Center dInvestigations Preventives et Cliniques

Paris, France

Center dInvestigations Preventives et Cliniques

Paris, France
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Ben-Shlomo Y.,University of Bristol | Spears M.,University of Bristol | Boustred C.,University of Bristol | May M.,University of Bristol | And 28 more authors.
Journal of the American College of Cardiology | Year: 2014

Objectives The goal of this study was to determine whether aortic pulse wave velocity (aPWV) improves prediction of cardiovascular disease (CVD) events beyond conventional risk factors. Background Several studies have shown that aPWV may be a useful risk factor for predicting CVD, but they have been underpowered to examine whether this is true for different subgroups. Methods We undertook a systematic review and obtained individual participant data from 16 studies. Study-specific associations of aPWV with CVD outcomes were determined using Cox proportional hazard models and random effect models to estimate pooled effects. Results Of 17,635 participants, a total of 1,785 (10%) had a CVD event. The pooled age- and sex-adjusted hazard ratios (HRs) per 1-SD change in loge aPWV were 1.35 (95% confidence interval [CI]: 1.22 to 1.50; p < 0.001) for coronary heart disease, 1.54 (95% CI: 1.34 to 1.78; p < 0.001) for stroke, and 1.45 (95% CI: 1.30 to 1.61; p < 0.001) for CVD. Associations stratified according to sex, diabetes, and hypertension were similar but decreased with age (1.89, 1.77, 1.36, and 1.23 for age ≤50, 51 to 60, 61 to 70, and >70 years, respectively; pinteraction <0.001). After adjusting for conventional risk factors, aPWV remained a predictor of coronary heart disease (HR: 1.23 [95% CI: 1.11 to 1.35]; p < 0.001), stroke (HR: 1.28 [95% CI: 1.16 to 1.42]; p < 0.001), and CVD events (HR: 1.30 [95% CI: 1.18 to 1.43]; p < 0.001). Reclassification indices showed that the addition of aPWV improved risk prediction (13% for 10-year CVD risk for intermediate risk) for some subgroups. Conclusions Consideration of aPWV improves model fit and reclassifies risk for future CVD events in models that include standard risk factors. aPWV may enable better identification of high-risk populations that might benefit from more aggressive CVD risk factor management.


Regnault V.,French Institute of Health and Medical Research | Regnault V.,University of Lorraine | Thomas F.,Center dInvestigations Preventives et Cliniques | Osborne-Pellegrin M.,French Institute of Health and Medical Research | And 5 more authors.
Journal of the American College of Cardiology | Year: 2012

Objectives: The study was to explore whether the brachial/carotid pulse pressure (B/C-PP) ratio selectively predicts the sex difference in age-related cardiovascular (CV) death. Background: Hypertension and CV complications are more severe in men and post-menopausal women than in pre-menopausal women. C-PP is lower than B-PP, and the B/C-PP ratio is a physiological marker of PP amplification between B and C arteries that tends toward 1.0 with age. Methods: The study involved 72,437 men (ages 41.0 ± 11.1 years) and 52,714 women (39.5 ± 11.6 years). C-PP was calculated for each sex by a multiple regression analysis including B-PP, age, height and risk factors, and a method validated beforehand in a subgroup of 834 subjects. During the 12 years of follow-up, 3,028 men and 969 women died. Results: In the total population, the adjusted hazard ratios (HR) (95% confidence interval [CI]) of B/C-PP ratio were: 1) for all-cause mortality: men, HR: 1.51 (95% CI: 1.47 to 1.56), women; HR: 2.46 (95% CI: 2.27 to 2.67) (p < 0.0001); and 2) for CV mortality: men, HR 1.81 (95% CI: 1.70 to 1.93); women, HR: 4.46 (95% CI: 3.66 to 5.45) (p < 0.0001). The B/C-PP impact on mortality did not significantly increase from younger men to those <55 years of age, from: HR: 1.44 (95% CI: 1.31 to 1.58) to HR 1.65 (95% CI: 1.48 to 1.84), but increased significantly with age in women: HR: 3.19 (95% CI: 2.08 to 4.89) versus HR: 5.60 (95% CI: 4.17 to 7.50) (p < 0.01). Thus, the mortality impact of B/C-PP ratio was 3-fold higher in women than in men <55 years old. Conclusions: PP amplification is highly predictive of differences in CV risk between men and women. In post-menopausal women, the attenuation of PP amplification, mainly related to increased aortic stiffness, contributes to the significant increase in CV risk. © 2012 American College of Cardiology Foundation.


