References of "SCHEEN, André"
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See detailRole du stress psychosocial dans les maladies complexes.
Scantamburlo, Gabrielle ULg; SCHEEN, André ULg

in Revue Médicale de Liège (2012), 67(5-6), 234-42

Complex diseases are chronic diseases where the interrelations between genetic predisposition and environmental factors play an essential role in the arisen and the maintenance of the pathology. Upon ... [more ▼]

Complex diseases are chronic diseases where the interrelations between genetic predisposition and environmental factors play an essential role in the arisen and the maintenance of the pathology. Upon psychological stress, the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system are activated resulting in release of glucocorticoids and catecholamines. Chronic stress may induce complex diseases where alterations of nervous, endocrine and immune systems are involved. Thus, chronic stress is more likely to induce a range of effects, depending on the capacity of the subject to cope with stress. CRH ("Corticotropin Releasing Hormone") is a key factor in the stress-immunity relationship. In this article, we propose an overview of the interrelations between central nervous, endocrine and immune systems and implications for health and diseases. The objective for the clinician is to propose therapeutic strategies targeting changes in human behaviour to cope with a potentially stressful environment. [less ▲]

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See detailMaladies complexes: des interactions genes-environnement au probleme de sante publique.
SCHEEN, André ULg; Bours, Vincent ULg

in Revue Médicale de Liège (2012), 67(5-6), 217-9

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See detailRole de l'environnement dans les maladies complexes: pollution atmospherique et contaminants alimentaires.
SCHEEN, André ULg; Giet, Didier ULg

in Revue Médicale de Liège (2012), 67(5-6), 226-33

Our polluted environment exposes human beings, along their life, to various toxic compounds that could trigger and aggravate different complex diseases. Such a phenomenon is well recognized for ... [more ▼]

Our polluted environment exposes human beings, along their life, to various toxic compounds that could trigger and aggravate different complex diseases. Such a phenomenon is well recognized for cardiovascular diseases, respiratory diseases and cancers, but other chronic inflammatory disorders may also been implicated. The most common factors, but also the most toxic, and thereby the most extensively investigated, are air pollutants (both indoor and outdoor pollution) and various contaminants present in drinking water and food (organic compounds, chemical products, heavy metals, ...). The complex interrelationships between food and pollutants, on the one hand, and between gene and environmental pollutants, including the influence of epigenetics, on the other hand, deserve further careful studies. [less ▲]

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See detailEpigenetique, interface entre environnement et genes: ro1e dans les maladies complexes.
SCHEEN, André ULg; Junien, C.

in Revue Médicale de Liège (2012), 67(5-6), 250-7

Epigenetics is the study of heritable changes in gene expression or cellular phenotype caused by mechanisms other than changes in the underlying DNA sequence. Epigenetics is one of the major mechanisms ... [more ▼]

Epigenetics is the study of heritable changes in gene expression or cellular phenotype caused by mechanisms other than changes in the underlying DNA sequence. Epigenetics is one of the major mechanisms explaining the "Developmental Origin of Health and Diseases" (DOHaD). Besides genetic background inherited from parents, which confers susceptibility to certain pathologies, epigenetic changes constitute the memory of previous events, either positive or negative, along the life cycle, including at the in utero stage. The later exposition to hostile environment may reveal such susceptibility, with the development of various pathologies, among them numerous chronic complex diseases. The demonstration of such a sequence of events has been shown for metabolic diseases as obesity, metabolic syndrome and type 2 diabetes, cardiovascular disease and cancer. In contrast to genetic predisposition, which is irreversible, epigenetic changes are potentially reversible, thus giving targets not only for prevention, but possibly also for the treatment of certain complex diseases. [less ▲]

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See detailRelations entre gain baroreflexe et stress pulsatile chez le patient diabetique de type 1.
SCHEEN, André ULg; MARCHAND, Monique ULg; PHILIPS, Jean-Christophe ULg

in Annales de Cardiologie et d'Angeiologie (2012)

AIM OF THE STUDY: Cardiovascular autonomic neuropathy (CAN) and early arterial stiffness are frequent complications in type 1 diabetes. The aim of our work is to study the relationships between CAN ... [more ▼]

