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OBJECTIVES: Although menopausal hormone therapy (MHT) remains the most effective treatment for vasomotor symptoms of menopause, its association with the development of arterial hypertension remains unclear. We sought to explore associations between different formulations of MHT and incident hypertension among menopausal women in a prospective cohort study. METHODS: We used the Etude Epidemiologique de femmes de la Mutuelle Generale de l'Education (E3N) cohort, a French prospective population-based study initiated in 1990 on 98,995 women. Out of these, 49,905 menopausal women with complete information on the use of MHT, and without prevalent hypertension at inclusion were included. RESULTS: The mean age of the population at baseline was 54.2 ±â€Š4.3 years, and 32,183 (64.5%) reported ever using MHT. Among these women, 10,173 cases of incident hypertension were identified over an average follow-up time of 10.6 years. Compared with women who never used MHT, those who ever used it had an increased risk of incident hypertension (adjusted HR 1.07, 95% CI 1.02-1.12) after adjustment for body mass index and other potential confounders. Oral but not transdermal estrogen use was associated with an increased risk of hypertension (adjusted HR = 1.09; 95% CI: 1.04-1.14 and HR = 1.03; 95% CI: 0.99-1.07, respectively). However, the HRs associated with oral and transdermal estrogens did not differ significantly (P-homogeneity = 0.09). Regarding the role of concomitant progestogens, pregnane and norpregnane derivatives were significantly associated with hypertension risk (HR = 1.12; 95% CI: 1.06-1.19 and HR = 1.06; 95% CI: 1.01-1.13, respectively). CONCLUSIONS: MHT was associated with a modest but significant increased risk of incident hypertension, especially when using oral estrogen in combination with a progestogen such as pregnane and norpregnane derivatives. Surveillance of blood pressure should be added to the medical surveillance of MHT users.Video Summary:http://links.lww.com/MENO/A802.

Dyslipidaemia is a major risk factor for cardio-vascular disease, as it promotes atherosclerosis. While cross-sectional studies have identified higher serum cholesterol amongst individuals with the A blood group, there is less evidence from prospective studies whether this translates into a higher risk of dyslipidaemia that requires treatment, nor if this genetic factor interacts with smoking status. This study aimed to prospectively determine potential associations between smoking, ABO blood groups, and risk of incident dyslipidaemia requiring treatment, and to assess associations over strata of blood ABO group. We assessed associations between blood ABO group, smoking and dyslipidaemia in 74,206 women participating in the E3N cohort. We included women who did not have cardiovascular disease at baseline. Logistic regression was used to determine associations between ABO group, smoking and prevalent dyslipidaemia at baseline. Cox proportional hazard models were then used to determine if blood ABO group and smoking were associated with the risk of incident dyslipidaemia, amongst women free of dyslipidaemia at baseline. At baseline 28,281 women with prevalent dyslipidaemia were identified. Compared to the O-blood group, the non-O blood group was associated higher odds of with prevalent dyslipidaemia (ORnon-O = 1.09 [1.06: 1.13]). Amongst the women free of dyslipidaemia at baseline, 6041 incident cases of treated dyslipidaemia were identified during 454,951 person-years of follow-up. The non-O blood groups were associated with an increased risk of dyslipidaemia when compared to the O-group (HRnon-O = 1.16 [1.11: 1.22]), specifically the A blood-group (HRA = 1.18 [1.12: 1.25]). Current smokers were associated with an increased risk of incident dyslipidaemia (HR smokers = 1.27 [1.16: 1.37]), compared to never-smokers. No evidence for effect modification between smoking and ABO blood group was observed (p-effect modification = 0.45), although the highest risk was observed among AB blood group women who smoked (HR = 1.76 [1.22: 2.55]). In conclusion, the non-O blood groups, specifically the A group were associated with an increased risk of dyslipidaemia. Current smokers were associated with a 30% increased risk of dyslipidaemia. These results could aid in personalised approaches to the prevention of cardiovascular risk-factors.

ObjectiveMigraine has been identified as a potential risk factor for hypertension in prospective studies. In women, migraine prevalence decreases after menopause, but no studies have determined whether migraine is associated with hypertension after menopause. This study sought to determine whether history of migraine was associated with an increased risk of hypertension among menopausal women.MethodsWe assessed associations between migraine and hypertension in a longitudinal cohort study of 56,202 menopausal women participating in the French E3N cohort, with follow-up beginning in 1993. We included women who did not have hypertension or cardiovascular disease at the time of menopause. Migraine was classified as ever or never at each questionnaire cycle. Cox proportional hazards models were used to investigate relations between migraine and hypertension, controlling for potential confounding. A secondary analysis with baseline in 2011 considered aura status, grouping participants reporting migraine as migraine with aura, migraine without aura, or unknown migraine type.ResultsDuring 826,419 person-years, 12,501 cases of incident hypertension were identified, including 3,100 among women with migraine and 9,401 among women without migraine. Migraine was associated with an increased risk of hypertension in menopausal women (hazard ratio [HR]migraine 1.29 [95% confidence interval 1.24, 1.35]) and was consistent in post hoc sensitivity analyses, such as when controlling for common migraine medications. Associations between migraine and hypertension were similar whether or not women reported aura (HRmigraine aura 1.54 [1.04, 2.30], HRmigraine no aura 1.32 [0.87, 2.02], p heterogeneity 0.60). Associations were slightly stronger among ever users of menopausal hormone therapy (HRmigraine 1.34 [1.27, 1.41]) than among never users (HRmigraine 1.19 [1.11, 1.28]).ConclusionsMigraine was associated with an increased risk of hypertension among menopausal women. In secondary analysis, we did not observe a significant difference between migraine with aura and migraine without aura.

Several international guidelines concerning lower extremity arterial disease (LEAD) have been published recently, in particular, by the American Heart Association the European Society of Cardiology/European Society for Vascular Surgery, the European Society for Vascular Medicine and the Society for Vascular Surgery. These guidelines differ in some respects and certain issues are not addressed. The objective of this consensus driven by the French Societies of vascular Medicine and surgery was to analyze the disparities between the different guidelines, as well as certain issues not covered, and develop proposals with regard to these points. The following fields of LEAD have been explored: 1) classifications, 2) clinical evaluation, 3) diagnostic criteria, 4) quantification of arterial stenosis using duplex ultrasound, 5) detection of asymptomatic multisite lesions, 6) screening for LEAD in the context of cardiac disease, 7) medical treatment, 8) supervised exercise therapy, 9) revascularization and revascularization of the internal artery stenosis, 10) management of chronic limb ischemia, 11) longitudinal follow-up, and 12) diet.

