Cardiovascular disease is the leading cause of morbidity and mortality in women, and its development results from both traditional risk factors and female-specific determinants that emerge across the life course. This narrative review explores the role of physical activity in reducing risk associated with five major sex-specific cardiovascular determinants: hormonal contraception, polycystic ovary syndrome, endometriosis, pregnancy complications and menopause. This review synthesized up-to-date studies exploring the associations between these conditions and cardiovascular risk in women, as well as research assessing whether physical activity may help to reduce this risk through various mechanisms. Hormonal contraception, polycystic ovary syndrome, endometriosis, pregnancy complications and menopause are each associated with distinct or overlapping pathophysiological pathways that involve metabolic dysfunction, systemic inflammation, endothelial impairment, adverse vascular remodelling or prothrombotic alterations. Together, these mechanisms contribute to an elevated lifetime risk of cardiovascular disease in women. Physical activity appears to improve many of these underlying processes, although the level of evidence, the magnitude and the specificity of these benefits vary by condition. Physical activity is a central and highly relevant approach to preventing cardiovascular disease in women exposed to sex-specific risk factors. Although current evidence is encouraging, further research is needed to clarify mechanistic pathways, strengthen causal inference and refine exercise prescriptions adapted to each condition. Individualized risk assessment and the integration of physical activity into long-term preventive and clinical management strategies are essential to reduce the cardiovascular burden in women.

ABSTRACT Menopause is associated with increased blood pressure (BP) and vasomotor symptoms (VMS), both elevating cardiovascular risk. Exercise can induce postexercise hypotension (PEH), with responses varying by exercise type and population characteristics. This study aimed to (1) examine the effect of high‐intensity interval exercise (HIIE) and isometric resistance exercise (IRE) compared to control session (CONT) on PEH in normotensive postmenopausal women and (2) examine the VMS effect on PEH responses. A cross‐over randomized controlled trial was conducted in 29 women (15 with moderate‐to‐severe VMS, 14 without), aged 55 ± 3 years. HIIE included 2 sets of 12*15‐s at 100% maximal aerobic power, IRE included 4*2‐min at 30% maximal voluntary contraction, and CONT included a sitting period. PEH was assessed 30 min post‐session and with 24‐h assessment, providing data on dipping profiles and BP variability. Repeated measures ANOVA with Bonferroni post hoc tests were conducted. HIIE induced systolic PEH at +30 min postexercise compared to pre‐exercise (−6.1 mmHg, p = 0.048) and CONT (−8.1 mmHg, p = 0.010). For IRE, nocturnal systolic (SBP) and diastolic (DBP) BP decreased versus CONT (SBP: −3.2 mmHg, p = 0.008; DBP: −2.0 mmHg, p = 0.003) and HIIE (SBP: −3.4 mmHg, p = 0.004; DBP: −2.2 mmHg, p < 0.001), increasing dippers proportion. In women with VMS, nocturnal SBP was lower after IRE than HIIE (−5.6 mmHg, p = 0.002). Both HIIE and IRE induced PEH in postmenopausal women, with HIIE reducing BP +30 min postexercise and IRE improving nocturnal BP and increasing dippers. In women with VMS, the nocturnal BP response varies according to exercise modality. Trial Registration The study is registered on clinicaltrials.gov (n°NCT06533982)

Une action globale sur le mode de vie améliore le contrôle de l’HTA, réduit les risques cardiovasculaires, et peut diminuer les besoins médicamenteux : alimentation adaptée : régime DASH riche en fibres, réduction du sel (< 5g/j), perte de poids, baisse d’alcool, apport en potassium ; activité physique régulière : aérobie≥150min/semaine+renforcement musculaire dynamique et isométrique+activités douces (Yoga, Qi Gong) ; gestion du stress, qualité du sommeil, arrêt du tabac.