AIM OF THE STUDY: Cardiovascular autonomic neuropathy (CAN) and early arterial stiffness are frequent complications in type 1 diabetes. The aim of our work is to study the relationships between CAN (estimated by baroreflex gain calculation) and arterial stiffness (estimated by pulsatile stress) in type 1 diabetic patients. PATIENTS AND METHODS: In a cross-sectional study, we calculated baroreflex gain and pulsatile stress in 167 type 1 diabetic patients and 160 matched non-diabetic subjects whose blood pressure was continuously monitored with a Finapres((R)) device in a postural test (squatting test). The baroreflex gain was calculated by plotting the pulse intervals (R-R) against systolic blood pressure values during the transition phase from squatting to standing. Pulsatile stress was estimated by the pulse pressurexheart rate product. In a longitudinal study, the baroreflex gain and pulsatile stress were calculated before and after a mean follow-up of 79+/-33 months in type 1 diabetic patients. RESULTS: Cross-sectional data showed a decrease in baroreflex gain and an increase in pulsatile stress in type 1 diabetic patients versus the matched non-diabetic subjects. A significant correlation between the baroreflex gain and pulsatile stress was present. Type 1 diabetic patients with lower baroreflex gain had a higher value of pulsatile stress when compared to those with higher baroreflex gain. During follow-up, a significant reduction in baroreflex gain (but without significantly increased pulsatile stress) was observed. A univariate analysis showed that the decrease of the baroreflex gain is not correlated with the time interval between the two tests, neither type 1 diabetes duration nor mean glycated hemoglobin values, but significantly with the pulsatile stress increase. CONCLUSION: In type 1 diabetic patients, the baroreflex gain is decreased and the pulsatile stress is increased when these markers are compared to age-matched non-diabetic subjects. There is a relationship between indices of CAN and arterial stiffness. Nevertheless, the baroreflex gain (marker of CAN) is impaired earlier than the pulsatile stress in this type 1 diabetic population with inadequate glycaemic control. [less ▲]

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See detailDipeptidylpeptidase-4 (DPP-4) inhibitors are favourable to glucagon-like peptide-1 (GLP-1) receptor agonists: yes.
SCHEEN, André ULg

in European Journal of Internal Medicine (2012), 23(2), 126-31

The pharmacological treatment of type 2 diabetes (T2DM) is becoming increasingly complex, especially since the availability of incretin-based therapies. Compared with other glucose-lowering strategies ... [more ▼]

The pharmacological treatment of type 2 diabetes (T2DM) is becoming increasingly complex, especially since the availability of incretin-based therapies. Compared with other glucose-lowering strategies, these novel drugs offer some advantages such as an absence of weight gain and a negligible risk of hypoglycaemia and, possibly, better cardiovascular and beta-cell protection. The physician has now multiple choices to manage his/her patient after secondary failure of metformin, and the question whether it is preferable to add an oral dipeptidylpeptidase-4 (DPP-4) inhibitor (gliptin) or an injectable glucagon-like peptide-1 (GLP-1) receptor agonist will emerge. Obviously, DPP-4 inhibitors offer several advantages compared with GLP-1 receptor agonists, especially regarding easiness of use, tolerance profile and cost. However, because they can only increase endogenous GLP-1 concentrations to physiological (rather than pharmacological) levels, they are less potent to improve glucose control, promote weight reduction ("weight neutrality") and reduce blood pressure compared to GLP-1 receptor agonists. Of note, none of the two classes have proven long-term safety and positive impact on diabetic complications yet. The role of DPP-4 inhibitors and GLP-1 receptor agonists in the therapeutic armamentarium of T2DM is rapidly evolving, but their respective potential strengths and weaknesses should be better defined in long-term head-to-head comparative controlled trials. Instead of trying to answer the question whether DPP-4 inhibitors are favourable to GLP-1 receptor agonists (or vice versa), it is probably more clinically relevant to look at which T2DM patient will benefit more from one or the other therapy considering all his/her individual clinical characteristics ("personalized medicine"). [less ▲]

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See detailPharmacokinetic evaluation of atorvastatin and sitagliptin in combination for the treatment of type 2 diabetes.
SCHEEN, André ULg

in Expert Opinion on Drug Metabolism & Toxicology (2012), 8(6), 745-58

INTRODUCTION: Patients with type 2 diabetes (T2DM) are exposed to a high risk of cardiovascular disease (CVD) requiring a global therapeutic approach. Statin therapy has proven its efficacy in reducing ... [more ▼]

