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OBJECTIVES Metformin therapy has previously been associated with reduced abdominal aortic aneurysm growth rate in diabetic patients and shown to suppress the formation and progression of abdominal aortic aneurysm in normoglycemic mice. Here, we investigated the association between Metformin treatment and prevalence of aneurysm in the ascending aorta (AscAA). METHODS A total of 734 patients undergoing open-heart surgery for AscAA and/or aortic valve disease were studied. Diabetes status and medication use were self-reported by the patients in a systematic questionnaire. Aortic dilatation was defined as an aortic root or ascending aortic diameter ≥4.0 cm. High-sensitivity C-reactive protein levels were assessed as a measure of systemic inflammation. RESULTS We could confirm the inverse association between diabetes and AscAA prevalence (16% vs 43.9%, for diabetic and non-diabetic patients, respectively; Odds ratio 0.243; 95% CI, 0.129–0.460, P CONCLUSIONS Our data do not support a protective effect of Metformin therapy in AscAA formation. Subj collection 161, 173

Objective: We aimed to develop clinical classifiers to identify prevalent ascending aortic dilatation in patients with BAV and tricuspid aortic valve (TAV). Methods: This study included BAV (n=543) and TAV (n=491) patients with aortic valve disease and/or ascending aortic dilatation but devoid of coronary artery disease undergoing cardiothoracic surgery. We applied machine learning algorithms and classic logistic regression models, using multiple variable selection methodologies to identify predictors of high risk of ascending aortic dilatation (ascending aorta with a diameter above 40 mm). Analyses included comprehensive multidimensional data (i.e., valve morphology, clinical data, family history of cardiovascular diseases, prevalent diseases, demographic, lifestyle and medication). Results: BAV patients were younger (60.4±12.4 years) than TAV patients (70.4±9.1 years), and had a higher frequency of aortic dilatation (45.3% vs. 28.9% for BAV and TAV, respectively. PConclusions: Cardiovascular risk profiles appear to be more predictive of aortopathy in TAV patients than in patients with BAV. This adds evidence to the fact that BAV- and TAV-associated aortopathy involve different pathways to aneurysm formation and highlights the need for specific aneurysm preventions in these patients. Further, our results highlight that machine learning approaches do not outperform classical prediction methods in addressing complex interactions and non-linear relations between variables.

We aimed to study sex differences in aortopathy and valve disease among patients undergoing aortic valve replacement and/or surgical procedure for ascending aortic aneurysm and assess whether differences are specific for patients with bicuspid aortic valve (BAV) compared with patients with tricuspid aortic valve.We used a single-center and observational cohort including 1045 patients undergoing elective open heart surgical procedure for aortic valve disease and/or ascending aortic aneurysm at the Karolinska Hospital (Stockholm, Sweden).Women (33.0%) were older than men (mean [SD]; 67.9 [11] years vs 62.5 [13] years for men; P.001). No significant sex difference in prevalence of ascending aortic aneurysm was found according to absolute measures (P = .19); however, women had a greater dilation of the ascending aorta when normalized for body surface area (mean, 21.8 [SD, 6.3] mm/mIn this large study of patients undergoing cardiac surgical procedure, we found a greater degree of aortic dilation in women compared with men, suggesting a need for earlier monitoring of women. Moreover, women with BAV had a significantly higher prevalence of aortic stenosis compared with men. These results describe the aorta and valvular characteristics of patients by sex and provide guidance regarding which patients might benefit from closer surveillance.

BACKGROUND: There are no comparative data on pathological predictors at diagnosis, between African Caribbean and Caucasian men with prostate cancer (PCa), in equal-access centers. The objective of this study was to evaluate the grade groups of an African Caribbean cohort, newly diagnosed with PCa on prostate biopsy, compared with a Caucasian French Metropolitan cohort. METHODS: A retrospective, a comparative study was conducted between 2008 and 2016 between the University Hospital of Martinique in the French Caribbean West Indies, and the Saint Joseph Hospital in Paris. Clinical, biological, and pathological data were collected at diagnosis. The primary outcome was the grade groups for Gleason score; the secondary outcome was the PCa detection rate. Multivariate analysis was performed using linear regression. RESULTS: Of the 1880 consecutive prostate biopsy performed in the African Caribbean cohort, 945 had a diagnosis of PCa (50.3%) and 500 of 945 in the French cohort (33.8%). African Caribbean patients were older (mean 68.5 vs 67.5 years; P = .028), had worse clinical stage (13.2% vs 5.2% cT3-4; P