Background Pre-operative myocardial fibrosis and remodeling impact on outcomes after aortic valve replacement (AVR). We aimed at investigating the prognostic impact of preoperative electrocardiographic (ECG) markers of left ventricular (LV) myocardial damage, i.e. bundle branch block (BBB) and ECG strain pattern after (surgical or transcatheter) AVR for severe aortic stenosis (AS). Methods Between April 2008 and October 2017, we explored consecutive patients referred to our Heart Valve Clinic for first AVR for severe AS. Detailed pre-operative phenotyping and ECG analysis were performed. Patients were followed-up after AVR for major cardiac events (ME), i.e. cardiovascular death, cardiac hospitalization for acute heart failure and stroke. Results BBB and ECG strain were respectively observed in 13.5 and 21% of the 1122 patients included. These ECG markers identified a subgroup of older patients, with higher NYHA class and more advanced myocardial disease as detected by echocardiography, i.e. higher LV mass and lower LV ejection fraction, global longitudinal strain and integrated backscatter, than patients without ECG strain or BBB. ME occurred in 212 (18.6%) patients during a mean follow-up of 4.4 ± 1.5 years with higher incidence in case of ECG strain or BBB (HR 1.56, 95%CI 1.13–2.14, p = 0.006; HR 1.47, 95%CI 1.02–2.13, p = 0.04 respectively). The prognostic value of ECG strain remained significant after adjustment for age, diabetes and pre-operative LVEF. Conclusions Pre-operative ECG markers of myocardial damage identify a subgroup of AS patients at high risk of post-AVR cardiovascular complications irrespective of other prognostic factors and should help the multiparametric staging of cardiac damage to guide AVR.

Multiple randomised controlled trials have shown high doses of cocoa to reduce blood pressure and improve endothelial function. However, evidence regarding long-term consumption of cocoa and its potential effect on hypertension is lacking. We aimed to prospectively evaluate if cocoa intake from various food sources was associated with incident hypertension. Among 45,653 women of the E3N cohort, chocolate consumption was estimated from a 208 item dietary questionnaire and 24-h recall. Quantities of cocoa for certain foods including chocolate drinks, Danish pastries, chocolate biscuits, chocolate cakes, chocolate candy-bars, plain chocolate bars, and chocolate desserts, were estimated using a detailed food composition table. Using Cox models with time-update exposures, we assessed associations between specific sources of cocoa, and hypertension risk. Self-reported cases were validated using a drug reimbursement database. 12,793 cases of hypertension were identified. Median cocoa consumption in the entire cohort was 2.3 g/day at baseline. Moderate but not high cocoa consumption from all sources was inversely associated with the risk of hypertension (hazard ratios HRQ1–Q3 0.93 [0.88:0.98], HRQ1–Q4 0.98 [0.93:1.03], p for trend

Cardiovascular diseases are become the primary cause of death in women. The cardiovascular risk of the woman has unknown specificities and remains underestimated. At equal age, women have more cardio vascular risk factors than men. All these specificities must be taken into account for an optimized evaluation of cardiovascular risk and for improvement of CV management in women. Some traditional risk factors are more deleterious in women such as hypertension, tobacco, diabetes or psycho-social stress and they are less well controlled compared to men. Women are also exposed to hormonal risk factors (contraception, pregnancy and menopause) or to emergent risk situations (migraine with aura, endometriosis, polycystic ovary syndrome, auto-immune diseases…). Conversely, lifestyle measures (regular physical activity, no smoking, healthy diet, stress management) are extremely effective in primary and secondary prevention in women. Predicting the risk of cardiovascular events in women is difficult because the classic risk scores (SCORE, Framingham…) do not take into account hormonal CV specificities and underestimate the women CV risk. Until then, only the specific women AHA stratification of CVR allowed for appropriate care for them. Recently, at the initiative of the French Society of hypertension, a consensus of experts proposed a stratification of CVR adapted to French women, to help practitioners in their care, especially for the two hormonal periods as contraception and menopause.

Background Previous studies have shown conflicting results regarding the influence of cardiovascular risk-factors on venous thromboembolism. This study aimed to determine if these risk-factors, i.e. physical activity, smoking, hypertension, dyslipidaemia, and diabetes, were associated with the risk of venous thromboembolism, and to determine if these associations were confounded by BMI. Methods We used data from the E3N cohort study, a French prospective population-based study initiated in 1990, consisting of 98,995 women born between 1925 and 1950. From the women in the study we included those who did not have prevalent arterial disease or venous thromboembolism at baseline; thus 91,707 women were included in the study. Venous thromboembolism cases were self-reported during follow-up, and verified via specific mailings to medical practitioners or via drug reimbursements for anti-thrombotic medications. Hypertension, diabetes and dyslipidaemia were self-reported validated against drug reimbursements or specific questionnaires. Physical activity, and smoking were based on self-reports. Cox-models, adjusted for BMI and other potential risk-factors were used to determine hazard ratios for incident venous thromboembolism. Results During 1,897,960 person-years (PY), 1, 649 first incident episodes of thrombosis were identified at an incidence rate of 0.9 per 1000 PY. This included 505 cases of pulmonary embolism and 1144 cases of deep vein thrombosis with no evidence of pulmonary embolism. Hypertension, dyslipidaemia, diabetes, smoking and physical activity were not associated with the overall risk of thrombosis after adjustment for BMI. Conclusions Traditional cardiovascular risk factors were not associated with the risk of venous thromboembolism after adjustment for BMI. Hypertension, dyslipidaemia and diabetes may not be risk-factors for venous thromboembolism.

Studies have identified non-linear inverse relationships between physical activity and the risk of stroke. A U-shaped response has been observed between haemorrhagic stroke and physical activity. The objective of this study was to investigate the associations between physical activities on stroke. We used data from the E3N cohort study, a French prospective study of women initiated in 1990. From the women in the study, we included those without cardiovascular disease or cancer at baseline, resulting in 94,169 women. We assessed total physical activity in 1993, grouped as quartiles. Cox models adjusted for potential confounders were used to assess the relationship with stroke, considering cases until 2008. Splines were used to assess the shape of the response. Similarly, we then considered high and low-intensity physical activity grouped as tertiles. Among the included women, with a mean age of 51.2 ± 6.7 years, 592 cases of stroke were identified over an average follow-up time of 16.2 years. Total physical activity was associated with a lower stroke risk (HRQ1-Q4 = 0.38 [0.31, 0.49]). An inverse relationship was observed between physical activity and all stroke sub-types. A non-linear (L-shaped) relationship was observed for all-stroke, and ischemic stroke, and a U-shaped response for sub-arachnoid and intracerebral haemorrhage. High-intensity activities were associated with a U-shaped response for haemorrhagic stroke types. Low-intensity activities were associated with a linear response for all stroke types. Our results support other observations that physical activity may reduce stroke risk.