Thomas F.,Center dInvestigations Preventives et Cliniques | Pannier B.,Center dInvestigations Preventives et Cliniques | Benetos A.,Center dInvestigations Preventives et Cliniques | Benetos A.,Nancy University Hospital Center | Vischer U.M.,University of Geneva
Journal of Hypertension | Year: 2011

Objective: The metabolic syndrome predicts the risk of cardiovascular and all-cause death, but its clinical relevance in the elderly remains debatable. We aimed to determine the impact of the metabolic syndrome on all-cause mortality according to age, in comparison with hypertension alone. Methods: We studied 129 655 participants (82 110 men and 47 545 women) undergoing a standard health check-up at the Investigations Préventives et Cliniques center (Paris, France). Mean follow-up was 4.9 ± 2.6 years. The prevalence of the metabolic syndrome and its components was determined according to age group (<55, 55-65, >65 years old). All-cause mortality according to metabolic syndrome and age was determined using Cox regression model analysis, unadjusted or adjusted for age, sex, smoking and other confounding factors. Results: The prevalence of the metabolic syndrome and all its components except lipid parameters strongly increased with age. All-cause mortality associated with the metabolic syndrome (using three different definitions) was significantly elevated in participants below 55 years old, and was little affected by adjustment for confounding factors. However, it decreased from 1.77 (1.45-2.16) in participants below 55 years old to 1.12 (0.84-1.48) in participants above 65 years old [hazard ratio (95% confidence interval); National Cholesterol Education Program definition]. Waist circumference, fasting blood glucose and lipid parameters failed to predict mortality in participants above 65 years old. In contrast, hypertension (blood pressure > 140/90 mmHg or treatment) remained a significant predictor of all-cause mortality [hazard ratio 1.30 (95% confidence interval 1.02-1.66)] in participants above 65 years old. CONCLUSIONS: In a setting representative of primary care, hypertension but not the metabolic syndrome remains a strong risk factor for all-cause mortality in participants above 65 years old. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Thomas F.,Center dInvestigations Preventives et Cliniques | Pannier B.,Center dInvestigations Preventives et Cliniques | Benetos A.,Nancy University Hospital Center | Vischer U.M.,University of Geneva
Vascular Health and Risk Management | Year: 2013

The aim of the study was to determine the role of obesity evaluated by body mass index (BMI), waist circumference (WC), and their combined effect on all-cause mortality according to age and related risk factors. This study included 119, 090 subjects (79, 325 men and 39, 765 women), aged from 17 years to 85 years, who had a general health checkup at the Centre d'Investigations Préventives et Cliniques, Paris, France. The mean follow-up was 5.6±2.4 years. The prevalence of obesity, defined by WC and BMI categories, was determined according to age groups (<55, 55-65, >65 years). All-cause mortality according to obesity and age was determined using Cox regression analysis, adjusted for related risk factors and previous cardiovascular events. For the entire population, WC adjusted for BMI, an index of central obesity, was strongly associated with mortality, even after adjustment for hypertension, dyslipidemia, and diabetes. The prevalence of obesity increased with age, notably when defined by WC. Nonetheless, the association between WC adjusted for BMI and mortality was not observed in subjects >65 years old (hazard ratio [HR] =1.010, P=NS) but was found in subjects <55 (HR =1.030, P<0.0001) and 55-65 years old (HR =1.023, P<0.05). By contrast, hypertension (HR =1.31, P<0.05), previous cardiovascular events (HR =1.98, P<0.05), and smoking (HR =1.33, P<0.05) remained associated with mortality even after age 65. In conclusion, WC adjusted for BMI is strongly and independently associated with all-cause mortality before 65 years of age, after taking into account the associated risk factors. This relationship disappears in subjects >65 years of age, suggesting a differential impact of visceral fat deposition according to age. © 2013 Thomas et al.


Karusisi N.,French Institute of Health and Medical Research | Karusisi N.,University Pierre and Marie Curie | Thomas F.,Center dInvestigations Preventives et Cliniques | Meline J.,French Institute of Health and Medical Research | And 2 more authors.
International Journal of Behavioral Nutrition and Physical Activity | Year: 2013