Systems of care have been challenged to control progression of the COVID-19 pandemic. Whether this has been associated with delayed reperfusion and worse outcomes in French patients with ST-segment elevation myocardial infarction (STEMI) is unknown.Aim: To compare the rate of STEMI admissions, treatment delays, and outcomes between the first peak of the COVID-19 pandemic in France and the equivalent period in 2019.Methods: In this nationwide French survey, data from consecutive STEMI patients from 65 centres referred for urgent revascularization between 1 March and 31 May 2020, and between 1 March and 31 May 2019, were analysed. The primary outcome was a composite of in-hospital death or non-fatal mechanical complications of acute myocardial infarction.Results: A total of 6306 patients were included. During the pandemic peak, a 13.9±6.6% (P=0.003) decrease in STEMI admissions per week was observed. Delays between symptom onset and percutaneous coronary intervention were longer in 2020 versus 2019 (270 [interquartile range 150-705] vs 245 [140-646]min; P=0.013), driven by the increase in time from symptom onset to first medical contact (121 [60-360] vs 150 [62-420]min; P=0.002). During 2020, a greater number of mechanical complications was observed (0.9% vs 1.7%; P=0.029) leading to a significant difference in the primary outcome (112 patients [5.6%] in 2019 vs 129 [7.6%] in 2020; P=0.018). No significant difference was observed in rates of orotracheal intubation, in-hospital cardiac arrest, ventricular arrhythmias and cardiogenic shock.Conclusions: During the first peak of the COVID-19 pandemic in France, there was a decrease in STEMI admissions, associated with longer ischaemic time, exclusively driven by an increase in patient-related delays and an increase in mechanical complications. These findings suggest the need to encourage the population to seek medical help in case of symptoms., Contexte. Les systèmes de santé à travers le monde ont été fortement mis à l’épreuve afin de contrôler la progression de l’épidémie de la COVID-19. L’éventualité que la réorganisation des soins ait pu influencer les délais de reperfusion ou le devenir des patients présentant des syndromes coronaires aigus avec sus-décalage du segment ST (SCA ST +) n’a pas été explorée en France.Objectif. Comparer le taux d’admissions pour SCA ST+, les délais de traitement et enfin le devenir de ces patients entre la première vague épidémique de la COVID-19 et pendant la période similaire en 2019.Méthodes. Dans ce registre national multicentrique, les patients avec SCA ST+ provenant de 65 centres français admis en urgence pour revascularisation entre le 1e mars et le 31 mai 2020 et entre le 1e mars et le 31 mai 2019 ont été analysés. Le critère de jugement principal était un critère composite regroupant la mortalité intrahospitalière toute cause confondue et les complications mécaniques en lien avec l’infarctus.Résultats. Un total de 6 306 patients ont été inclus. Pendant le pic de la pandémie une réduction de 13,9 ± 6,6 % (P = 0,003) des admissions pour SCA ST+ a été observée par semaine. Les délais entre l’apparition des symptômes et l’angioplastie percutanée était significativement augmentés 270 (150−705) versus 245 (140−646) minutes (P = 0,013). Cette augmentation était exclusivement liée à une augmentation du temps entre l’apparition des symptômes et le premier contact médical 121 (60−360) en 2019 versus 150 (62−420) minutes en 2020 (P = 0,002). Durant cette période a été constaté un plus grand nombre de complications mécaniques (0,9 % vs 1,7 % (P = 0,029) conduisant à une augmentation significative de notre critère de jugement principal 112 patients (5,6) en 2019 vs 129 (7,6 %) en 2020 (P = 0,018).Conclusions. Pendant le premier pic de la pandémie il a été constaté : une diminution du taux de SCA ST + associé à un temps d’ischémie prolongé, poussé par l’augmentation du temps entre l’apparition des symptômes et le premier contact médical et enfin un plus grand nombre de complications mécaniques. Ces observations suggèrent la nécessité d’encourager la population à consulter au moindre symptôme inquiétant.