Data on the effect of masks on ventilatory parameters are limited to maximal exercise. Their effects during submaximal exercise mimicking dailiy activties are unknown. The primary outcome was O2 consumption (VO2) at a level corresponding to 75% of the maximal speed determined in a previous maximal treadmill test without a mask. Randomized 3-arm non-inferiority cross-over trial comparing the effects of surgical and cloth masks to a sham mask. Subjects with no overt cardiac or pulmonary disease and practicing sport regularly were included. The non-inferiority threshold was set at −2 ml/kg/min. We analyzed 41 subjects (age: 38 ± 12 years, male: 66%, BMI: 22.5 ± 2.5). At 75% of maximal aerobic speed, heart rate was 164 ± 14 bpm and VO2 was 42 ± 6 ml/min/kg with the sham mask. Although the mean difference in VO2 between the sham mask and either the cloth or surgical masks was small (−2.2 and −1.4 ml/kg/min, respectively), the lower limit of the 97.5% confidence interval for both masks (−3.0 and −2.2 ml/kg/min, respectively) exceeded the predefined non-inferiority limit of −2 ml/kg/min, and we cannot conclude non-inferiority. Carbon dioxide production (VCO2) with the sham mask was 2652 ± 581 ml/min and was significantly lower with both the cloth and surgical masks (mean difference: −160 [IC95%: −235;−84] ml/min, p < 0.0001 and −121 [−184;−59] ml/min p< 0,0001, respectively). Example of a subject see Figure 1. Expiratory volume (EV) was 78.50 ± 15,28 l/min in the sham group. It was significantly higher in both cloth and surgical groups (mean difference: −11.28 l/min [IC95%: −14.37;−8.19] l/min, p < 0.0001 and −7.70 l/min [−9.63;−5.77 l/min], p < 0.0001, respectively). Compared to the placebo mask, both the surgical and cloth masks increased discomfort in several aspects: humidity, warmth, itchiness, tightness, maladjustment, fatigue (all p-values < 0.0001). Both surgical or tissue masks induced decreased marginally VO2 consumption. In contrast, EV was reduced with both surgical and tissue masks suggesting that masks significantly reduced ventilation during exercise.

SARS-CoV-2 infection can induce cardiac damages. Therefore, in the absence of clear data, a systematic cardiac evaluation was recommended for athletes before return-to-play after recent SARS-CoV-2 infection. To assess the prevalence of anomalies detected by this systematic cardiac screening. We reviewed the medical files of elite athletes referred for cardiac evaluation before return to play after a non-hospitalized SARS-CoV-2 infection (based on a positive PCR or antigen test), from March 2020 to July 2021, in 12 French centers. In total, 554 high level athletes were included (mean age 23 ± 6 years), mostly male (72%). An ECG, echocardiography and exercise test was performed respectively in 551 (99.5%), 497 (89.7%) and 293 (52.9%) of athletes. We found anomalies with a potential link with SARS-CoV-2 infection in 4 ECG (0.7%), 3 echocardiographies (0.6%) and 3 exercises test (1.0%). Cardiac magnetic resonance imaging was performed in 34 athletes (6.1%), mostly due to abnormal first line examinations, and was abnormal in 1 (2.9%). The rate of those abnormalities was not higher in case of cardiac symptoms or in patients with more severe forms of non-hospitalized SARS-CoV-2 infection. Only one had a possible SARS-CoV-2 myocarditis and was temporally contraindicated to return-to-play. None had a major cardiac event declared during the follow-up (Fig. 1). The prevalence of cardiac involvement after non-hospitalized forms of SARS-CoV-2 infection in athletes are very low. A systematic cardiac screening before return-to-play seems not be mandatory in the majority of athletes.

Objective: Launched by the International Society of Hypertension and supported by the World League Against Hypertension, May Measurement Month (MMM) is a worldwide campaign to screen for hypertension. The objective of this study is to identify, valorize, and publicize the data obtained in France and Monaco on the occasion of MMM 2022 under the auspices of the French Society of Hypertension (SFHTA). Design and method: The SFHTA proposed ‘an MMM protocol kit’ adapted in French and declared to the Committee for the Protection of Persons with the support of the French Society of Cardiology. A blood pressure monitor (Omron HEM-FL31/M3 Comfort) was sent to the centers that had requested it. 12 centers participated from June to October. Results: Are summarized in the table. In this population of 1187 subjects, women were in the majority. Eight out of 10 screened subjects measured their BP at least once a year. 34% declared themselves to be hypertensive, and among the treated hypertensives, 56% reported being on monotherapy. 10% of the screened individuals are not vaccinated against COVID. Conclusions: The SFHTA, which is positively involved with European and International bodies to raise awareness of hypertension screening, has encouraged its members to participate collectively. Our MMM data collected remain limited about interpretation in public health and at the level of the French population. Nevertheless, the MMM approach could help alert to the public, health professionals, and government authorities to reduce the burden of hypertension. Thanks to all the teams of each site who participated in this campaign.

