References of "Kulbertus, Henri"
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See detailL'atherosclerose: une maladie complexe.
Kulbertus, Henri ULg; LANCELLOTTI, Patrizio ULg

in Revue Médicale de Liège (2012), 67(5-6), 273-8

Atherosclerosis is a complex disease resulting from an interaction between environmental risk factors (diet, smoking habit, lack of exercise, stress) and a favourable genetic profile. In the recent past ... [more ▼]

Atherosclerosis is a complex disease resulting from an interaction between environmental risk factors (diet, smoking habit, lack of exercise, stress) and a favourable genetic profile. In the recent past, the analysis of the genetic factors involved has considerably progressed. A significant number of genetic variants associated with the various phenotypes of atherosclerosis or its risk factors have been identified. Each, taken individually, only exerts a modest influence, but as a group, they play a significant role, albeit as yet not precisely quantified, in the aetiology of atherosclerosis. The individual response to various therapies prescribed in atherosclerosis can also be significantly influenced by genetic factors. In the next future, genetics and pharmacogenetics will represent major determinants of our approach to the prevention and individualized treatment of atherosclerosis and its complications. [less ▲]

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See detailPrevention cardio-vasculaire: la "polypill", une solution pour vaincre l'inertie clinique et le manque d'observance?
Scheen, André ULg; Lefebvre, Pierre ULg; Kulbertus, Henri ULg

in Revue Médicale de Liège (2010), 65(5-6), 267-72

The concept of "polypill" for cardiovascular prevention was introduced in 2003 in a landmark paper of the British Medical Journal. A model based on results provided by evidence-based medicine suggested ... [more ▼]

The concept of "polypill" for cardiovascular prevention was introduced in 2003 in a landmark paper of the British Medical Journal. A model based on results provided by evidence-based medicine suggested that a "polypill", that contains a statin, three blood pressure lowering drugs (each at half standard dose), aspirin and folic acid, would result in an 80% reduction in the incidence of coronary and cerebrovascular events, while being associated with a good tolerance profile and offering a favourable cost-effectiveness ratio. The present paper aims at presenting the new advances dealing with this new paradigm in cardiovascular prevention. We will present the progresses of the "polypill" concept since 2003, the results of a first controlled clinical trial, the pharmaceutical feasibility for routine clinical use and the potential pharmaco-economical impacts of such a strategy. The "polypill" may offer a solution to avoid physician's clinical inertia and reduce patients's lack of compliance, two drawbacks in the field of cardiovascular prevention. [less ▲]

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See detailEditorial 2006 : le RMLg entre dans la 7e décénnie
Kulbertus, Henri ULg; Giet, Didier ULg

in Revue Médicale de Liège (2006), 61(1), 1-2

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See detailEditorial
Kulbertus, Henri ULg; Scheen, André ULg

in Revue Médicale de Liège (2005), 60(1), 1-4

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See detailLe diabete sucre: une maladie exemplative a bien des egards. Preambule.
Scheen, André ULg; Kulbertus, Henri ULg

in Revue Médicale de Liège (2005), 60(5-6), 269-72

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See detailPredictors of rapid QRs widening in patients with coronary artery disease and left ventricular dysfunction
LANCELLOTTI, Patrizio ULg; Kulbertus, Henri ULg; PIERARD, Luc ULg

in American Journal of Cardiology (2004), 93(11), 1410-1412

To assess the predictors of rapid QRS widening in patients with chronic ischemic left ventricular dysfunction, 82 patients who underwent greater than or equal to2 electrocardiograms and exercise Doppler ... [more ▼]

To assess the predictors of rapid QRS widening in patients with chronic ischemic left ventricular dysfunction, 82 patients who underwent greater than or equal to2 electrocardiograms and exercise Doppler echocardiography were studied. In a multivariate analysis, left ventricular end-diastolic Volume, a large increase in mitral regurgitant volume during exercise, and diabetes emerged as independent predictors of QRS widening. (C)2004 by Excerpta Medica, Inc. [less ▲]