IntroductionThe non-O blood groups have previously been associated with higher risk of cardiovascular disease in prospective cohort studies. While cross-sectional studies have identified higher serum cholesterol amongst A-group individuals, there is no evidence from prospective studies whether this translates into a higher risk of dyslipidaemia that requires treatment. This study aimed to prospectively determine potential associations between ABO blood groups and risk of incident dyslipidaemia requiring treatment.MethodsWe assessed associations between blood ABO group and dyslipidaemia in women participating in the E3N cohort. We included women who did not have cardiovascular disease at baseline. We used logistic regression to determine associations between ABO group and prevalent dyslipidaemia at baseline. Cox proportional hazard models were used to determine if blood ABO group was associated with an increased risk of incident dyslipidaemia, controlling for potential confounding.ResultsAt baseline, 55,512 women were included, and 10,058 incident cases of dyslipidaemia were identified at a rate of 17.6/1,000 PY. Of these participants, 24,510 reported being of the O-group, and 31,002 of non-O. Non-O blood groups were associated with prevalent dyslipidaemia (OR = 1.17 [1.13: 1.21]). The non-O blood groups were associated with an increased risk of dyslipidaemia (HR non-O = 1.14 [1.10: 1.19]), specifically the A group (HRA = 1.18 [1.13: 1.23]). Interactions with smoking were considered possible (p-interaction = 0.06), with AB smokers showing the highest risk of dyslipidaemia (HRAB smokers = 1.54 [1.12: 2.11]).ConclusionNon-O blood group, specifically the A group were associated with a moderately increased risk of dyslipidaemia.

IntroductionPrevious studies have identified a positive association between the inflammatory potential of the diet and hypertension. It is not known if BMI is an effect modifier for this association, nor if the association is dose-respondent. This study aimed to assess the association between the dietary inflammatory index (DII) and the risk of hypertension, and assess any effect modification from BMI.MethodsData from the E3N cohort study, a French prospective population-based study initiated in 1990 was used. From the women in the study, we included those who completed a detailed diet history questionnaire, and who did not have prevalent hypertension or cardiovascular disease at baseline, resulting in 46,652 women. The adapted DII was assessed with data from the dietary questionnaire. Hypertension cases were self-reported and verified through a drug-reimbursement database. Cox proportional hazard models were used to calculate hazard ratios. Spline regression was used to determine any dose-respondent relationship.ResultsDuring 884,267 person-years, 13,183 cases of incident hypertension were identified. The median DII in the population was slightly pro-inflammatory (DII = + 0.44). A highly pro-inflammatory diet (DII > 3.0) was associated with a slight increase in hypertension risk (HRQ1-Q5 = 1.07 [1.02, 1.13]). Evidence was observed for effect modification from BMI, with associations strongest amongst women in the 18.5–21.0 BMI range (HRQ1-Q5 = 1.17 [1.06, 1.29]). A weak dose-respondent relationship was observed.ConclusionEvidence for a weak association between DII and hypertension was observed. Associations were stronger amongst healthy-lean women.

Purpose: The relationship between egg and cholesterol intakes, and cardiovascular disease is controversial. Meta-analyses indicate that egg consumption is associated with increased cardiovascular disease and mortality, but reduced incidence of hypertension, a major risk factor for cardiovascular disease. This study aims to investigate the associations between consumption of egg and cholesterol, and hypertension risk in a cohort of French women. Methods: We used data from the E3N cohort study, a French prospective population-based study initiated in 1990. From the women in the study, we included those who completed a detailed diet history questionnaire, and who did not have prevalent hypertension or cardiovascular disease at baseline, resulting in 46,424 women. Hypertension cases were self-reported. Egg and cholesterol intake was estimated from dietary history questionnaires. Cox proportional hazard models with time-updated exposures were used to calculate hazard ratios. Spline regression was used to determine any dose&ndash, respondent relationship. Results: During 885,321 person years, 13,161 cases of incident hypertension were identified. Higher cholesterol consumption was associated with an increased risk of hypertension : HRQ1-Q5 = 1.22 [1.14:1.30], with associations similar regarding egg consumption up to seven eggs per week: HR4&ndash, 7 eggs = 1.14 [1.06:1.18]. Evidence for a non-linear relationship between hypertension and cholesterol intake was observed. Conclusion: Egg and cholesterol intakes were associated with a higher risk of hypertension in French women. These results merit further investigation in other populations.

Several studies have reported associations of hypertension with cancer, but not all results were conclusive. We examined the association of systolic (SBP) and diastolic (DBP) blood pressure with the development of incident cancer at all anatomical sites in the European Prospective Investigation into Cancer and Nutrition (EPIC). Hazard ratios (HRs) (95% confidence intervals) were estimated using multivariable Cox proportional hazards models, stratified by EPIC-participating center and age at recruitment, and adjusted for sex, education, smoking, body mass index, physical activity, diabetes and dietary (in women also reproductive) factors. The study included 307,318 men and women, with an average follow-up of 13.7 (standard deviation 4.4) years and 39,298 incident cancers. We confirmed the expected positive association with renal cell carcinoma: HR = 1.12 (1.08-1.17) per 10 mm Hg higher SBP and HR = 1.23 (1.14-1.32) for DBP. We additionally found positive associations for esophageal squamous cell carcinoma (SCC): HR = 1.16 (1.07-1.26) (SBP), HR = 1.31 (1.13-1.51) (DBP), weaker for head and neck cancers: HR = 1.08 (1.04-1.12) (SBP), HR = 1.09 (1.01-1.17) (DBP) and, similarly, for skin SCC, colon cancer, postmenopausal breast cancer and uterine adenocarcinoma (AC), but not for esophageal AC, lung SCC, lung AC or uterine endometroid cancer. We observed weak inverse associations of SBP with cervical SCC: HR = 0.91 (0.82-1.00) and lymphomas: HR = 0.97 (0.93-1.00). There were no consistent associations with cancers in other locations. Our results are largely compatible with published studies and support weak associations of blood pressure with cancers in specific locations and morphologies.