BACKGROUND:Resistant hypertension (RHT) is a major health care concern affecting 20 to 30% of hypertensive patients and increasing cardiovascular risk. Recent renal denervation trials have suggested a high prevalence of accessory renal arteries (ARA) in RHT. Our objective was to compare the prevalence of ARA in RHT vs. non-resistant hypertension (NRHT).METHODS:Eighty-six patients with essential hypertension who benefited from an abdominal CT-scan or MRI during their initial workup were retrospectively recruited in 6 French ESH (European Society of Hypertension) centers. At the end of a follow-up period of at least 6 months, patients were classified between RHT or NRHT. RHT was defined as uncontrolled blood pressure despite the optimal doses of three antihypertensive agents of which one is a diuretic or similar, or controlled by ≥ 4 medications. Blinded independent central review of all radiologic renal artery charts was performed.RESULTS:Baseline characteristics were: age 50±15 years, 62% males, BP 145±22/87±13mmHg. Fifty-three (62%) patients had RHT and 25 (29%) had at least one ARA. Prevalence of ARA was comparable between RHT (25%) and NRHT patients (33%, P=0.62), but there were more ARA per patient in NRHT (2±0.9) vs. RHT (1.3±0.5, P=0.05), and renin levels were higher in ARA group (51.6±41.7 mUI/L vs. 20.4±25.4 mUI/L, P=0.001). ARA were similar in diameter or length between the 2 groups.CONCLUSIONS:In this retrospective series of 86 essential hypertension patients, we found no difference in the prevalence of ARA in RHT and NRHT. More comprehensive studies are needed to answer this question.

Background: SARS-CoV-2 infection can induce cardiac damage. Therefore, in the absence of clear data, a cardiac evaluation was recommended for athletes before returning to play after recent SARS-CoV-2 infection. Aim: To assess the proportion of anomalies detected by this cardiac screening. Methods: We reviewed the medical files of elite athletes referred for cardiac evaluation before returning to play after a non-hospitalized SARS-CoV-2 infection (based on a positive polymerase chain reaction or antigen test) from March 2020 to July 2021 in 12 French centres. Results: A total of 554 elite athletes (professional or national level) were included (median age 22 years, 72.0% male). An electrocardiogram (ECG), echocardiogram and exercise test were performed in 551 (99.5%), 497 (89.7%) and 293 (52.9%) athletes, respectively. We found anomalies with a potential link with SARS-CoV-2 infection in four ECGs (0.7%), three echocardiograms (0.6%) and three exercise tests (1.0%). Cardiac magnetic resonance imaging was performed in 34 athletes (6.1%), mostly due to abnormal first-line examinations, and was abnormal in one (2.9%). The rates of those abnormalities were not higher among athletes with cardiac symptoms or more severe forms of non-hospitalized SARS-CoV-2 infection. Only one athlete had a possible SARS-CoV-2 myocarditis and sport was temporally contraindicated. None had a major cardiac event declared during the follow-up. Conclusion: The proportion of cardiac involvement after non-hospitalized forms of SARS-CoV-2 infection in athletes are very low. Systematic cardiac screening before returning to play seems to be unnecessary. (c) 2022 Elsevier Masson SAS. All rights reserved.