Background: To compare the clinical outcomes between patients with and without diabetes admitted to hospital with COVID-19.Methods: Retrospective multicentre cohort study from 24 academic tertiary medical centres in France including 2851 patients (675 with diabetes) hospitalised for COVID-19 between February 26 and April 20, 2020. A propensity score matching method (1:1 matching including patient characteristics, medical history, vital signs, and laboratory results) was used to compare patients with and without diabetes (n=603 in each group). The primary outcome was admission to intensive care unit (ICU) or in-hospital death. Results: Patients with diabetes were older (71 ± 13 vs. 65 ± 18 years; pConclusions: In this retrospective cohort of patients hospitalised for COVID-19, diabetes was not significantly associated with a higher risk of COVID-19 severe outcomes after propensity score matching.Trial registration NCT04344327

Background and Aims: The mechanisms underlying bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) ascending aortic aneurysm are still unknown. We sought to identify predictors of aortopathy in BAV and TAV patients, respectively, and determine the genetic contribution to the valve phenotype. Methods: This study included BAV (n=545) and TAV (n=496) patients with aortic valve disease and/or ascending aorta dilatation but devoid of coronary artery disease. We applied machine learning algorithms and classic logistic regression models using multiple variable selection methodologies to predict individuals of high risk of aneurysm. Analyses included comprehensive multidimensional data (i.e., valve morphology, plasma analyses, genetic- and clinical data, family history of cardiovascular diseases, prevalent diseases, demographic, lifestyle and medication). The genetic impact on phenotype was estimated in a genome-wide complex trait analysis using a variance components model. Results: BAV patients were younger (60.4±12.3 years) than TAV patients (70.2±9.5 years), and had a higher frequency of aortic dilatation (45.1% and 29% for BAV and TAV, respectively. P Conclusions: The predictive classifier of TAV patients is clinically relevant and potentially offers important implications for better targeting TAV individual at high risk of developing aneurysm. Cardiovascular risk profiles appear to be more predictive of aortopathy than valve morphology and genetic data in TAV patients, whereas in BAV patients, the genetic contribution exceeds environmental factors.

Background Our study aimed to compare the clinical outcomes of patients with and without diabetes admitted to hospital with COVID-19. Methods This retrospective multicentre cohort study comprised 24 tertiary medical centres in France, and included 2851 patients (675 with diabetes) hospitalized for COVID-19 between 26 February and 20 April 2020. A propensity score-matching (PSM) method (1:1 matching including patients’ characteristics, medical history, vital statistics and laboratory results) was used to compare patients with and without diabetes (n = 603 per group). The primary outcome was admission to an intensive care unit (ICU) and/or in-hospital death. Results After PSM, all baseline characteristics were well balanced between those with and without diabetes: mean age was 71.2 years; 61.8% were male; and mean BMI was 29 kg/m2. A history of cardiovascular, chronic kidney and chronic obstructive pulmonary diseases were found in 32.8%, 22.1% and 6.4% of participants, respectively. The risk of experiencing the primary outcome was similar in patients with or without diabetes [hazard ratio (HR): 1.16, 95% confidence interval (CI): 0.95–1.41; P = 0.14], and was 1.29 (95% CI: 0.97–1.69) for in-hospital death, 1.26 (95% CI: 0.9–1.72) for death with no transfer to an ICU and 1.14 (95% CI: 0.88–1.47) with transfer to an ICU. Conclusion In this retrospective study cohort of patients hospitalized for COVID-19, diabetes was not significantly associated with a higher risk of severe outcomes after PSM. Trial registration number NCT04344327.