RESUME Dans sa strategie nationale de sante pour les maladies hypertensives, la Societe francaise d’HTA ( www.sfhta.eu ) propose des recommandations de prevention globale avec une correction des inegalites sociales et geographiques en integrant les specificites des DOM-ROM (recommandations 5 a 9). Il s’agit d’integrer la prevention de l’HTA dans les actions generales de sante publique a enseigner des la petite enfance, en accord avec les preconisations de la Federation Francaise de Cardiologie ( www.fedecardio.org ) : la lutte contre la sedentarite, la pratique d’une activite physique reguliere, une alimentation equilibree, l’absence de la premiere cigarette, la prevention du stress chronique en particulier au travail et de la depression. Il est recommande de prevoir un plan de lutte specifique contre l’obesite en Outre-Mer et d’amener tous les professionnels de sante a renforcer le depistage du surpoids et de l’obesite a tous âges. Il est necessaire d’informer le patient hypertendu que l’hygiene de vie permet de renforcer l’efficacite du traitement voire de l’alleger. Il convient de favoriser le depistage de l’HTA surtout en presence d’un contexte familial d’HTA ou de mauvaises conditions socio-economiques, notamment en Outre-mer. Le medecin traitant, le pharmacien et l’infirmier y ont leur place ainsi que les centres de sante au travail et les centres d’examens de sante de la Caisse Primaire d’Assurance Maladie.

Cardiovascular diseases are the first cause of death in women. Their frequency is underestimated because of their atypical feminine clinical presentation. The pathway "heart, arteries and women", initiated at Lille's hospital center in 2013, was designed to improve pluridisciplinar approaches for women. Thus, obstructive sleep apnea (OSA), known as a metabolic risk factor, was studied in several works. In post-menopausal women with cardiovascular risk, frequency of OSA seems underestimated. Clinical presentation of OSA in feminine patients can be misleading, and its screening seems essential, in light of its major cardiovascular impact.

Diagnosis of abdominal aortic aneurysm (AAA) at preoperative stage is increasingly frequent. It carries both a local risk of rupture and an increased global cardiovascular risk. Patients with AAA have indeed a 20 times higher risk of dying from myocardial infarction or stroke than from a ruptured aneurysm. Cardiovascular risk factors control is therefore essential, particularly smoking cessation. Treatment in cardiovascular prevention is also warranted. Seeking for atheromatous sites is needed as they determine prognosis. Evidence of the benefit of medical treatment to slow AAA growth is still lacking. In practice, it is recommended to prescribe statins and angiotensin converting enzyme inhibitor to prevent cardiovascular events. These preventive measures are as well necessary to improve postoperative prognosis and must be continued after surgical repair. A vascular medical and surgical cooperation is primordial to enhance comprehensive management of patients with AAA.

Importance Modern data regarding incidence and modes of death of patients with aortic stenosis (AS) are restricted to tertiary centers or studies of aortic valve replacement (AVR). Objective To provide new insights into the natural history of outpatients with native AS based on a large regionwide population study with inclusion by all cardiologists regardless of their mode of practice. Design, Setting, and Participants Between May 2016 and December 2017, consecutive outpatients with mild (peak aortic velocity, 2.5-2.9 m/s), moderate (peak aortic velocity, 3-3.9 m/s), and severe (peak aortic velocity, ≥4 m/s) native AS graded by echocardiography were included by 117 cardiologists from the Nord-Pas-de-Calais region in France. Analysis took place between August and November 2020. Main Outcomes and Measures Natural history, need for AVR, and survival of patients with AS were followed up. Indications for AVR were based on current guideline recommendations. Results Among 2703 patients (mean [SD] age, 76.0 [10.8] years; 1260 [46.6%] women), 233 (8.6%) were recruited in a university public hospital, 757 (28%) in nonuniversity public hospitals, and 1713 (63.4%) by cardiologists working in private practice. A total of 1154 patients (42.7%) had mild, 1122 (41.5%) had moderate, and 427 (15.8%) had severe AS. During a median (interquartile range) of 2.1 (1.4-2.7) years, 634 patients underwent AVR and 448 died prior to AVR. Most deaths were cardiovascular (200 [44.7%]), mainly associated with congestive heart failure (101 [22.6%]) or sudden death (60 [13.4%]). Deaths were noncardiovascular in 186 patients (41.5%) and from unknown causes in 62 patients (13.8%). Compared with patients with mild AS, there was increased cardiovascular mortality in those with moderate (hazard ratio, 1.47 [95% CI, 1.07-2.02]) and severe (hazard ratio, 3.66 [95% CI, 2.52-5.31]) AS. The differences remained significant when adjusted for baseline characteristics or in time-dependent analyses considering AS progression. In asymptomatic patients, moderate and mild AS were associated with similar cardiovascular mortality (hazard ratio, 0.99 [95% CI, 0.44-2.21]). Conclusions and Relevance While patients in this study with moderate AS had a slightly higher risk of cardiovascular death than patients with mild AS, this risk was much lower than that observed in patients with severe AS. Moreover, in asymptomatic patients, moderate and mild AS were associated with similar cardiovascular mortality.

Hypertension and tobacco smoking are two major modifiable risk factors for atheromatous disease and its cardiovascular complications. If systolic hypertension (SBP≥140mmHg and DBP

Menopause is associated with a significant increase in arterial and metabolic risk. Systolic hypertension is common in post-menopausal women. Measurement of blood pressure should be repeated systematically at each visit. Ambulatory blood pressure measurements should be encouraged, especially to detect nocturnal hypertension and to prevent more efficiently women at risk. Self-testing of hypertension by home blood pressure should be encouraged at menopause. Antihypertensive treatment should be initiated after ambulatory blood pressure monitoring in association with reinforced lifestyle. Furthermore, global level of cardiovascular risk should take into account before starting antihypertensive treatment. There are no women specificities in the choice of the initial treatment except thiazide diuretics which should be preferred in osteoporotic women. In hypertensive women and with disabling climacteric symptoms under 60 and within 10 years after the onset of menopause, post-menopausal hormone therapy can be offered in absence of arterial or venous contraindications. A preliminary discussion between gynecologist, cardiologist and general practionner is necessary before deciding to treat a post-menopausal women for her climacteric symptoms. A clear information on the benefit-risk balance of post-menopausal hormone therapy should be given to the women. The information should be recorded in the medical file. Cooperation between cardiologists, gynecologists and general practionners should be promoted in France, to optimize the care pathways in these women at risk and to improve medical practices.