Background: Physical activity is considered as a major component of a healthy lifestyle. However, few studies have examined the relationships between the spatial accessibility to sport facilities and sport practice with a sufficient degree of specificity. The aim of this study was to investigate the associations between the spatial accessibility to specific types of sports facilities and the practice of the corresponding sports after carefully controlling for various individual socio-demographic characteristics and neighborhood socioeconomic variables.Methods: Data from the RECORD Study involving 7290 participants recruited in 2007-2008, aged 30-79 years, and residing in the Paris metropolitan area were analyzed. Four categories of sports were studied: team sports, racket sports, swimming and related activities, and fitness. Spatial accessibility to sport facilities was measured with two complementary approaches that both take into account the street network (distance to the nearest facility and count of facilities around the dwelling). Associations between the spatial accessibility to sport facilities and the practice of the corresponding sports were assessed using multilevel logistic regression after adjusting for individual and contextual characteristics.Results: High individual education and high household income were associated with the practice of racket sports, swimming or related activities, and fitness over the previous 7 days. The spatial accessibility to swimming pools was associated with swimming and related sports, even after adjustment for individual/contextual factors. The spatial accessibility to facilities was not related to the practice of other sports. High neighborhood income was associated with the practice of a racket sport and fitness.Conclusions: Accessibility is a multi-dimensional concept that integrates educational, financial, and geographical aspects. Our work supports the evidence that strategies to increase participation in sport activities should improve the spatial and financial access to specific facilities, but also address educational disparities in sport practice. © 2013 Karusisi et al.; licensee BioMed Central Ltd.


Leal C.,French Institute of Health and Medical Research | Leal C.,University Pierre and Marie Curie | Leal C.,EHESP School of Public Health | Bean K.,Center dInvestigations Preventives et Cliniques | And 3 more authors.
Epidemiology | Year: 2011

Background: We investigated whether neighborhood socioeconomic characteristics, measured within person-centered areas (ie, centered on individuals' residences) are associated with body mass index (BMI [kg/m 2]) and waist circumference. We used propensityscore matching as a diagnostic and validation tool to examine whether socio-spatial segregation (and related structural confounding) allowed us to estimate neighborhood socioeconomic effects adjusted for individual socioeconomic characteristics without excessive model extrapolations. Methods: Using the RECORD (Residential Environment and CORonary heart Disease) Cohort Study, we conducted cross-sectional analyses of 7230 adults from the Paris region. We first estimated the relationships of 3 neighborhood socioeconomic indicators (education, income, real estate prices) with BMI and waist circumference using traditional multilevel regression models adjusted for individual covariates. Second, we examined whether these associations persisted when estimated among participants exchangeable based on their probability of living in low-socioeconomic-status neighborhoods (propensity-score matched samples). Copyright © 2011 by Lippincott Williams & Wilkins.


Havard S.,French Institute of Health and Medical Research | Havard S.,University Pierre and Marie Curie | Reich B.J.,North Carolina State University | Bean K.,Center dInvestigations Preventives et Cliniques | And 2 more authors.
Occupational and Environmental Medicine | Year: 2011

Objectives To explore social inequalities in residential exposure to road traffic noise in an urban area. Methods Environmental injustice in road traffic noise exposure was investigated in Paris, France, using the RECORD Cohort Study (n=2130) and modelled noise data. Associations were assessed by estimating noise exposure within the local area around participants' residence, considering various socioeconomic variables defined at both individual and neighbourhood level, and comparing different regression models attempting or not to control for spatial autocorrelation in noise levels. Results After individual-level adjustment, participants' noise exposure increased with neighbourhood educational level and dwelling value but also with proportion of non-French citizens, suggesting seemingly contradictory findings. However, when country of citizenship was defined according to its human development level, noise exposure in fact increased and decreased with the proportions of citizens from advantaged and disadvantaged countries, respectively. These findings were consistent with those reported for the other socioeconomic characteristics, suggesting higher road traffic noise exposure in advantaged neighbourhoods. Substantial collinearity between neighbourhood explanatory variables and spatial random effects caused identifiability problems that prevented successful control for spatial autocorrelation. Conclusions Contrary to previous literature, this study shows that people living in advantaged neighbourhoods were more exposed to road traffic noise in their residential environment than their deprived counterparts. This case study demonstrates the need to systematically perform sensitivity analyses with multiple socioeconomic characteristics to avoid incorrect inferences about an environmental injustice situation and the complexity of effectively controlling for spatial autocorrelation when fixed and random components of the model are correlated.


Leal C.,French Institute of Health and Medical Research | Leal C.,University Pierre and Marie Curie | Leal C.,EHESP School of Public Health | Bean K.,Center dInvestigations Preventives et Cliniques | And 3 more authors.
American Journal of Epidemiology | Year: 2012

Because of the strong correlations among neighborhoods' characteristics, it is not clear whether the associations of specific environmental exposures (e.g., densities of physical features and services) with obesity can be disentangled. Using data from the RECORD (Residential Environment and Coronary Heart Disease) Cohort Study (Paris, France, 20072008), the authors investigated whether neighborhood characteristics related to the sociodemographic, physical, service-related, and social-interactional environments were associated with body mass index and waist circumference. The authors developed an original neighborhood characteristic-matching technique (analyses within pairs of participants similarly exposed to an environmental variable) to assess whether or not these associations could be disentangled. After adjustment for individual/neighborhood socioeconomic variables, body mass index/waist circumference was negatively associated with characteristics of the physical/service environments reflecting higher densities (e.g., proportion of built surface, densities of shops selling fruits/vegetables, and restaurants). Multiple adjustment models and the neighborhood characteristic-matching technique were unable to identify which of these neighborhood variables were driving the associations because of high correlations between the environmental variables. Overall, beyond the socioeconomic environment, the physical and service environments may be associated with weight status, but it is difficult to disentangle the effects of strongly correlated environmental dimensions, even if they imply different causal mechanisms and interventions. © 2012 The Author.