The rapid increase in population aging and associated age-related cognitive decline requires identifying innovative and effective methods to prevent it. To manage this socio-economic challenge, physical, cognitive, and combined stimulations are proposed. The superiority of simultaneous training compared to passive control and physical training alone seems to be an efficient method, but very few studies assess the acute effect on executive function. This study aimed to investigate the acute effect of simultaneous physical and cognitive exercise on executive functions in healthy older adults, in comparison with either training alone. Seventeen healthy older adults performed three experimental conditions in randomized order: physical exercise, cognitive exercise, and simultaneous physical and cognitive exercise. The protocol involved a 30 min exercise duration at 60% of theoretical maximal heart rate or 30 min of cognitive exercise or both. Executive functions measured by the Stroop task and pre-frontal cortex oxygenation were assessed before and after the intervention. We found a main effect of time on executive function and all experimental condition seems to improve inhibition and flexibility scores (<0.05). We also found a decrease in cerebral oxygenation (Δ[HbO2]) in both hemispheres after each intervention in all cognitive performance assessed (p < 0.05). Simultaneous physical and cognitive exercise is as effective a method as either physical or cognitive exercise alone for improving executive function. The results of this study may have important clinical repercussions by allowing to optimize the interventions designed to maintain the cognitive health of older adults since simultaneous provide a time-efficient strategy to improve cognitive performance in older adults.

Objective: Euroaspire surveys highlighted the insufficiency of control of cardiovascular risk factor (CVRF) in coronary patient in secondary prevention. Patient profiles have changed, making it difficult to analyse these data over time. Our aim was to establish the state of CVRF control in two cohorts of French hypertensive patients in different clinical situations of primary and secondary prevention by following the variables assessed in Euroaspire. Design and method: Of each of the 22 participating hypertension specialist consultations, the first 20 patients (followed for at least one year) were included. Theoretical objectives were notified for each patient according to clinical profile. Two cohorts were formed, Cohort 1 (C1) in 2009 (n = 185) and Cohort 2 (C2) in 2019 (n = 260). Patients were classified according to their prevention (P) profile: primary (P1) and secondary (P2). Results: Baseline data are summarized in Table 1. The main statistically significant results between C2 vs C1 respectively are: younger people (58.8 vs 63.9 y) and more women in P1 (50% vs 32%); higher systolic blood pressure (BP) in P2 (143.7 vs 134.7 mm Hg), whereas higher diastolic BP in P1 (81.7 vs 76.6 mm Hg); fewer diabetic patients in P1 (19% vs 41%); poorly BP targets met in P1 (43% vs 63%); lower number of antihypertensive drugs in both groups (P1: 2.17 vs 2.66; P2: 2.62 vs 3.16); prescription of statins felt by half in P1 (30% vs 43%) within 10y. Conclusions: The high prevalence of unhealthy lifestyles, modifiable CVRF and inadequate use of drug therapies to achieve BP and lipid goals, are documented findings of the Euroaspire surveys in coronary patient, which we confirm in our hypertensive patients. Indeed, the P1 patient is less well managed than 10 years. In P2, there is no difference between the two cohorts, no improvement in BP control, possibly related with a reduction in the number of antihypertensive drugs. Ambition targets allocated for global prevention by combating the clinical inertia in titrating treatments must be a medical priority in clinical practice. Thanks to patients and Club des Jeunes Hypertensiologues.

Hypertension is much less common in children than in adults. The group of experts decided to perform a review of the literature to draw up a position statement that could be used in everyday practice. The group rated recommendations using the GRADE approach. All children over the age of 3 years should have their blood pressure measured annually. Due to the lack of data on cardiovascular morbidity and mortality associated with blood pressure values, the definition of hypertension in children is a statistical value based on the normal distribution of blood pressure in the paediatric population, and children and adolescents are considered as having hypertension when their blood pressure is greater than or equal to the 95th percentile. Nevertheless, it is recommended to use normative blood pressure tables developed according to age, height and gender, to define hypertension. Measuring blood pressure in children can be technically challenging and several measurement methods are listed here. Regardless of the age of the child, it is recommended to carefully check for a secondary cause of hypertension as in 2/3 of cases it has a renal or cardiac origin. The care pathway and principles of the therapeutic strategy are described here.