Cardiovascular diseases are the primary cause of death in women. Cardiovascular risk is specific and often underestimated in women. At equal age, women have more cardiovascular risk factors than men. Some of them such as smoking and diabetes are associated with greater increase of cardiovascular risk and poorer prognosis in women as compared to men. In addition, women have a specific hormonal risk linked to contraception, pregnancy and menopause. Prevention, screening and diagnosis are generally implemented both at later stages and less frequently than in men because of particularities in clinical presentation, and treatments are not optimal in women. All these specificities must be considered for an optimized evaluation of cardiovascular risk and an improvement of management in women.Les maladies cardiovasculaires sont la première cause de décès chez la femme. Le risque cardiovasculaire de la femme est spécifique et souvent sous-estimé. À âge égal, les femmes ont plus de facteurs de risque cardiovasculaires que les hommes. Certains facteurs de risque comme le tabac ou le diabète sont associés à une augmentation plus importante du risque cardiovasculaire et un pronostic plus péjoratif chez la femme que chez l’homme. À cela s’ajoute un risque hormonal spécifique lié à la contraception, à la grossesse et à la ménopause. La prévention, le dépistage et le diagnostic des maladies cardiovasculaires sont généralement moins fréquents et plus tardifs chez la femme que chez l’homme en raison d’une symptomatologie spécifique, et le traitement à visée cardiovasculaire est encore sous-optimal. L’ensemble de ces spécificités doivent être prises en compte pour une évaluation optimisée du risque cardiovasculaire et une amélioration de la prise en charge des femmes.

Background High carbohydrate intake raises blood triglycerides, glucose, and insulin; reduces HDLs; and may increase risk of coronary heart disease (CHD). Epidemiological studies indicate that high dietary glycemic index (GI) and glycemic load (GL) are associated with increased CHD risk. Objectives The aim of this study was to determine whether dietary GI, GL, and available carbohydrates are associated with CHD risk in both sexes. Methods This large prospective study—the European Prospective Investigation into Cancer and Nutrition—consisted of 338,325 participants who completed a dietary questionnaire. HRs with 95% CIs for a CHD event, in relation to intake of GI, GL, and carbohydrates, were estimated using covariate-adjusted Cox proportional hazard models. Results After 12.8 y (median), 6378 participants had experienced a CHD event. High GL was associated with greater CHD risk [HR 1.16 (95% CI: 1.02, 1.31) highest vs. lowest quintile, p-trend 0.035; HR 1.18 (95% CI: 1.07, 1.29) per 50 g/day of GL intake]. The association between GL and CHD risk was evident in subjects with BMI (in kg/m2) ≥25 [HR: 1.22 (95% CI: 1.11, 1.35) per 50 g/d] but not in those with BMI Conclusions This large pan-European study provides robust additional support for the hypothesis that a diet that induces a high glucose response is associated with greater CHD risk.

Cardiovascular diseases are become the primary cause of death in women. The cardiovascular risk of the woman has unknown specificities and remains underestimated. At equal age, women have more cardio vascular risk factors than men. All these specificities must be taken into account for an optimized evaluation of cardiovascular risk and for improvement of CV management in women. Some traditional risk factors are more deleterious in women such as hypertension, tobacco, diabetes or psycho-social stress and they are less well controlled compared to men. Women are also exposed to hormonal risk factors (contraception, pregnancy and menopause) or to emergent risk situations (migraine with aura, endometriosis, polycystic ovary syndrome, auto-immune diseases…). Conversely, lifestyle measures (regular physical activity, no smoking, healthy diet, stress management) are extremely effective in primary and secondary prevention in women. Predicting the risk of cardiovascular events in women is difficult because the classic risk scores (SCORE, Framingham…) do not take into account hormonal CV specificities and underestimate the women CV risk. Until then, only the specific women AHA stratification of CVR allowed for appropriate care for them. Recently, at the initiative of the French Society of hypertension, a consensus of experts proposed a stratification of CVR adapted to French women, to help practitioners in their care, especially for the two hormonal periods as contraception and menopause.

Menopause is associated with a significant increase in arterial and metabolic risk. Systolic hypertension is common in post-menopausal women. Measurement of blood pressure should be repeated systematically at each visit. Ambulatory blood pressure measurements should be encouraged, especially to detect nocturnal hypertension and to prevent more efficiently women at risk. Self-testing of hypertension by home blood pressure should be encouraged at menopause. Antihypertensive treatment should be initiated after ambulatory blood pressure monitoring in association with reinforced lifestyle. Furthermore, global level of cardiovascular risk should take into account before starting antihypertensive treatment. There are no women specificities in the choice of the initial treatment except thiazide diuretics which should be preferred in osteoporotic women. In hypertensive women and with disabling climacteric symptoms under 60 and within 10 years after the onset of menopause, post-menopausal hormone therapy can be offered in absence of arterial or venous contraindications. A preliminary discussion between gynecologist, cardiologist and general practionner is necessary before deciding to treat a post-menopausal women for her climacteric symptoms. A clear information on the benefit-risk balance of post-menopausal hormone therapy should be given to the women. The information should be recorded in the medical file. Cooperation between cardiologists, gynecologists and general practionners should be promoted in France, to optimize the care pathways in these women at risk and to improve medical practices.

Preeclampsia is a specific risk factor chronic of hypertension, of coronary events (Ray et al., 2005), of stroke (Brown et al., 2006), of chronic renal failure (Kattah and Garovic, 2005; McDonald et al., 2003; Williams, 2003) and a specific risk factor of cardio-cerebrovascular mortality (Magnussen et al., 2009). According to Magnusson et al. (2009), the relative long-term risk of developing hypertension is multiplied by 4; the risk of diabetes and metabolic syndrome multiplied by 3; the risk of coronary heart disease and stroke multiplied by 2. Cardiovascular risk is particularly important when pregnancy was complicated by maternal and fetal events or occurring precociously (Williams, 2003; Newstead et al., 2007). Early PE is associated with a relative risk of death by 7 of CV disease. Several pathophysiological factors are common between CV disease and preeclampsia: endothelial dysfunction, hypertension, obesity, insulin resistance, dyslipidemia and CV heredity. Metabolic syndrome could be the link between preeclampsia and CV disease. Hypertension in pregnancy and preeclampsia could unmask metabolic syndrome "latent" existing (Silva et al., 2008). Recently, scientific societies have published guidelines dedicated to cardiovascular risk in women and for the prevention of stroke in women. They recognize hypertension in pregnancy and preeclampsia as specific emerging risk (Mosca et al., 2011; European Society of Gynecology et al., 2011; Bushnell et al., 2014). Paradoxically, information and prevention of these women at risk is insufficient to ignorance and lack of awareness among health professionals (Brown et al., 2013). The education of women has become a major issue of prevention, developing specific consultation after delivery, encouraging them to optimize their lifestyle with a coordinated follow-up (Newstead et al., 2007; Mosca et al., 2011; European Society of Gynecology et al., 2011; Bushnell et al., 2014, Harskamp and Zeeman, 2007). In the end, the implementation of structured care pathway, further monitoring of these women, aims to improve the practices of health professionals (Manten et al., 2007; Adams et al., 2014; Mounier-Vehier et al., 2014).

