Philippe Sosner

Exercise and longevity

Aging is a natural and complex physiological process influenced by many factors, some of which are modifiable. As the number of older individuals continues to increase, it is important to develop interventions that can be easily implemented and contribute to successful aging. In addition to a healthy diet and psychosocial well-being, the benefits of regular exercise on mortality, and the prevention and control of chronic disease affecting both life expectancy and quality of life are well established. We summarize the benefits of regular exercise on longevity, present the current knowledge regarding potential mechanisms, and outline the main recommendations. Exercise can partially reverse the effects of the aging process on physiological functions and preserve functional reserve in the elderly. Numerous studies have shown that maintaining a minimum quantity and quality of exercise decreases the risk of death, prevents the development of certain cancers, lowers the risk of osteoporosis and increases longevity. Training programs should include exercises aimed at improving cardiorespiratory fitness and muscle function, as well as flexibility and balance. Though the benefits of physical activity appear to be directly linked to the notion of training volume and intensity, further research is required in the elderly, in order to develop more precise recommendations, bearing in mind that the main aim is to foster long-term adherence to physical activity in this growing population.

Clinical and laboratory characteristics of infective endocarditis when associated with spondylodiscitis.

Abstract.Spondylodiscitis is rarely observed in association with infective endocarditis (IE). In the study presented here, 92 cases of definite IE were examined. Spondylodiscitis was present in 14 (15%) cases. The mean age of patients with spondylodiscitis was 69.1±13.6 years (range, 33–87 years). The male-to-female ratio was 8:6. Predisposing heart disease was found in nine (64.3%) cases. Back pain was reported in all cases. Spondylodiscitis was diagnosed before endocarditis in all cases. The infection affected the lumbar spine in 10 (71%) cases. A bacterium was isolated in all cases: group D Streptococcus (n=5; 35.7%), coagulase-negative Staphylococcus (n=4; 28.6%), and others (n=5). Endocarditis affected predominantly the aortic valve (43%). The outcome was favourable in 12 cases. No differences in clinical features, evolution of disease, or laboratory values were found between IE patients with and IE patients without spondylodiscitis. Spondylodiscitis does not appear to worsen prognosis of IE, although the need for cardiac valve replacement seems to be more frequent in IE patients with spondylodiscitis. IE should be included in the differential diagnosis in patients with infectious spondylodiscitis and risk factors for endocarditis. In such patients, echocardiography should be performed routinely.

Atherosclerosis risk in HIV-infected patients: The influence of hepatitis C virus co-infection

BACKGROUNDnThe influence of hepatitis C virus (HCV) infection on atherosclerosis risk in HIV-infected patients has not been adequately evaluated in real-life situations.nnnOBJECTIVES AND METHODSnWe compared indexes of early atherosclerosis evaluated by echo-Doppler ultrasound (presence of plaque in carotid or femoral arteries) in 18 HCV-HIV co-infected patients versus 22 HIV mono-infected patients.nnnRESULTSnPrevalence of subclinical carotid plaque was significantly higher in HCV-HIV co-infected patients (p=0.04), despite of the fact LDL-cholesterol and blood pressure (BP) were lower in the co-infected patients (p=0.003). HCV chronic infection (OR=10; IC: 1.5-72; p=0.02) was an independent risk factor.nnnCONCLUSIONnThis cross sectional study suggests that HCV infection might be an independent cardiovascular risk factor in HCV-HIV co-infected patients. HCV infection might be considered as not only a liver infection but also as a metabolic disease in HIV patients, justifying regular cardiovascular surveillance.

Aldosterone-to-renin ratio for diagnosing aldosterone-producing adenoma: A multicentre study

BACKGROUNDnBiological diagnostic criteria for diagnosing aldosterone-producing adenoma (APA) are not well-established.nnnAIMnThe aim of the study was to establish the best biological predictors of APA.nnnMETHODSnA prospective register was implemented in 17 secondary or tertiary hypertension centres. The inclusion criterion was one of the following: onset of hypertension before 40 years of age; history of hypokalaemia; drug-resistant hypertension (resistant to three drugs); or spironolactone efficiency on BP.nnnRESULTSnAmong the 338 collected cases, 192 patients had two aldosterone-to-renin ratio (ARR) determinations (after 1 hour supine and at least 1 hour upright) on the same occasion. Twenty-five patients (8.2%) had biological hyperaldosteronism and an adrenal adenoma identified by computed tomography. APA was histologically confirmed in all 12 patients who underwent surgery. Histologically proven APAs were used as the gold standard in receiver operating characteristic (ROC) curve analysis. ARRs were computed with a minimum renin value set at 5 ng/L to avoid misclassification of so-called low-renin hypertension. To predict an APA, the ARR area under the ROC curve was 0.93. A supine ARR cut-off value of 32ng/ng provided the highest sum of sensitivity (92%) plus specificity (92%). On the basis of an ARR≥32 ng/ng in the supine and/or upright position, sensitivity reached 100%.nnnCONCLUSIONnThe proposed cut-off value of 32 ng/ng for ARR (minimum renin value set at 5 ng/L) in one of two determinations had 100% sensitivity and 72% specificity with 20% positive and 100% negative predictive values for diagnosing APA.

