Lucie Chastaingt

L’artériopathie oblitérante des membres inférieurs (AOMI) est une pathologie cardio-vasculaire dont la morbi mortalité continue à croitre. Malgré cela, elle reste une pathologie négligée parmi les maladies cardio-vasculaires, car ne recevant pas un traitement médical optimal. Et au sein même de l’AOMI, certaines populations restent négligées par la recherche épidémiologique, alors même qu’elles semblent être de plus en plus concernées par l’AOMI. L’objectif général de cette thèse est donc d’étudier l’épidémiologie de l’AOMI et son évolution dans le contexte de certaines populations particulièrement négligées (les femmes, une population rurale d’Afrique subsaharienne et les sujets très âgés). Nous nous attacherons aussi à déterminer si la vaccination antigrippale est aussi négligée chez les artériopathes que ne l’est leur prise en charge médicale globale. Notre travail a consisté en 4 études complémentaires. Les facteurs associés à l’AOMI et à sa prise en charge et leur évolution temporelle ont été recherchés chez les femmes et les sujets âgés à partir d’une cohorte française. Les femmes sont significativement plus concernées que les hommes par l’ischémie critique mais dans le même temps elles ont moins souvent un geste de revascularisation ou un traitement médical optimal que les hommes. Les sujets très âgés présentent de plus en plus une ischémie critique, avec une majoration des gestes de revascularisation, mais un traitement médical optimal qui reste peu suivi dans le temps. La vaccination antigrippale reste limitée chez les artériopathes, avec nécessité de majorer l’information des patients sur le sujet de cette vaccination. Enfin, l’Index de Pression Systolique (IPS) apparait comme associé à la survenue d’évènement cardio-vasculaires et de décès à 5 ans en population générale.

Peripheral artery disease (PAD) is characterized by blockage of the arteries that supply the lower extremities, often occurring as a result of atherosclerosis and thrombosis. PAD affects approximately 230 million people worldwide, with a growing prevalence owing to population ageing and concomitant cardiovascular risk factors, including smoking, diabetes mellitus, hypertension and dyslipidaemia. Patients with PAD have an increased risk of major cardiovascular and limb events, and substantially poorer walking performance compared with those without PAD. The screening and identification of PAD involves clinical and imaging assessments of disease extent and severity and stratification of individual risk to ensure appropriate management. Patients with PAD should be treated with guideline-directed medical therapy (GDMT), including antithrombotic, lipid-lowering, glucose-lowering and anti-hypertensive therapies, and exercise therapies that aim to improve function as well as cardiovascular and limb outcomes. For patients with compromised limb viability, such as acute and chronic limb-threatening ischaemia, or severe functional impairment that does not improve with exercise training, lower extremity revascularization is recommended. Given the complexity of PAD management, a multidisciplinary vascular team is required to achieve the best individualized treatment. Further research efforts should focus on reducing ischaemic events and health disparities and on optimizing the implementation of GDMT and exercise therapy, as well as improving the quality of life in patients with PAD.

Summary: Background: In the latest American Heart Association guidelines, influenza vaccination is recommended for patients with peripheral arterial disease (PAD). The vaccination coverage in this specific population is currently unknown. This study aims to determine the adherence to influenza vaccination in a PAD population and identify associated determinants. Patients and methods. Hospitalized patients and outpatients with PAD from two university departments of vascular medicine were prospectively included. A questionnaire was administered to collect sociodemographic data, cardiovascular risk factors, influenza vaccination status, history of cardiovascular disease, and perception and knowledge about vaccination. Logistic regression was conducted to assess vaccination determinants. Results: Over a six-month period, 494 patients were included (median age 69.5, IQR [63–77], 78% male). Overall, 60.1% were either vaccinated or intended to be (Group 1). Vaccination was associated with age (odds-ratio [OR]=1.055, 95% confidence intervals [95%CI]: 1.035–1.075, p<0.0001), abdominal aorta aneurysm (OR=0.390, 95%CI: 0.229–0.664, p=0.001), chronic obstructive pulmonary disease (OR=0.545, 95%CI: 0.367–0.810, p=0.003), chronic renal disease (OR=0.630, 95%CI: 0.400–0.993, p=0.046), and valvulopathy (OR=2.444, 95%CI: 1.122–5.326, p=0.025). Only 25.3% received vaccination information mainly from their general practitioners. Among patients against vaccination, 59.9% considered themselves not concerned about potential influenza consequences on their PAD, and 37.6% did not intend to change their decision. Conclusions: This study highlights the low adherence to influenza vaccination in the PAD population of 2 university hospital centers. Vaccination is often related to age, and there is a need for adapted information regarding influenza consequences on cardiovascular disease overall, particularly on PAD. Addressing common information and advice about vaccination will be a challenge.

Summary: Background: Cardiovascular risk factors (CVRF) are associated with major cause of death and disability in Sub-Saharan Africa, especially in women. The contribution of obstetrical, psychological, and socio-economic factors in CVRF are not yet well described in Africa. We aimed to compare the prevalence of CVRF between men and women, and to determine the factors associated to these sex-related differences. Patients and methods: A cross-sectional study was conducted on the 2019 data of the TAHES cohort in a geographically defined general population in Benin. A standardized questionnaire adapted from the World Health Organization (WHO) STEPS instrument was used to collect data. Univariate and multivariate analysis has been performed to determine CVRF differences in both sexes. Women-specific logistic regressions have been performed on CVRF previously identified as positively associated to female sex, to assess their association with socio-economic, psychological, and obstetrical factors. Results: We included 1583 patients, with a median age of 39 years [range: 32–53 years]. Prevalence of diabetes (1.2% vs. 3.4%, p=0.0042), abnormal kidney function (15.5% vs. 8.4%, p=0.0002), obesity (12.5% vs. 4.1%, p<0.0001), tobacco-smoking (3.4% vs. 14.1%, p<0.0001) and reduced physical activity (69.9% vs. 50.7%, p<0.0001) differed significantly between women and men, respectively. In multivariate analysis, female sex was independently and significantly associated with obesity, anxiety, depression and reduced physical activity. Number of pregnancies was associated with a reduced physical activity. Hypertension was associated with gestational hypertension. Conclusions: Obesity and reduced physical activity are significantly and independently more frequent in Beninese women than the male counterparts. Hypertension prevalence in Benin is alarming in both sexes. Targeted prevention strategies against obesity, gestational hypertension and sedentary lifestyle are advocated in African women.