Points essentiels La maladie coronaire est la premiere cause de mortalite chez les femmes en Europe et dans les pays industrialises. Elle tue 7 fois plus que le cancer du sein. Les deces lies a la maladie coronaire sont en augmentation et n’epargnent pas la femme jeune ( La maladie coronaire de la femme constitue un probleme de sante publique sous-estime. Les femmes doivent devenir des cibles prioritaires de prevention. La vision traditionnelle de la maladie coronaire comme une ischemie myocardique avec obstruction des gros troncs coronaires ne suffit pas a representer tous les aspects de la maladie ischemique chez la femme. L’ischemie myocardique sans stenose des gros troncs coronaires, s’integrant dans l’atteinte microvasculaire, est meconnue et negligee. Pourtant, c’est une situation a haut risque cardiovasculaire. La presentation clinique et la symptomatologie de la maladie coronaire presentent des particularites tres trompeuses chez la femme. La maladie coronaire de la femme reste sous-diagnostiquee et sous-traitee. Il est indispensable d’ameliorer la prise en charge des femmes a risque cardiovasculaire, dont les inegalites participent a la surmortalite coronarienne feminine. Une nouvelle approche diagnostique et therapeutique est necessaire. Elle doit prendre en compte la stratification du risque specifique, l’evaluation de la douleur particuliere et la moindre performance des tests diagnostiques.

Background Conflicting information exists about whether sex differences modulate outcome in patients with coronary artery disease (CAD). Our aim was to analyze baseline characteristics, medical management, risk factor control, and long-term outcome according to gender in patients with stable CAD. Methods We analyzed data from the contemporary multicenter CORONOR registry, which included 4184 consecutive outpatients with stable CAD. Follow-up was performed at 5 years with adjudication of clinical events. Results There were 3252 (77.7%) men and 932 (22.3%) women. Women were older than men, more likely to have hypertension, and less likely to smoke. They had more frequent angina but less frequent multivessel CAD. Evidence-based medications were widely used with only few differences according to gender. Women had a poorer control of cardiovascular risk with higher systolic blood pressure and LDL-cholesterol. The composite endpoint - cardiovascular death, myocardial infarction, or ischemic stroke - occurred in 536 patients. When adjusted for baseline characteristics, five-year outcomes were similar for women and men for the composite endpoint (Hazard ratio [95% confidence interval]: 1.03 [0.81-1.31], P=0.817). Conclusions In contemporary practice, women with stable CAD had a poorer control of cardiovascular risk. However, at 5-year follow-up, cardiovascular outcomes were similar for both genders.

The definition of prosthesis–patient mismatch (PPM) remains to be refined to enhance its prognosis insight after surgical aortic valve replacement (SAVR) for severe aortic stenosis, especially in obese patients [(1)][1]. We aimed at investigating the respective prevalence and prognostic value of

Diagnosis of abdominal aortic aneurysm (AAA) at preoperative stage is increasingly frequent. It carries both a local risk of rupture and an increased global cardiovascular risk. Patients with AAA have indeed a 20 times higher risk of dying from myocardial infarction or stroke than from a ruptured aneurysm. Cardiovascular risk factors control is therefore essential, particularly smoking cessation. Treatment in cardiovascular prevention is also warranted. Seeking for atheromatous sites is needed as they determine prognosis. Evidence of the benefit of medical treatment to slow AAA growth is still lacking. In practice, it is recommended to prescribe statins and angiotensin converting enzyme inhibitor to prevent cardiovascular events. These preventive measures are as well necessary to improve postoperative prognosis and must be continued after surgical repair. A vascular medical and surgical cooperation is primordial to enhance comprehensive management of patients with AAA.

Summary Background Cardiovascular disease is the primary cause of death in women. Prevention, screening and diagnosis are generally implemented at later stages and less frequently than in men, and provision of treatment is not optimal in women. Aims To assess the relevance of targeted screening for myocardial ischaemia in women with multiple risk factors, and to identify which specific factors target women more effectively. Methods We undertook a prospective observational study with retrospective data collection based on a cohort of symptomatic or asymptomatic women with multiple cardiovascular risk factors. All women underwent non-invasive diagnostic testing through the “Heart, arteries and women”, healthcare pathway available at Lille University Hospital, between 1 January 2013 and 30 June 2014. Results Screening was positive in 15.7% of the 287 participants. Thirty women had a coronary angiography: of these, 22 (73.3%) had no evidence of obstructive coronary artery disease. The independent predictive factors for positive screening were >5 years since menopause (odds ratio [OR] 3.9; P = 0.0016); high-density lipoprotein cholesterol ≤0.5 g/dL (OR 2.3; P = 0.0356); and body mass index ≥30 kg/m2 (OR 3.7; P = 0.0009). Symptoms were predictive of positive screening (P = 0.010), but were mostly atypical. Based on these observations, we developed a clinical coronary score to target screening more efficiently (area under the curve 0.733). Positive screening resulted in low rates of revascularization (16.6%), but a significant increase in the prescription of statins (P = 0.002), antiplatelet agents (P Conclusion Screening for myocardial ischaemia among selected women at risk of cardiovascular disease can be useful to improve medical treatment.

Cardiovascular diseases are the first cause of death in women. Their frequency is underestimated because of their atypical feminine clinical presentation. The pathway "heart, arteries and women", initiated at Lille's hospital center in 2013, was designed to improve pluridisciplinar approaches for women. Thus, obstructive sleep apnea (OSA), known as a metabolic risk factor, was studied in several works. In post-menopausal women with cardiovascular risk, frequency of OSA seems underestimated. Clinical presentation of OSA in feminine patients can be misleading, and its screening seems essential, in light of its major cardiovascular impact.

