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Objectives: The aim of our study was to determine the effect of the menopause on various coronary heart disease (CHD) risk factors and on the global risk of CHD in a population based sample of women, making the difference between menopause and age related effects., Study Design: The Third French MONICA cross-sectional survey on cardiovascular risk included 1730 randomly selected women, aged 35-64 years, representative from the general population., Main Outcome Measures: Women were defined as post-menopausal (postM; n=696), peri-menopausal (periM; n=183) or pre-menopausal (preM; n=659) based on the date of last menses. Socio-demographic, clinical and biological data were collected. Analyses of variance were used to compare means., Results: PostM women had significantly higher age-adjusted levels of total cholesterol (6.0mmol/L in postM vs. 5.7mmol/L in preM, p<0.05) and LDL cholesterol (3.9mmol/L vs. 3.6mmol/L, p<0.05). There was no difference in HDL cholesterol or triglyceride levels, glycemia or blood pressure. Further adjustment on body mass index and hormonal treatments did not modify the results. No risk factor was significantly different between periM and postM. However, the Framingham 10-year risk of CHD was higher in postM, as compared with periM (5.1% vs. 5.0%, p<0.05). In postM women, lipids and the Framingham risk were not associated with elapsed time since menopause., Conclusions: The CHD risk increases during the sixth decade could be explained not only by estrogen deprivation but also by an effect on lipid profile, which is likely to occur in the peri-menopause period., (Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.)

Introduction: The reasons why statins are under-utilized in elderly patients remain poorly understood. The aim of this study was to identify the reasons given by cardiologist for the non-prescription of statins in elderly CHD patients., Methods: Two cross-sectional pharmaco-epidemiological surveys were carried out among French cardiologists. The sample consisted of 1148 coronary patients aged 35 to 69 years and 1489 patients aged > or =70 years. Patients' risk factors, medical history, treatments, lipid values and the physicians' various motives for the non-prescription of statins were recorded., Results: Patients not treated with statins reached 37% in the age-group > or =70 years and 14% in the age-group 35-69 years. The main reason given for statin non-prescription was the lack of a medical indication (2.5% of the age-group 35-69 years and 14% of the age-group > or =70 years). Among patients > or =70 years, the lack of indication was more often cited in the following conditions: 1) in very old patients (36% of lack of indication in the age-group >85 years vs. 10% in 70-75 years), 2) when lipid values were not available (20% when data were not available vs. 9%) and 3) when the patient had no prior history of myocardial infarction (MI) (20% when no history of MI vs. 7%). These factors were not associated with lack of indication among patients <70 years. History of intolerance or side effect was given for 1.3% and 14% of patients for each of the groups (35-69 and > or =70) and poor overall patient adherence was cited in 1% and 2%, respectively., Conclusion: The primary reason for the under-prescription of statins in elderly coronary patients is the perceived lack of indication, which stresses the need of extensive guidelines for prescription in elderly patients. Several factors associated with this perception seem to be specific to the elderly.

Objective: The value of exercise testing (ET) in asymptomatic subjects remains controversial and is unknown in countries with a low coronary heart disease (CHD) incidence. The aim of this study was to investigate the ability of ET to improve the prediction of a first coronary event in such a population., Methods: Using a prospective cohort study, 1051 consecutive healthy asymptomatic adults were enrolled in a cardiovascular screening program including ET. The pre-test risk of CHD was evaluated by the 10-year Framingham risk function. Positive ET was defined as a horizontal or downsloping ST-segment depression >/=1.0 mm. The primary outcome was total coronary events (CE) occurrence, including cardiac deaths, acute myocardial infarction and stable or unstable angina. The mean follow-up period was 6 years., Results: Subjects were aged 18-79 years and 36% were women. A total of 89 subjects (8.5%) had a positive ET. Positive exercise testing was associated with CE occurrence in a univariate analysis only in subjects with higher pre-test risk, defined by a 10-year Framingham risk >10.4% [hazards ratio (HR)=2.61; 95% confidence interval (CI) (1.07-6.40)]. In this risk category, ET was able to provide incremental information over the major risk factors in both men and women [risk factor-adjusted HR for positive ET=2.86; 95% CI (1.14-7.20)]. This risk excess in subjects with positive ET persisted even when a coronary revascularization was performed. Subjects with intermediate pre-test probability (10-15%) and positive ET had a post-test probability of CE largely equivalent to the probability in subjects with known CHD., Conclusion: Additional information provided by ET in subjects with a pre-test risk at 10-years >10% should lead to a more efficient use of risk-reducing therapies than it would be the case in this risk category with the analysis of traditional risk factors only.

Introduction: Although platelet antiaggregants, beta-blockers and statins have proved their efficacy as secondary prevention in all types of patients with arterial and thrombotic disease, these therapeutic categories remain under-used in the elderly. The reasons for this under-prescription are poorly understood. The aim of this study was to determine the reasons for not prescribing the principal secondary prevention therapies in elderly coronary patients., Methods: Two transversal pharmaco-epidemiological surveys were carried out in a representative sample of French cardiologists. They included 1489 coronary patients aged 35 to 69 years and 1148 patients aged over 70 years, respectively. Risk factors, medical history, current treatments and reasons for non-prescription of the principal therapies were collected., Results: In subjects aged 70 years or over, antiaggregants were not prescribed in 24% of patients, versus 7.5% of younger patients. Statins were not prescribed in 37% of those over 70 years, versus 14% of younger patients. Beta-blockers were not prescribed in 42% of elderly patients versus 23% of younger patients. ACE inhibitors were not prescribed in 57.6% of elderly subjects and 48.2% of younger subjects. Combinations of three or four secondary prevention treatments were half as frequently prescribed in patients over the age of 70. According to the physicians, the main reason for non-prescription in elderly patients was a lack of indication, which concerned 8% of the entire sample with respect to antiaggregants, 9% for beta-blockers and 14% for statins. These very high percentages were not found in younger subjects (1%, 3% and 2.5%, respectively)., Conclusion: Our results confirm under-use of the principal secondary prevention therapies in elderly subjects, mainly because of a lack of indication, according to the physicians. In these patients, indications for secondary prevention appear to be tributary to numerous factors, such as age, the type of medical history, the availability of lipid parameters or compliance. In response to questions by practitioners, specific recommendations would be useful concerning secondary prevention in elderly coronary patients.