Background: The impact of changes in cardiovascular health (CVH) on cardiovascular disease (CVD) and total and all-cause mortality has yet to be described. Methods: CVH was computed according to smoking, body mass index, total cholesterol, blood glucose and blood pressure, physical activity and diet. Change in CVH was defined as a point-to-point difference in each metric or the score. We used time-dependent Cox Proportional Hazard models to calculate hazard ratios for all-cause mortality and CVD events among 10,656 adult participants from the ARIC study, aged 44 to 66 years at baseline (1987-1989) and followed up until 2014. Hazard ratios for all-cause mortality and CVD event according to CVH change at the component metrics and an aggregate score level were calculated with Cox Proportional Hazard models with consistently low CVH considered as the reference group. Results: Overall, 17% of the sample improved their overall CVH, while the percentage which maintained a low CVH or decreased CVH was 29% and 21%, respectively. Higher levels of overall CVH over time were associated with a graded decrease in risk in CVD events and all-cause mortality. The hazard ratios for all-cause mortality among participant that decreased their overall CVH from favorable to low or moderate, that increased their CVH from low to moderate or favorable, and had consistently favorable CVH, as compared with the constantly low CVH group, were: 0.47 (95% confidence interval [CI], 0.39 to 0.57), 0.80 (95 CI%, 0.72 to 0.89), and 0.37 (95% CI, 0.30 to 0.46). The risk reductions were of a same magnitude for CVD events. In the adjusted Cox time dependent model, compared with low overall CVH, having moderate or favorable CVH was associated with a decreased risk in mortality: 24% (HR=0.76, 95% CI, 0.72 to 0.80) and 44% (HR=0.56, 95% CI, 0.51 to 0.62), respectively and a decreased risk in CVD 37% (HR=0.63, 95% CI, 0.59 to 0.66) and 56% (HR=0.44, 95% CI, 0.39 to 0.49), respectively. Conclusion: Earlier life stage favorable CVH was associated with lower CVD events and total and cause-specific mortality regardless of CVH change patterns over time. Furthermore, improving CVH is associated with lower CVD event risk and lower total and all-cause mortality. However, we observed an alarming low percentage of overall CVH improvement and a high percentage of maintaining low overall CVH. Understanding the mechanisms underlying CVH change patterns may help to tackle the low prevalence of moderate or optimal CVH.

Background: Current time trends of objectively measured cardiovascular health and their relation with population attributable risk for mortality over time -in Western Europe are unknown.We aimed to investigate time trends in cardiovascular health metrics and estimate the population attributable risks of these metrics in relation to all-cause mortality in the population at large, as well as in important subgroups. Methods: In this study, we used a community-based sample of 366,270 adults from France who had a standardized examination to assess cardiovascular risk factors between 1992 and 2011 and with outcome surveillance spanning until 2016 (25 years), Temporal trends of cardiovascular health metrics were computed using metrics defined by the American Heart Association:smoking, body mass index, total cholesterol, blood glucose and blood pressure and physical activity. Population attributable fraction for all-cause mortality over 25 years were measure. Results: Mean age was 44.7 (SD 13) years and 38% (138,228) were women. Overall, few participants (≤3.5%) met all 6 ideal cardiovascular health metrics at any timepoint. The prevalence of meeting ≥5 ideal cardiovascular health metrics increased from 6.2% in 1992-1996 to 16.6% in 2007-2011 (P Conclusions and relevance: Overall cardiovascular health improved from 1992 until 2011 in French adults from the community who benefited from a free standardized health examination. However, the improvement in cardiovascular health was less strong in those with low socio-economic status as compared to those with a higher socio-economic status. Furthermore, the fraction of all-cause mortality attributable to cardiovascular health remained high throughout the study period.

Background: Little is known about the association between bicuspid aortic valves (BAV) and ascending aorta dilatation in the population. We aimed to firstly determine the predictors of aortopathy in BAV patients and secondly to develop a clinical classifier to predict aortopathy in a large group of individuals with bicuspid aortic valve. Method: This study includes 1041 patients (including 545 BAV patients and 506 tricuspid aortic valves (TAV) patients) aged 18 or above with aortic valve disease and/or ascending aorta dilatation but devoid of coronary artery disease and primarily not planned for another concomitant valve surgery. Aortic complications of patients were assessed at baseline. Using automated machine-learning, we applied 10-fold cross-validation logistic regression incorporating multidimensional information (i.e., valvular dysfunction, valves morphology, blood sampling, genetic data, clinical data, family history of cardiovascular diseases, prevalent diseases data, demographic characteristics, lifestyle habits data and medication). Results: Among the 545 BAV subjects (age 64.89 +/- 12 years, 68% men). The prevalence of BAV associated with aneurysm (dilatation) (BAV-D) and without aneurysm (BAV-ND) was 54.9% and 45.1% (p Conclusion: Our findings raise the issue of how to implement prevention of aortopathy in BAV patients in a clinical setting and suggest/demonstrated that cardiovascular risk profiles appear to be more predictive than valve morphology, genetic data and circulating plasma proteins.