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See detailL'etude clinique du mois. REVERSAL et PROVE-iT: confirmation du concept the lower, the better" dans le traitement de l'hypercholesterolemie chez le patient coronarien."
Scheen, André ULg; Kulbertus, Henri ULg

in Revue Médicale de Liège (2004), 59(3), 167-73

Statins, as compared to placebo, have proven their efficacy in reducing cardiovascular events in patients with or without cardiovascular disease and in a large range of cholesterol levels. Two new head-to ... [more ▼]

Statins, as compared to placebo, have proven their efficacy in reducing cardiovascular events in patients with or without cardiovascular disease and in a large range of cholesterol levels. Two new head-to-head randomised trials comparing intensive treatment with atorvastatin 80 mg/day with moderate treatment with pravastatin 40 mg/day were recently completed. The mechanistic "Reversing Atherosclerosis with Aggressive Lipid Lowering" (REVERSAL) trial randomised 502 patients with stable coronary disease. Atorvastatin 80 mg (leading to a mean LDL cholesterol of 79 mg/dl) was superior to pravastatin 40 mg (mean LDL of 110 mg/dl) in terms of limiting the progression of atheroma assessed with the use of intravascular ultrasonography after 18 months of follow up (p = 0.02). These differences may be related to the greater reduction in atherogenic lipoprotein (-46% versus -26%, p < 0.001) and C-reactive protein (-36% versus -5%, p < 0.001) in patients treated with atorvastatin as compared to pravastatin. In the clinical "Pravastatin or Atorvastatin Evaluation and Infection Therapy" (PROVE-IT) trial, 4162 patients with acute coronary syndromes were randomised to either atorvastatin 80 mg or pravastatin 40 mg and followed for a mean of 24 months. Again, atorvastatin (mean LDL of 62 mg/dl) was superior to pravastatin (mean LDL of 95 mg/dl), resulting in a 16% percent lower risk of the primary end point, a composite of major cardiovascular events (p = 0.005). Thus, both REVERSAL and PROVE-IT support the concept "the lower, the better". However, they do not allow to disentangle the independent and interdependent effects of statins on LDL cholesterol and the process of arterial inflammation. What so ever, the results suggest that the target LDL cholesterol level may be lower than recommended in the current guidelines in high-risk patient so that a sea change in the prevention and management of atherosclerotic vascular disease may occur very soon. [less ▲]

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See detailL'etude clinique du mois. INTERHEART": la preuve par 9. Neuf facteurs de risque predisent neuf infarctus du myocarde sur dix."
Scheen, André ULg; Kulbertus, Henri ULg

in Revue Médicale de Liège (2004), 59(11), 676-9

INTERHEART is a standardised case-control study of acute myocardial infarction in 52 countries representing every inhabited continent. 15152 cases and 14820 controls were enrolled. Collectively, 9 factors ... [more ▼]

INTERHEART is a standardised case-control study of acute myocardial infarction in 52 countries representing every inhabited continent. 15152 cases and 14820 controls were enrolled. Collectively, 9 factors accounted for 90% of myocardial infarctions in men and 94% in women. These factors were 6 risk factors (dyslipidaemia characterized by high apoB/apoA1 ratio, smoking, hypertension, diabetes mellitus, abdominal obesity and stressful psychosocial factors) and 3 protective factors (daily consumption of fruits and vegetables, regular alcohol consumption, and regular physical activity). These findings suggest that interventions targeting these 9 factors have the potential to prevent most premature cases of myocardial infarction and that these strategies should be implemented worldwide. [less ▲]

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See detailL'etude clinique du mois. L'etude ALLHAT-LLT.
Kulbertus, Henri ULg; Scheen, André ULg

in Revue Médicale de Liège (2003), 58(1), 53-8

ALLHAT-LLT was part of the ALLHAT study. The purpose was to determine whether pravastatin compared with usual care reduces all-cause mortality in older, moderately hypercholesterolaemic, hypertensive ... [more ▼]