Benetos A.,Nancy University Hospital Center | Thomas F.,Center dInvestigations Preventives et Cliniques | Joly L.,Nancy University Hospital Center | Blacher J.,University of Paris Descartes | And 5 more authors.
Journal of the American College of Cardiology | Year: 2010

Objectives: The aim of this study was to determine whether the carotid/brachial (C/B) ratio is an independent predictor of cardiovascular (CV) risk. Background: Brachial and carotid pulse pressure (PP) are independent predictors of CV risk, mainly in elderly patients. Because PP is physiologically lower at the brachial than at the carotid arterial site, PP amplification is represented by the C/B ratio and could independently predict CV risk. Methods: In a Paris population (n = 834), brachial and carotid PP were measured from sphygmomanometry and pulse wave analysis. With stepwise multiple regression, carotid PP was calculated from a nomogram including age, sex, body height, brachial PP, and plasma glucose. This model was applied to 125,151 subjects, followed for 12 years, during which 3,997 deaths occurred (735 of CV origin). With Cox regression analysis, multi-adjusted hazard ratios (HRs) were calculated for 1 SD increase of brachial PP, calculated carotid PP, and C/B ratio. Results: Brachial PP was significantly associated with both CV and all-cause mortality (HR: 1.16, 95% confidence interval [CI]: 1.13 to 1.19, and HR: 1.13, 95% CI: 1.10 to 1.17, respectively). Calculated carotid PP predicted a similar risk (HR: 1.21, 95% CI: 1.15 to 1.28, and HR: 1.18, 95% CI: 1.12 to 1.25, respectively). Finally, the C/B ratio was a strong risk predictor (HR: 1.22, 95% CI: 1.12 to 1.32, and HR: 1.41, 95% CI: 1.14 to 1.73, respectively). Addition of drug treatment and other confounding variables did not statistically modify the results. Conclusions: Brachial PP, calculated carotid PP, and C/B PP amplification all predict CV mortality. In contrast to brachial and carotid PP, the C/B ratio is less dependent on blood pressure calibration and thus can be directly applicable to large population studies. © 2010 American College of Cardiology Foundation.


Jaffiol C.,University of Paris Descartes | Thomas F.,Center dInvestigations Preventives et Cliniques | Bean K.,Center dInvestigations Preventives et Cliniques | Jego B.,Center dInvestigations Preventives et Cliniques | Danchin N.,Center dInvestigations Preventives et Cliniques
Diabetes and Metabolism | Year: 2013

Aim: This study examined the association between deprivation and diabetes in a large French population, and evaluated the impact of deprivation on diabetes after taking in account a number of confounding factors. Methods: A total of 32,435 men and 16,378 women, aged 35 to 80 years, who had a health checkup at the "Centre d'Investigations Préventives et Cliniques" (IPC Centre: a preventive medical center in Paris, France), between January 2003 and December 2006, were evaluated. Socioeconomic deprivation was assessed using the EPICES score. The most deprived subjects were those in the fifth quintile of score distribution. Results: Several cardiovascular risk markers increased significantly in deprived subjects. In both genders, deprivation was associated with deleterous health status and lifestyle habits. In women, BMI, central obesity and the metabolic syndrome were associated with deprivation. The prevalence of diabetes increased with deprivation level. Compared with the first quintile of EPICES score distribution, the prevalence of diabetes was three to eight times higher in the fifth quintile. After taking into account age, and biological, clinical and lifestyle parameters, the risk of diabetes onset (odds ratio) among deprived vs. non-deprived subjects was 2.54 (95% CI: 1.99-3.24) in men and 2.2 (95% CI: 1.44-3.35) in women. Conclusion: In the general French population, deprivation was associated with deleterious health status and lifestyle. Risk of diabetes increased linearly with deprivation level and, after taking into account various confounding factors, the risk of diabetes remained significantly higher among deprived subjects. Other factors such as nutrition should now be examined to explain the excess risk of diabetes among the most deprived people. © 2012 Elsevier Masson SAS.

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