Prognostic Value of Resting Heart Rate on Cardiovascular and Renal Outcomes in Type 2 Diabetic Patients A competing risk analysis in a prospective cohort

OBJECTIVE Epidemiological studies and randomized clinical trials have demonstrated in various populations that resting heart rate (RHR) was an independent predictor of cardiovascular (CV) risk and all-cause mortality. However, few data specifically evaluated the relationship between RHR and long-term CV and renal complications in a large population of type 2 diabetic (T2D) patients. RESEARCH DESIGN AND METHODS We performed a single-center, prospective analysis in 1,088 T2D patients. RHR was determined at baseline by electrocardiogram. The primary outcome was a composite criterion of CV and renal morbi-mortality (CV death, nonfatal myocardial infarction and/or stroke, hospitalization for heart failure, renal replacement therapy), which was adjusted for death from non-CV cause as a competing event. The secondary outcome was a renal composite criterion (renal replacement therapy or doubling of baseline serum creatinine) adjusted for all-cause death as a competing event. RESULTS During median follow-up of 4.2 years, 253 patients (23%) and 62 patients (6%) experienced the primary and secondary outcomes, respectively. In the subgroup of patients with CV disease history at baseline (n = 336), RHR was found to be associated with the incidence of primary outcome (P = 0.0002) but also with renal risk alone, adjusted for all-cause death as a competing event (secondary outcome; P < 0.0001). In patients without history of CV disease, no relation was found between RHR and the incidence of CV and/or renal events. CONCLUSIONS In the real-life setting, RHR constitutes an easy and less time-consuming factor that would permit identification of CV disease diabetic patients with an increased risk for long-term CV and renal complications.

Renal complications correlate with electrical atrial vulnerability hallmarks in type 2 diabetic patients

Type 2 diabetes (T2D) is an important risk factor for atrialfibrillation (AF) and cardiovascular diseases [1,2]. While diabeticnephropathy is a well-established risk factor for cardiovascularoutcomes [3,4], its association with AF is not clearly defined. Theaim of this study was to characterize the relationship betweendiabeticnephropathyandelectricalatrialvulnerability,namelyAFandprolonged P-wave duration (PWD).The T2D study population originated from the SURDIAGENE andDIAB2NEPHROGENE studies [5]. Clinical, biological and ECG data ofstudy participantswereexaminedfor the presence of AFor prolongedPWD. PWD referred to the longest PWD from the surface ECG.Measurements were performed manually by two investigators usingpapertracesandamagnifyinglenstodefinethedeflectionsonthe12-lead ECG, as previously described [6]. Patients with poor ECG qualityand patients with no AF nor sinus rhythmwere excluded of the study,particularly patients with paced atrial rhythm.Bivariate comparisons were conducted using the t-test fornormally distributed continuous variables or the Mann–Whitneytest for not-normally distributed variables, and Chi-2 or Chi-2 fortrend tests for categorical variables. Comparisons between groups(PWD quartiles) were performed using Kruskal–Wallis analysis ofvariance.Logisticregressionanalysiswithbackwardvariableselectionwas performed by considering AF as a dependent variable. Potentialpredictorsfor prolongedPWD (superiorto PWD medianvalue)with ap valueb0.20 in bivariate analysis were added to the multivariatestepwise logistic regression model using backward variable selection.

Mesures de la pression artérielle

Correspondance : Jacques Blacher Unite hypertension arterielle, prevention et therapeutique cardiovasculaire Centre de diagnostic et de therapeutique Hotel-Dieu, AP-HP 1, place du Parvis Notre-Dame 75181 Paris cedex 4 jacques.blacher@htd.aphp.fr Membres du groupe de travail : Jacques Amar, Athanase Benetos, Jacques Blacher (redacteur), Guillaume Bobrie, Bernard Chamontin, Xavier Girerd, Jean-Michel Halimi, Daniel Herpin, Claire Mounier-Vehier, Jean-Jacques Mourad, Jean Ribstein, Bruno Schnebert, Bernard Vaisse.

418 INFLUENCE OF HEPATITIS C VIRUS (HCV) INFECTION ON ATHEROSCLEROSIS RISK IN HIV-INFECTED ADULTS

According to a new standard operating procedure, all 7683 patients who were seen in our emergency wards between May and November 2008 and in whom a blood sample was taken as part of the routine medical work-up were tested for the presence of anti-HCV antibodies. Anti-HCV positive patients were further analysed for the presence of viremia by real-time PCR. A total of 194 patients (2.5%) were found to be anti-HCV positive. 44% were female. The average age of these patients was 55 years. So far, 110 anti-HCV positive sera were further screened for HCV-RNA and 60% of them were HCV-RNA positive and 66% had elevated AST levels. Only 35% of HCV-RNA positive patients had a history of previous antiviral therapy. No difference in anti-HCV prevalence has been observed whether the patients from the traumatology or internal emergency ward were analysed. In conclusion, in patients of the Berlin Charite emergency wards the antiHCV prevalence was 5 times higher as expected form previous general population studies in Germany. In view of the progress made in recent years in the treatment of patients with HCV infection and the favourable outcome when treated at early stages, these data can be taken as a strong hint for a more general HCV screening at least in great urban areas.