INTRODUCTION: Patients with type 2 diabetes (T2DM) are exposed to a high risk of cardiovascular disease (CVD) requiring a global therapeutic approach. Statin therapy has proven its efficacy in reducing CVD events in T2DM patients. Dipeptidylpeptidase-4 inhibitors (gliptins), which are increasingly used to target hyperglycemia, also offer promising preliminary results regarding a possible reduction in CVD events. As most patients with T2DM may be treated with both a statin and a gliptin, dual pharmacological therapy, possibly as a fixed-dose combination (FDC), deserves further consideration. AREAS COVERED: The reader is provided with an update of information on the pharmacokinetics (PK) and pharmacodynamics (PD) of atorvastatin and sitagliptin . The article provides an analysis of the potential PK/PD interactions between the two compounds and puts into perspective the potential cardiovascular protection that such a dual therapy may offer in patients with T2DM. EXPERT OPINION: Atorvastatin and sitagliptin are not prone to PK drug-drug interactions. Their coadministration, either separately or in an FDC, improves both blood glucose levels and cholesterol concentrations, without clinically relevant adverse events. The atorvastatin plus sitagliptin combination may be used to reduce LDL cholesterol and hyperglycemia in patients with T2DM, with the aim to improve CVD prognosis and adherence to therapy. [less ▲]

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See detailHypertension et diabete: a propos d'une association commune mais complexe.
SCHEEN, André ULg; Philips, J.-C.; Krzesinski, Jean-Marie ULg

in Revue Médicale de Liège (2012), 67(3), 133-8

Both diabetes mellitus and arterial hypertension are commonly observed in a single patient. However, the relationship between these two entities is rather complex and there is a great heterogeneity ... [more ▼]

Both diabetes mellitus and arterial hypertension are commonly observed in a single patient. However, the relationship between these two entities is rather complex and there is a great heterogeneity regarding the underlying pathophysiological mechanisms and the clinical presentations. These particularities may have important consequences from a therapeutic point of view, as far as blood pressure targets or even pharmacological strategies are concerned. The present article will discuss the various causes of hypertension in the different types of diabetes, the different forms of hypertension in the diabetic patient, the modalities of treating hypertension in presence of various specific complications (metabolic syndrome, coronary heart disease or renal impairment), and the specificities when hypertension is associated with diabetic cardiovascular autonomic neuropathy. [less ▲]

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See detailComment je traite ... une dyslipidemie en fonction du profil de risque cardiovasculaire.
Descamps, O. S.; SCHEEN, André ULg; De Backer, G. et al

in Revue Médicale de Liège (2012), 67(4), 167-73

The new guidelines from the European Atherosclerosis Society and the European Society of Cardiology include a number of new items. Here we demonstrate their application in several different clinical ... [more ▼]

The new guidelines from the European Atherosclerosis Society and the European Society of Cardiology include a number of new items. Here we demonstrate their application in several different clinical examples. We focus on the 4 items most pertinent for medical practice: 1) the stratification of risk of cardiovascular disease into 4 categories ('very high', 'high', 'moderate' and 'low risk'), involving--for primary prevention cases--the use of the SCORE table, which has been calibrated for Belgium and where the risk can be adjusted according to HDL cholesterol and the presence of other risk factors; 2) the choice of more stringent therapeutic targets for LDL cholesterol (< 70 mg/dl for 'very high' risk patients, 100 mg/dl for 'high' risk patients and 115 mg/dl for patients at 'moderate' risk); 3) the choice of other therapeutic targets (non-HDL cholesterol and apolipoprotein B levels) for patients at 'very high' or 'high' risk with combined dyslipidaemia; and 4) follow-up of lipid parameters and muscular and hepatic enzymatic profiles. [less ▲]

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See detailLes nouvelles recommandations Europeennes pour le traitement des dyslipidemies en prevention cardiovasculaire.
Descamps, O. S.; De Backer, G.; Annemans, L. et al

in Revue Médicale de Liège (2012), 67(3), 118-27

The new guidelines from the European Atherosclerosis Society and the European Society of Cardiology include a number of updated items. In this paper, we summarize 4 of these changes that we consider to be ... [more ▼]