Changes in parameters of longitudinal systolic function after cardiac surgery (i.e., tricuspid annular plane systolic excursion [TAPSE] and peak systolic velocity [PSV] of tricuspid annulus obtained by M-mode or Doppler tissue imaging) have been described for many years, with almost no data on their

Preeclampsia is a specific risk factor chronic of hypertension, of coronary events (Ray et al., 2005), of stroke (Brown et al., 2006), of chronic renal failure (Kattah and Garovic, 2005; McDonald et al., 2003; Williams, 2003) and a specific risk factor of cardio-cerebrovascular mortality (Magnussen et al., 2009). According to Magnusson et al. (2009), the relative long-term risk of developing hypertension is multiplied by 4; the risk of diabetes and metabolic syndrome multiplied by 3; the risk of coronary heart disease and stroke multiplied by 2. Cardiovascular risk is particularly important when pregnancy was complicated by maternal and fetal events or occurring precociously (Williams, 2003; Newstead et al., 2007). Early PE is associated with a relative risk of death by 7 of CV disease. Several pathophysiological factors are common between CV disease and preeclampsia: endothelial dysfunction, hypertension, obesity, insulin resistance, dyslipidemia and CV heredity. Metabolic syndrome could be the link between preeclampsia and CV disease. Hypertension in pregnancy and preeclampsia could unmask metabolic syndrome "latent" existing (Silva et al., 2008). Recently, scientific societies have published guidelines dedicated to cardiovascular risk in women and for the prevention of stroke in women. They recognize hypertension in pregnancy and preeclampsia as specific emerging risk (Mosca et al., 2011; European Society of Gynecology et al., 2011; Bushnell et al., 2014). Paradoxically, information and prevention of these women at risk is insufficient to ignorance and lack of awareness among health professionals (Brown et al., 2013). The education of women has become a major issue of prevention, developing specific consultation after delivery, encouraging them to optimize their lifestyle with a coordinated follow-up (Newstead et al., 2007; Mosca et al., 2011; European Society of Gynecology et al., 2011; Bushnell et al., 2014, Harskamp and Zeeman, 2007). In the end, the implementation of structured care pathway, further monitoring of these women, aims to improve the practices of health professionals (Manten et al., 2007; Adams et al., 2014; Mounier-Vehier et al., 2014).

Coronary artery disease is the leading death for women in Europe and developed countries. It kills seven times more than breast cancer. The number of deaths from coronary artery disease increase and affects also younger women ( 55 years old). Coronary artery disease in women is a major public health problem, often underestimated. Women should become a priority target of prevention. Traditional vision of coronary artery disease as myocardial ischemia due to obstruction of major coronary arteries do not represent all the aspects of ischemic disease in women. Myocardial ischemia without obstruction of major coronary arteries, described as microvascular dysfunction is often unknown and ignored. It is yet a situation at high cardiovascular risk. Presentation and symptoms of coronary artery disease are misleading in women. Coronary artery disease in women remains under-diagnosed and under-treated. It is necessary to improve management of women at cardiovascular risk, whose inequalities contribute to the excess of female mortality from coronary artery disease. Coronary artery disease in women needs new diagnostic and therapeutic approaches. It must take into account specific risk stratification, evaluation of particular chest pain and reduced performance of non-invasive testing.

Contexte Le syndrome d’apnees du sommeil (SAS) est un facteur de risque cardiovasculaire reconnu. Chez la femme, sa frequence augmente au moment de la menopause. La presentation clinique feminine du SAS est atypique, a l’origine d’un retard diagnostique. L’objectif principal de l’etude a ete d’etudier le SAS chez les femmes menopausees a risque cardiovasculaire (RCV) eleve a tres eleve selon la stratification americaine specifique de la femme. Methode Etude observationnelle retrospective, sur une population de 91 patientes menopausees hospitalisees pour un bilan programme dans le centre d’excellence d’HTA-vasculaire au CHU de Lille entre le 1 er janvier 2013 et le 1 er janvier 2015. Toutes les femmes incluses ont eu un depistage de SAS par polygraphie ventilatoire ou polysomnographie. Les caracteristiques demographiques, antecedents, facteurs de risque cardiovasculaires (RCV) et reponses aux auto-questionnaires de depistage du SAS ont ete etudies. Le diagnostic de SAS etait pose devant un index apnees/hypopnees (IAH) > 5 (recommandations francaises). Resultats Le diagnostic de SAS etait confirme chez 73 % des patientes. La severite du SAS etait stratifiee en fonction de l’IAH en SAS leger (5 30) (24 %). Dans un cas sur 5, l’IAH etait non renseigne. Parmi ces SAS, un sur deux relevait d’un appareillage par pression positive continue. Chez les patientes ayant un SAS modere a severe et/ou appareille, l’absence de baisse de la pression arterielle (PA) nocturne etait retrouvee dans 49% des cas pour la pression systolique et dans 22% des cas pour la pression diastolique. Les patientes a « tres haut RCV » selon la classification de l’American Heart Association (AHA) avaient plus souvent un SAS (OR = 4,3, p = 0,0012). Il n’y avait pas d’autre difference significative retrouvee sur les autres variables etudiees, en particulier l’anciennete de la menopause. Conclusion Les patientes menopausees a RCV eleve a tres eleve sont a tres haut risque de SAS. Il est necessaire d’utiliser la stratification dediee au RCV chez ces patientes pour cibler prioritairement les femmes relevant d’un depistage du SAS, en s’aidant aussi de la mesure ambulatoire de la PA sur 24 heures pour la PA nocturne. Les auto-questionnaires de depistage, pas assez discriminants chez la femme, devront etre adaptes a leurs specificites cliniques. Ce sera un des objectifs a court terme du parcours de sante « cœur-arteres-femmes », au CHU de Lille.

