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Summary: Background: In France, screening for cardiovascular risk factors is recommended during annual preventive visits. However, data are lacking on the temporal trend in women's uptake to preventive care services, and in cardiovascular and mortality outcomes. The aim of the study was to investigate the participation and mortality of women in annual preventive care services in a major preventive medicine center in France. Method: Ee conducted repeated cross-sectional studies including a total of 366,270 individuals who had a first examination at the Centre d'Investigations Préventives et Cliniques, France, between January 1992 and December 2011. Findings: Women's participation was low below 50 years of age, then increases from 50 to 70 years, and is lower for women older than 70 years. The gap in female participation was more pronounced among individuals with high education, low social deprivation, and no depressive symptoms. Compared with the general population, the screened population had significantly lower standardized mortality ratios (SMRs) among both men and women, for all age ranges. Screened women aged 18-49 years showed a lower mortality gain compared with men of the same age; SMRs did not differ significantly by sex for individuals over 50 years. Interpretation: In this community-based sample, compared with men, women's participation to annual preventive care services was lower, and screened women had a lower mortality gain. Despite the demonstrated benefit of annual check-ups on health, there is a gender gap in adherence to preventive programs and in efficiency of screening programs, especially in the young age range. This gap in cardiovascular disease prevention may result in poorer cardiovascular health in women. Urgent adaptations to overcome this gender gap in preventive screening in France are warranted. Funding: Bamba Gaye is supported by the Fondation Recherche Médicale grant.

Background/Objectives: The baroreflex is a crucial mechanism acutely modulating vascular tone and heart rate response to maintain blood pressure (BP) in an optimal range. A decrease in baroreflex sensitivity (BRS) is associated with ageing, and pathological conditions such as hypertension and diabetes. Antihypertensive agents are generally known to have beneficial effect on the BRS, however it is still uncertain if the effect is mediated through a more compliant arterial wall or a sympathoinhibitory action. Methods: In the Paris Prospective Study III [1], spontaneous baroreflex, carotid stiffness and pharmacological drugs intake were available in 7967 adults (aged 55–75 years). The neural component of the baroreflex sensitivity (nBRS) was obtained with a cross-spectral analysis of variations in carotid distention rate and R-R intervals. Pharmacological classes were analysed according to the Anatomical Therapeutic Chemical (ATC) classification. Individuals with a BP lowering medication (BP-treated) were paired to non-BP treated individuals with a similar cardiovascular risk (controls) using a propensity score matching procedure (n = 1182 pairs). Results: Amongst pharmacological classes of BP lowering agents, only agents acting on the renin-angiotensin system (ACEi-ARB) were associated with nBRS (β = –0.08, p = 0.045). Compared to their matched controls, ACEi-ARB users had lower nBRS (2.79 ± 0.66 vs. 2.90 ± 0.62, p = 0.03). In multivariate analysis, ACEi-ARB remained significant (stdβ = –0.09, p = 0.025) after adjustment for carotid stiffness (stdβ = 0.25, p < 0.001) and systolic pressure (stdβ = –0.20, p < 0.001). Conclusion: In this epidemiological study, ACEi-ARB were negatively associated with nBRS. This effect is independent of BP and stiffness, which may suggest an inhibition of sympathetic activity by ACEi-ARB.

Background: Large artery stiffness is an index of vascular ageing associated with cardiovascular mortality. While traditional risk factors for arterial stiffness are known, the contribution of socioeconomic factors are less reported. We sought to determine the relationship between arterial stiffness and socioeconomic deprivation (at the individual and neighborhood levels) in healthy males and females. Methods: In 7803 adults, carotid stiffness was determined by high-precision carotid echotracking. Individual deprivation data included education, living alone, occupation and Evaluation of the Deprivation and Inequalities of Health in Healthcare Centers (EPICES) score. Neighborhood deprivation was determined from commune level data (smallest administrative sub-division) available from French National Institute of statistics and Economic Studies (2011) using principal component analysis. The separate and combined associations between individual and neighborhood deprivation (main exposures) and carotid stiffness (outcome) were quantified using linear and multilevel model adjusted for traditional risk factors including age, mean blood pressure, body mass index, fasting glucose, high density lipoprotein, triglycerides, heart rate, history of cardiovascular disease, smoking, alcohol, and physical activity. Analyses were conducted separately in males and females. Results: Individual deprivation (lower education and occupation in males, and living alone and higher EPICES in both populations) was adversely related to carotid stiffness, independently of potential confounders (p < 0.05). Neighborhood deprivation was adversely related to carotid stiffness in males (p < 0.05) but not in females. Conclusion: Socioeconomic deprivation, both at the individual and, to a lesser extent, neighborhood level are associated with carotid stiffness in males. Only individual deprivation is associated with carotid stiffness in females.

