three risk factors is higher in the North than in the other regions and the number of subjects with no risk factor is higher in the South than in the other areas. This distribution of risk factors among regions supports the hypothesis that accumulation of coronary heart disease risk factors contributes to the decreasing North–East–South gradient of cardiovascular mortality rates in France.