Introduction Les maladies cardiovasculaires demeurent la premiere cause de mortalite chez les femmes. La prevention et la prise en charge cardiovasculaires doivent etre ameliorees. La femme presente un risque cardiovasculaire (RCV) specifique necessitant de prendre en compte son risque hormonal. L’impact des antecedents gyneco-obstetricaux, independamment des facteurs de RCV conventionnels, reste encore a determiner. L’objectif principal de cette etude etait d’etudier l’association entre les antecedents gyneco-obstetricaux et l’atherome carotidien. Methodes Il s’agit d’une etude observationnelle longitudinale monocentrique avec recueil retrospectif des donnees d’une cohorte de patientes menopausees a RCV suivies au CHRU de Lille entre le 1er janvier 2013 et le 31 decembre 2016. Le critere de jugement principal etait l’existence de lesions d’atherome carotidien soit plaque soit stenose significative a l’echo-Doppler des troncs supra-aortiques. Resultats La population etait constituee de 370 femmes menopausees d’âge moyen 63 ans. Des lesions d’atherome carotidien ont ete retrouvees chez 161 femmes (43,3 %). Les facteurs predictifs independants d’atherome carotidien etaient l’âge de plus de 65 ans (p = 0,007), la presence d’un diabete (p = 0,032) et une parite superieure a 2 (p = 0,024). Il existait une augmentation significative du RCV global evalue par la stratification europeenne (p Conclusion Une parite superieure a 2 etait associee au risque de lesions d’atherome carotidien independamment de l’âge et des facteurs de risque traditionnels sur une cohorte de femmes menopausees. Le nombre d’enfants est un critere facile a recueillir qui pourrait ameliorer la stratification du risque cardiovasculaire chez la femme.

Background Hypertension during pregnancy is the leading marker of risk for maternal and fetal morbidity and mortality. Hypertension during pregnancy occurs in 6 to 10% of pregnancies in the USA and in Europe. Because of the potential severity, of hypertension-related diseases for both mother and infant, medical practice needs to be optimized. Learned Societies consider the different various forms of pregnancy-related hypertension as a specific cardio-vascular (CV) situation that is included in the stratification of risk for women. Purpose To determine the interest of the systematic search for a potential etiological factor and the stratification of the CV risk in any women with some history of hypertension during pregnancy. Methods Between January 2010 to December 2015, we have retrospectively included 175 women with a prior history of hypertensive pregnancy in our excellence center of hypertension. Results Secondary hypertension was found in 25% of women, 58% of whom had primary hyperaldosteronism. A low renin hypertension was present in 30%. Women with secondary hypertension have more severe microalbuminuria (P = 0.019), more dilated left atrium (P = 0.051) and higher left ventricle pressure (P = 0.043). The prevalence of CV risk factors was high in this population: dyslipidemia in 78%, diabetes in 11%, smoking in 21%, CV heredity in 32% and metabolic syndrome in 57%. Thus, 58% of women were at high CV risk. Conclusion Women who experienced hypertension during pregnancy should systematically perform a CV risk assessment and a coordinated follow-up.

BackgroundCoronary artery disease is the leading cause of cardiovascular diseases, which remains the major cause of death for women. Prevention, screening and diagnosis tend to be performed at late stages and less frequently, and treatments are not optimal in women. The consequences of a targeted screening for myocardial ischemia in women at risk have not yet been studied.MethodsWe conducted a prospective observational study with retrospective data collection based on a cohort of female patients at cardiovascular risk, with or without symptoms, who benefited from a non-invasive diagnostic test, offered through the care pathway “Heart, arteries and women” from the Lille University hospital of Lille, between January 1st, 2013 and June 31st, 2014. The objective was to determine the relevance of this screening and which factors would help in targeting women more efficiently.ResultsThe screening gave a positive result in for 15.7% of the 287 women included.Among the 30 women that benefited from a coronarography, 72% had no obstructive coronary artery disease. The independent predictive factors of a positive screening were a menopause since more than 5 years (OR=4.17; p=0.001), an HDL-c≤0.5g/dL (OR=2.45; p=0.023) and an IMC≥32 (OR=4.58; p=0.0001). A clinical coronary score based on these factors was developed to target the screening (AUC 0.765). The symptoms, presents in half of the patients, were predictive of a positive screening (p=0.010) but were mostly atypical.The classical cardiovascular risk scores were inefficient at predicting a coronary artery disease (AUC 0.618 to 0.681). The positive screening had resulted into a low rate of revascularization (17%) but in a significant increase of in the prescription of statin (p=0.002), antiplatelet agents (p

Objectifs La maladie coronaire est au premier rang des maladies cardiovas-culaires, qui reste la premiere cause de mortalite chez la femme. Chez elle, la prevention, le depistage et les epreuves diagnostiques tendent a etre tardifs et moins frequemment realises, et le traitement sous-optimal. Il n'existe pas actuellement de donnees de la litterature sur les consequences d'un depistage cible de l'ischemie myocardique chez la femme a risque. La selection des patientes qui beneficieront le plus de ce depistage reste encore a definir. Methodes Il s'agit d'une etude observationnelle prospective avec recueil retrospectif des donnees d'une cohorte exhaustive de patientes hypertendues a risque cardiovasculaire, symptomatiques ou non, recues en soins externes dans le cadre du circuit « Cœur, arteres et femmes » au CHRU de Lille du 1 er janvier 2013 au 30 juin 2014, et ayant beneficie d'un test d'ischemie myocardique non invasif. L'objectif principal etait de determiner la pertinence de ce depistage ainsi que les facteurs susceptibles de mieux cibler les femmes a depister. Resultats Le depistage etait positif chez 15,7 % des 287 femmes incluses. Parmi les 30 femmes qui ont beneficie d'une coronarographie, 72% n'avaient pas d'obstruction coronaire significative. Les facteurs predictifs independants d'un depistage positif etaient une menopause de plus de 5 ans (OR = 4,17 ; p = 0,001), un HDL-c inferieur ou egal a 0,5 g/dL (OR = 2,45 ; p = 0,023) et un IMC superieur ou egal a 32 (OR = 4,58 ; p = 0,0001). Ils ont permis l'elaboration d'un score clinique coronaire pour cibler le depistage (AUC 0,765). Les symptomes, presents dans la moitie des cas, etaient predictifs d'un test positif (p = 0,010), mais majoritairement atypiques (dyspnee et douleur thoracique « non angineuse »). Les scores de risque cardiovasculaire classiques (Framingham, Agostino, Reynolds et SCORE) etaient peu performants pour predire une atteinte coronaire (AUC 0,618 a 0,681). Le depistage positif d'une maladie coronaire a entraine un faible taux de revascularisation apres coronarographie (17 %), mais une modification significative du traitement medicamenteux (p=0,001) avec une majoration de la prescription de statine (p = 0,002), d'antia-gregant plaquettaire (p Conclusion Le depistage de l'ischemie myocardique chez des femmes hypertendues a risque cardiovasculaire selectionnees permet une optimisation de leur prise en charge en prevention secondaire.