Background: Physical activity (PA) is beneficial for baroreflex sensitivity (BRS), but it is unclear whether the type of PA has similar effects on the neural (nBRS) or vascular (carotid stiffness) components of BRS. We sought to determine this in healthy adults from a community- based study via assessment of occupational (OPA), sport (SPA), leisure (LPA) and total PA (TPA). Methods: In 8649 adults aged 50 to 75 years, resting nBRS (estimated by low frequency gain, from carotid distension rate and heart rate) and carotid stiffness were measured by high-precision carotid echotracking. PA was self-reported using the Baecke questionnaire, which distinguishes OPA, SPA, LPA and TPA. The associations between PA and nBRS and carotid stiffness were quantified using multivariate linear regression analysis. Analyses were conducted separately in the working and non- working population. Results: In working adults (n = 5039), OPA was associated with lower nBRS function (p = 0.026) and borderline higher carotid stiffness (p = 0.08). When stratified by education, this association remained only in those with less than tertiary education. SPA was associated with higher nBRS (p = 0.0005) and borderline lower carotid stiffness (p = 0.052). Neither LPA nor TPA was associated with nBRS or carotid stiffness. In non-working adults (n = 3610), SPA and TPA were both associated with lower carotid stiffness (p = 0.012 and p = 0.020), but not nBRS. LPA was not associated with either parameter. Conclusion: Occupation-related PA is associated with lower nBRS function and higher carotid stiffness, especially in those with lower education. Higher amounts of sport-related PA are associated with higher nBRS and lower carotid stiffness.

Associations between road traffic noise and hypertension have been repeatedly documented, whereas associations with rail or total road, rail, and air (RRA) traffic noise have rarely been investigated. Moreover, most studies of noise in the environment have only taken into account the residential neighborhood. Finally, few studies have taken into account individual/neighborhood confounders in the relationship between noise and hypertension. We performed adjusted multilevel regression analyses using data from the 7,290 participants of the RECORD Study to investigate the associations of outdoor road, rail, air, and RRA traffic noise estimated at the place of residence, at the workplace, and in the neighborhoods around the residence and workplace with systolic blood pressure (SBP), diastolic blood pressure (DBP), and hypertension. Associations were documented between higher outdoor RRA and road traffic noise estimated at the workplace and a higher SBP [+1.36 mm of mercury, 95% confidence interval (CI): +0.12, +2.60 for 65-80 dB(A) vs 30-45 dB(A)] and DBP [+1.07 (95% CI: +0.28, +1.86)], after adjustment for individual/neighborhood confounders. These associations remained after adjustment for risk factors of hypertension. Associations were documented neither with rail traffic noise nor for hypertension. Associations between transportation noise at the workplace and blood pressure (BP) may be attributable to the higher levels of road traffic noise at the workplace than at the residence. To better understand why only noise estimated at the workplace was associated with BP, our future work will combine Global Positioning System (GPS) tracking, assessment of noise levels with sensors, and ambulatory monitoring of BP.

Background The mechanisms underlying the association between obstructive sleep apnea (OSA) and cardiovascular disease may include accelerated vascular aging. The aim was to compare the magnitude of vascular aging in patients with high versus low risk of OSA. Methods and Results In 2 community‐based studies, the PPS3 (Paris Prospective Study 3) and the Maastricht Study, high risk of OSA was determined with the Berlin questionnaire (a screening questionnaire for OSA). We assessed carotid artery properties (carotid intima‐media thickness, Young’s elastic modulus, carotid‐femoral pulse wave velocity, carotid pulse wave velocity, carotid diameter using high precision ultrasound echography), and carotid‐femoral pulse wave velocity (in the Maastricht Study only). Regression coefficients were estimated on pooled data using multivariate linear regression. A total of 8615 participants without prior cardiovascular disease were included (6840 from PPS3, 62% men, mean age 59.5±6.2 years, and 1775 from the Maastricht Study, 51% men, 58.9±8.1 years). Overall, high risk of OSA prevalence was 16.8% (n=1150) in PPS3 and 23.8% (n=423) in the Maastricht Study. A high risk of OSA was associated with greater carotid intima‐media thickness (β=0.21; 0.17–0.26), Young’s elastic modulus (β=0.21; 0.17–0.25), carotid‐femoral pulse wave velocity (β=0.24; 0.14–0.34), carotid pulse wave velocity (β=0.31; 0.26–0.35), and carotid diameter (β=0.43; 0.38–0.48), after adjustment for age, sex, total cholesterol, smoking, education level, diabetes mellitus, heart rate, and study site. Consistent associations were observed after additional adjustments for mean blood pressure, body mass index, or antihypertensive medications. Conclusions These data lend support for accelerated vascular aging in individuals with high risk of OSA. This may, at least in part, underlie the association between OSA and cardiovascular disease.