The new guidelines from the European Atherosclerosis Society and the European Society of Cardiology include a number of updated items. In this paper, we summarize 4 of these changes that we consider to be the most pertinent. Firstly, cardiovascular risk is now stratified according to 4 (previously 2) categories: "very high risk" (patients with cardiovascular disease, patients with diabetes > 40 years old who have at least one other risk factor, patients with kidney failure, or patients in primary prevention with a SCORE value > or = 10%); "high risk" (patients in primary prevention with a SCORE value > or = 5% and < 10% or patients with a particularly serious risk factor such as familial hypercholesterolaemia or patients with diabetes < 40 years old without any other risk factor); "moderate risk" (primary prevention with SCORE > or = 1% and < 5%); and "low risk" (primary prevention with SCORE < 1%). The SCORE value for patients in primary prevention is estimated using the SCORE table (calibrated for Belgium). Risk in this table may now be corrected according to HDL cholesterol level. Secondly, the therapeutic targets for each category are now more stringent: LDL cholesterol < 70 mg/dl (or reduced by at least 50%) if the risk is "very high"; < 100 mg/dl if the risk is "high"; and < 115 mg/dl if the risk is "moderate". Thirdly, for patients at "high" or "very high" risk, particularly in patients with combined dyslipidaemia, two further therapeutic targets should be considered: non-HDL cholesterol and apolipoprotein B levels. Fourthly, the follow-up of efficacy (lipid profile) and tolerance (hepatic and muscular enzymes) is described in more details so as to harmonize case management in clinical practice. [less ▲]

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See detailLa vignette therapeutique de l'etudiant: Quelles cibles glycemiques et lipidiques viser chez un patient diabetique de type 2?
Paquot, Nicolas ULg; SCHEEN, André ULg

in Revue Médicale de Liège (2012), 67(2), 98-103

Patients with type 2 diabetes are at high cardiovascular risk and require a global management targeting all risk factors. Target values for blood pressure have been discussed in a previous paper. The ... [more ▼]

Patients with type 2 diabetes are at high cardiovascular risk and require a global management targeting all risk factors. Target values for blood pressure have been discussed in a previous paper. The present clinical case summarizes the most important arguments concerning the choice of the target values for glucose control (glycated haemoglobin or HbA1c) and lipid management. As far as glucose control is concerned, the objective should be individually adjusted, based on the benefits/risks ratio, with a less stringent HbA1c level in presence of coronary heart disease and risk of severe hypoglycaemia. However, in absence of these two risks factors, the objective should be reinforced (HbA1c < 7%), essentially to prevent or retard microangiopathic lesions. As far as lipid management is concerned, the most crucial goal remains LDL cholesterol lowering, with a target value < 100 mg/dL in patients at high cardiovascular risk and <70 mg/dL in patients at very high risk, according to the recent European guidelines. Dyslipidaemia related to the metabolic syndrome (hypertriglyceridaemia, low HDL cholesterol) may also represent a therapeutic target (non-HDL cholesterol), although evidence is mostly missing in the literature. [less ▲]

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See detailLe medicament du mois: Linagliptine (Trajenta): un inhibiteur selectif de la DPP-4 a elimination renale negligeable.
SCHEEN, André ULg; Van Gaal, L. F.

in Revue Médicale de Liège (2012), 67(2), 91-7

Linagliptin (Trajenta) is a selective inhibitor of dipeptidyl peptidase-4, an enzyme that degrades two incretin hormones, GLP-1 ("Glucagon-Like Peptide-1") and GIP ("Glucose-dependent Insulinotropic ... [more ▼]