Tenascin-C (TN-C) is an extracellular matrix glycoprotein highly expressed in inflammatory and cardiovascular (CV) diseases. Serum TN-C has not yet been specifically studied in individuals with type 2 diabetes, a condition associated with chronic low-grade inflammation and increased CV disease risk. In this study, we hypothesised that elevated serum TN-C at enrolment in participants with type 2 diabetes would be associated with increased risk of death and major adverse CV events (MACE) during follow-up. We used a prospective, monocentric cohort of consecutive type 2 diabetes participants (the SURDIAGENE [SUivi Rénal, DIAbète de type 2 et GENEtique] cohort) with all-cause death as a primary endpoint and MACE (CV death, non-fatal myocardial infarction or stroke) as a secondary endpoint. We used a proportional hazard model after adjustment for traditional risk factors and the relative integrated discrimination improvement (rIDI) to assess the incremental predictive value of TN-C for these risk factors. We monitored 1321 individuals (58% men, mean age 64 ± 11 years) for a median of 89 months. During follow-up, 442 individuals died and 497 had MACE. Multivariate Cox analysis showed that serum TN-C concentrations were associated with an increased risk of death (HR per 1 SD: 1.27 [95% CI 1.17, 1.38]; p < 0.0001) and MACE (HR per 1 SD: 1.23 [95% CI 1.13, 1.34]; p < 0.0001). Using TN-C concentrations on top of traditional risk factors, prediction of the risk of all-cause death (rIDI: 8.2%; p = 0.0006) and MACE (rIDI: 6.7%; p = 0.0014) improved significantly, but modestly. In individuals with type 2 diabetes, increased serum TN-C concentrations were independently associated with death and MACE. Therefore, including TN-C as a prognostic biomarker could improve risk stratification in these individuals.

Tenascin-C (TNC) is an extracellular matrix glycoprotein highly expressed in inflammatory and cardiovascular (CV) pathologies. In heart failure or after myocardial infarction, elevated TNC is associated with adverse outcomes. Serum TNC has not yet been studied specifically in patients with type II diabetes, a condition associated with chronic low-grade inflammation and increased CV risk. We hypothesized that high serum TNC measured at enrolment in a large cohort of type II diabetic patients is associated with major adverse CV events (MACE) and death during follow-up. A prospective, monocentric cohort of consecutive type 2 diabetes patients (the SURDIAGENE cohort; total of 1338 patients; 58% men, mean ± SD age 64 ± 11 years) was followed for a median of 89 months for death as primary endpoint and MACE (i.e. CV death, myocardial infarction or stroke) as a secondary endpoint. Patients with stage ≥ 4 renal disease were excluded. During follow-up, 448 patients (representing 4.4% of the total person-years) died and 506 patients (representing 5.2% of the total person-years) presented with MACE. Cox multivariate analysis showed that increased serum TNC concentrations were significantly associated with death (HR per 10 ng/mL: 1.03 (1.01–1.05) P = 0.0095) and MACE (HR per 10 ng/mL: 1.02 (1.00–1.04) P = 0.0162), after adjustment for sex, age, established modifiable CV risk factors (active smoking, hypertension, hypercholesterolemia) and NT-proBNP levels. In patients with type 2 diabetes, we show for the first time that increased serum TNC concentrations are independently associated with MACE and death. These findings suggest that elevated TNC expression might be implicated in the increased CV risk associated with diabetes, and might be useful for CV risk stratification in this context.

Background. - Cardiovascular diseases are a leading cause of mortality, but a substantial proportion are preventable. Aims. - The Mutuelle generale de l'education nationale (MGEN), a provider of private health insurance in France, has developed the VIVOPTIM programme, a novel digital approach to healthcare based on individualized, multiprofessional, ranked management of cardiovascular risk factors. Methods. - Between November 2015 and June 2016, eligible individuals (age 30-70 years) from two regions of France were invited to participate. Volunteers completed a questionnaire based on the Framingham Heart Study Risk Score and were assigned to one of three cardiovascular risk levels. VIVOPTIM comprises four components: cardiovascular risk assessment, instruction on cardiovascular diseases and associated risk factors, personalized coaching (telephone sessions with a specially trained healthcare professional to provide information on risk factors and disease management, set individual health targets, monitor progress and motivate participants), and e-Health monitoring. Results. - Data from 2240 participants were analysed. Significant benefits were observed on mean systolic blood pressure (-3.4 mmHg), weight (-1.5 kg), smoking (-2.2 cigarettes/day) and daily steps (+1726 steps/day (all P<0.0001)), though not on weekly duration of exercise (-0.2 hours/week, P=0.619). Conclusion. - As a result of the positive mid-to-long-term results of the pilot programme on weight, smoking, blood pressure, and uptake of physical activity, the VIVOPTIM programme was extend to the whole of France in 2018 and has the potential to have a genuine impact on patient care and organization of the healthcare system in France. (C) 2020 Published by Elsevier Masson SAS.