Background: Late-life depression is related to poor quality of life and increased risk of mortality and cardiovascular disease. Effective interventions for prevention and treatment of late-life depression need to be developed, which requires a better understanding of late-life depression risk factors. Arterial stiffness may contribute to late-life depression via cerebrovascular damage, but evidence is scarce. Aim: To investigate the association between carotid artery stiffness and incident depressive symptoms in a large community-based cohort study. Methods: This longitudinal study included 7,013 participants (60 (SD 6) years; 36% women) free of depressive symptoms at baseline. Carotid stiffness (high-resolution echotracking) was determined at baseline. Presence of depressive symptoms was determined at baseline and at 4 and 6 years of follow-up and was defined as a score ≥7 on a validated 13-item questionnaire (Q2DA) and/or new use of antidepressants. Logistic regression and generalized estimating equations (GEE) were used. Results: In total, 6.9% (n = 484) of the participants had incident depressive symptoms at 4 or 6 years of follow-up. Greater carotid stiffness was associated with a higher incidence of depressive symptoms (Figure). Results were qualitatively similar when GEE was used instead of logistic regression. Conclusions: Greater carotid artery stiffness is associated with a higher incidence of depressive symptoms. This study supports the hypothesis that carotid artery stiffness contributes to the development of late-life depression.

The prevalence of the metabolic syndrome among adults from the French LEA childhood acute leukemia survivors’ cohort was prospectively evaluated considering the type of anti-leukemic treatment received, and compared with that of controls. The metabolic profile of these patients was compared with that of controls. A total of 3203 patients from a French volunteer cohort were age- and sex-matched 3:1 to 1025 leukemia survivors (in both cohorts, mean age: 24.4 years; females: 51%). Metabolic syndrome was defined according to the National Cholesterol Education Program’s Adult Treatment Panel III criteria. Metabolic syndrome was found in 10.3% of patients (mean follow-up duration: 16.3±0.2 years) and 4.5% of controls, (OR=2.49; P

IntroductionAssessing the contextual factors that influence walking for transportation is important to develop more walkable environments and promote physical activity. To advance previous research focused on residential environments and overall walking for transportation, the present study investigates objective environmental factors assessed around the residence, the workplace, the home--work itinerary, and the home--supermarket itinerary, and considered overall walking for transportation but also walking to work and to shops.MethodsData from the RECORD Study involving 7290 participants recruited in 2007-2008, aged 30-79 years, and residing in the Paris metropolitan area were analyzed. Multilevel ordinal regression analyses were conducted to investigate environmental characteristics associated with self-reported overall walking for transportation, walking to work, and walking to shops.ResultsHigh individual education was associated with overall walking for transportation, with walking to work, and walking to shops. Among workers, a high residential neighborhood education was associated with increased overall walking for transportation, while a high workplace neighborhood education was related to an increased time spent walking to work. The residential density of destinations was positively associated with overall walking for transportation, with walking to work, and with walking to shops, while the workplace density of destinations was positively associated with overall walking for transportation among workers. Environmental factors assessed around the itineraries were not associated with walking to work or to the shops.ConclusionThis research improves our understanding of the role of the environments on walking for transportation by accounting for some of the environments visited beyond the residential neighborhood. It shows that workers' walking habits are more influenced by the density of destinations around the workplace than around the residence. These results provide insight for the development of policies and programs to encourage population level active commuting.

Previous research on the influence of the food environment on weight status has often used impersonal measures of the food environment defined for residential neighborhoods, which ignore whether people actually use the food outlets near their residence. To assess whether supermarkets are relevant contexts for interventions, the present study explored between-residential neighborhood and between-supermarket variations in body mass index (BMI) and waist circumference (WC), and investigated associations between brands and characteristics of supermarkets and BMI or WC, after adjustment for individual and residential neighborhood characteristics.Participants in the RECORD Cohort Study (Paris Region, France, 2007-2008) were surveyed on the supermarket (brand and exact location) where they conducted their food shopping. Overall, 7 131 participants shopped in 1 097 different supermarkets. Cross-classified multilevel linear models were estimated for BMI and WC.Just 11.4% of participants shopped for food primarily within their residential neighborhood. After accounting for participants' residential neighborhood, people shopping in the same supermarket had a more comparable BMI and WC than participants shopping in different supermarkets. After adjustment for individual and residential neighborhood characteristics, participants shopping in specific supermarket brands, in hard discount supermarkets (especially if they had a low education), and in supermarkets whose catchment area comprised low educated residents had a higher BMI/WC.A public health strategy to reduce excess weight may be to intervene on specific supermarkets to change food purchasing behavior, as supermarkets are where dietary preferences are materialized into definite purchased foods.