Linagliptin (Trajenta) is a selective inhibitor of dipeptidyl peptidase-4, an enzyme that degrades two incretin hormones, GLP-1 ("Glucagon-Like Peptide-1") and GIP ("Glucose-dependent Insulinotropic Polypeptide"). As other molecules belonging to this pharmacological class, linagliptin improves blood glucose control of type 2 diabetic patients, without increasing hypoglycaemic risk, without promoting weight gain and with a good clinical and biological tolerance profile. Both efficacy and safety have been demonstrated in randomized controlled trials as monotherapy or in combination with other glucose-lowering agents, independent of demographic or clinical patient's characteristics. The pharmacokinetics specificity of linagliptin comprises its biliary excretion, with low hepatic metabolism (no drug-drug interactions) and, in contrast to other gliptins, its negligible renal elimination. Because of these favourable properties, linagliptin may be used without dose adjustment (5 mg once a day) in patients with renal impairment, as well as in elderly people. [less ▲]

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See detailMetformin + saxagliptin for type 2 diabetes.
SCHEEN, André ULg

in Expert Opinion on Pharmacotherapy (2012), 13(1), 139-46

INTRODUCTION: Metformin is considered as the first-line drug therapy for the management of type 2 diabetes. Dipeptidyl peptidase-4 (DPP-4) inhibitors, by promoting insulin secretion and reducing glucagon ... [more ▼]

INTRODUCTION: Metformin is considered as the first-line drug therapy for the management of type 2 diabetes. Dipeptidyl peptidase-4 (DPP-4) inhibitors, by promoting insulin secretion and reducing glucagon secretion in a glucose-dependent manner, offer new opportunities for oral therapy after failure of metformin. AREAS COVERED: An updated review of the literature demonstrates that saxagliptin, a DPP-4 inhibitor, and metformin may be administered together, separately or in fixed-dose combination (FDC), either as saxagliptin added to metformin or as initial combination in drug-naive patients. Both compounds exert complementary pharmacodynamic actions leading to better improvement in blood glucose control (fasting plasma glucose, postprandial glucose, HbA1c) than either compound separately. Adding saxagliptin to metformin monthotherapy results in a consistent, sustained and safe reduction in HbA1c levels. Tolerance is excellent without hypoglycemia or weight gain. EXPERT OPINION: The combination saxaglitpin plus metformin may be used as first-line or second-line therapy in the management of type 2 diabetes, especially as a valuable alternative to the classical metformin-sulfonylurea combination. [less ▲]

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See detailQuelles cibles glycémiques et lipidiques viser chez un patient diabétique de type 2 ?
PAQUOT, Nicolas ULg; SCHEEN, André ULg

in Revue Médicale de Liège (2012), 67

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See detailDiabète et Ramadan : représentations et pratiques de santé des patients et des soignants et intérêts de l'éducation thérapeutique du patient
Smaoui, N; Böhme, P; Collin, JF et al

in Diabètes & Métabolism (2012), 38(2), 47-48

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See detailCampagnes de sensibilisation au dépistage du diabète de type 2 dans les pharmacies. Comparaison de deux approches : glycémie capillaire et grille Findrisc
Böhme, P; Agrinier, N; Badia, M et al

in Diabètes & Métabolism (2012), 38(2), 7

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See detailA review of gliptins in 2011.
SCHEEN, André ULg

in Expert Opinion on Pharmacotherapy (2012), 13(1), 81-99

INTRODUCTION: Dipeptidylpeptidase-4 (DPP-4) inhibitors offer new options for the management of type 2 diabetes (T2DM). AREAS COVERED: This paper is an updated review, providing an analysis of both the ... [more ▼]

INTRODUCTION: Dipeptidylpeptidase-4 (DPP-4) inhibitors offer new options for the management of type 2 diabetes (T2DM). AREAS COVERED: This paper is an updated review, providing an analysis of both the similarities and the differences between the various compounds known as gliptins, currently used in the clinic (sitagliptin, vildagliptin, saxagliptin, alogliptin and linagliptin). This paper discusses the pharmacokinetic and pharmacodynamic characteristics of gliptins; both the efficacy and safety profiles of gliptins in clinical trials (compared with classical glucose-lowering agents), given as monotherapy or in combination, including in special populations; the positioning of DPP-4 inhibitors in the management of T2DM in recent guidelines; and various unanswered questions and perspectives. EXPERT OPINION: The role of DPP-4 inhibitors in the therapeutic armamentarium of T2DM is evolving, as their potential strengths and weaknesses become better defined. Future critical issues may include the durability of glucose control, resulting from better beta-cell protection, positive effects on cardiovascular outcomes and long-term safety issues. [less ▲]

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