[Heart and brain: are the risk factors the same? Are the results of primary and secondary trials comparable?].
The aim of this study was to identify the similitudes and the differences in the epidemiology and prevention of myocardial infarction and cerebrovascular accidents by analysis of trials of primary and secondary prevention of myocardial infarction and cerebrovascular accidents. The principal risk factors common to both pathologies are hypertension, smoking and increased LDL-cholesterol. However, the statistical significance with respect to causality differs from one pathology to the other. Similarly, the impact of preventive measures is not the same: the treatment of hypertension is more important in the prevention of cerebrovascular accidents than myocardial infarction; the situation is the other way around with respect to the treatment of hypercholesterolaemia. Of the therapeutic interventions, aspirin is effective in all stages of coronary artery disease but does not prevent cerebrovascular accidents in patients without documented atherosclerosis. Thrombolysis carries a much higher benefit/risk ratio in the treatment of myocardial infarction than in that of cerebral infarction. The so-called cardioprotective drugs, such as the betablockers and angiotensin converting enzyme inhibitors, have only been used to any extent in the secondary prevention of myocardial infarction. These differences reflect the fact that cerebrovascular accident covers a range of diseases much more diverse than does myocardial infarction, and also that the brain is much more exposed to haemorrhage whereas cardiac haematoma is highly unusual. Finally, cerebral atherosclerosis is a later event than coronary atherosclerosis and this has epidemiological implications which are difficult to assess. In conclusion, the prevention of myocardial infarction and of cerebrovascular accidents may proceed theoretically by a common pathway but in practice, it is very different.
Castaigne
A
A
Service de cardiologie, hôpital Henri-Mondor, Fédération des services de médecine cardiologique, Créteil.
Haziza
F
F
Lopes-Darmon
M E
ME
D001161:Arteriosclerosis / Q000150:complications / Q000628:therapy; D002561:Cerebrovascular Disorders / Q000209:etiology* / Q000517:prevention & control; D008078:Cholesterol, LDL / Q000097:blood; D002986:Clinical Trials as Topic; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications*; D006973:Hypertension / Q000150:complications* / Q000628:therapy; D009203:Myocardial Infarction / Q000209:etiology* / Q000517:prevention & control; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D015912:Thrombolytic Therapy
D008078:Cholesterol, LDL
Coeur et cerveau: le poids des facteurs de resque est-il le même? Les résultats des études de prévention primaire et secondaire sont-ils comparables?