Clinic-ambulatory blood pressure (BP) difference is influenced by patients- and device-related factors and inadequate clinic-BP measurement. We investigated whether nonadherence to antihypertensive medications may also influence this difference in a post hoc analysis of the DENERHTN trial (Renal Denervation for Hypertension). We pooled the data of 77 out of 106 evaluable patients with apparent resistant hypertension who received a standardized antihypertensive treatment and had both ambulatory BP and drug-screening results available at baseline after 1 month of standardized triple therapy and at 6 months on a median of 5 antihypertensive drugs. After drug assay samplings on study visits, patients took their antihypertensive treatment under supervision immediately after the start of the ambulatory BP recording, and supine clinic BP was measured 24 hours post-dosing; both allowed to calculate the clinic minus daytime ambulatory systolic BP (SBP) difference (clinic-SBP-day-SBP). A total of 29 (37.7%) were found nonadherent to medications at baseline and 38 (49.4%) at 6 months. At baseline, the mean clinic-SBP-day-SBP difference in the nonadherent group was 12.7 mmHg (95% CI, 7.8-17.7 mmHg, P<0.001). In contrast, clinic SBP was almost identical to day-SBP in the adherent group (clinic-SBP-day-SBP difference, 0.1 mmHg; 95% CI, -3.3 to 3.5 mmHg; P=0.947). Similar observations were made at 6 months. Using receiver operating characteristics curves, we found that a 6 mmHg cutoff of clinic-SBP-day-SBP difference had 67% sensitivity and 69% specificity to predict nonadherence to the triple therapy at baseline. In conclusion, a large clinic-SBP-day-SBP difference may help discriminating between adherence and nonadherence to treatment in patients with resistant hypertension. Clinical Trial Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT01570777.

Background. - Hypertension guidelines recommend moderate-intensity continuous training (MICT) for the primary or secondary prevention of hypertension. However, alternative modalities, such as high-intensity interval training (HIIT) on dry land or in water, have been studied less widely. Aim. - To assess chronic blood pressure (BP) response to a 2-week training programme involving six sessions of either MICT or HIIT performed on dry land or HIIT performed in an immersed condition, in participants with baseline office systolic/diastolic BP (SBP/DBP) >= 130/85 mmHg. Methods. - We randomly assigned 42 individuals (mean age 65 +/- 7 years; 52% men) with baseline office SBP/DBP >= 130/85 mmHg to perform six 24-minute sessions on an ergocycle (three times a week for 2 weeks) of either MICT on dry land, HIIT on dry land or HIIT in a swimming pool, and assessed BP responses using 24-hour ambulatory BP monitoring. Results. - While 2-week MICT and HIIT on dry land modified none of the 24-hour average haemodynamic variables significantly, immersed HIIT induced a significant decrease in 24-hour BP (SBP -5.1 +/- 7.3 [P= 0.02]; DBP -2.9 +/- 4.1 mmHg [P= 0.02]) and daytime BP (SBP -6.2 +/- 8.3 [P= 0.015]; DBP -3.4 +/- 4.0 mmHg [P= 0.008]), and slightly improved 24-hour and daytime pulse wave velocity (PWV) (24-hour PWV -0.17 +/- 0.23 m/s [P= 0.015]; daytime PWV -0.18 +/- 0.24 m/s [P= 0.02]). Conclusion. - HIIT on an immersed stationary ergocycle is an innovative method that should be considered as an efficient non-pharmacological treatment of hypertension. As such, it should now be implemented in a larger cohort to study its long-term effects on the cardiovascular system. (C) 2019 Elsevier Masson SAS. All rights reserved.

Diabetes & Metabolism - In Press.Proof corrected by the author Available online since lundi 12 mars 2018