ALLHAT-LLT was part of the ALLHAT study. The purpose was to determine whether pravastatin compared with usual care reduces all-cause mortality in older, moderately hypercholesterolaemic, hypertensive patients with at least one additional coronary heart disease (CHD) risk factor. 10,355 ambulatory patients, aged 55 years or more, with LDL cholesterol of 120-189 mg/dl (or, 100-129 mg/dl if known CHD) and triglycerides < 350 mg/dl, were randomised to pravastatin (40 mg/d; n = 5,170), or usual care (n = 5,185). Mean age was 66 years; 49% were women; 38% were black and 23% hispanic; 14% had a history of CHD and 35%, type 2 diabetes. Baseline mean total cholesterol was 224 mg/dl; LDL-C, 146 mg/dl; HDL-C, 48 mg/dl, and triglycerides, 152 mg/dl. Mean follow-up was 4.8 years. Among usual care patients, 32% of those with known CHD and 29% of those without CHD started taking lipid-lowering drugs. At year 4, total cholesterol was reduced by 17.2% with pravastatin and by 7.6% with usual care. A random sample had their LDL-C levels assessed: there was a reduction of 28% with pravastatin and of 11% with usual care. All-cause mortality was similar in the two groups (RR, 0.99; 95% CI, 0.89-1.11; p = 0.88), with 6-year mortality rates of 14.9% (pravastatin) and 15.3% (usual care). CHD event-rates were not different between the two groups (RR, 0.91; 95% CI, 0.79-1.04; p = 0.16); 6-year CHD event rates were 9.3% (pravastatin) and 10.4% (usual care), respectively. These results are likely due to the small differential in total cholesterol (9.6%) and LDL-C (16.7%) between pravastatin and usual care, compared with prior statin trials. Such an unusual differential essentially results from the open table of the study and from the possibility of prescribing a statin in the usual care group. [less ▲]

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See detailLa medecine preventive dans tous ses etats.
Kulbertus, Henri ULg; Scheen, André ULg

in Revue Médicale de Liège (2003), 58(4), 173-4

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See detailPrevention cardio-vasculaire par les statines: faut-il encore doser le cholesterol?
Scheen, André ULg; Kulbertus, Henri ULg

in Revue Médicale de Liège (2003), 58(4), 191-7

Statins, the most popular lipid-lowering agents, have proven their efficacy in preventing cardiovascular events in subjects with lower and lower initial plasma cholesterol levels. Besides, the protective ... [more ▼]

Statins, the most popular lipid-lowering agents, have proven their efficacy in preventing cardiovascular events in subjects with lower and lower initial plasma cholesterol levels. Besides, the protective effect does not seem to be directly related neither to the degree of the cholesterol reduction nor to the final level of plasma cholesterol level reached under treatment. Such observations suggest that statins may exert vascular protective effects, at least in part, independently of their specific cholesterol-lowering effect (so-called pleiotropic effects). The present paper will discuss the arguments pro and contra the dosage of cholesterolaemia before initiating a therapy with statin and during treatment follow up, both in subjects with previous cardiovascular events (secondary prevention) and in subjects with a high cardiovascular absolute risk but without previous clinical expression of atherosclerosis (primary prevention). [less ▲]

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See detailNumeros a theme et numero d'ete.
Kulbertus, Henri ULg; Scheen, André ULg

in Revue Médicale de Liège (2003), 58(7-8), 453-4

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See detailComment je previens ... les maladies cardio-vasculaires par une approche pharmacologique combinee: y a-t-il place pour une polypill"?"
Scheen, André ULg; Lefebvre, Pierre ULg; Kulbertus, Henri ULg

in Revue Médicale de Liège (2003), 58(9), 527-33

In the June 28, 2003 issue of the British Medical Journal, an extensive literature survey based on various large meta-analyses of the efficacy and safety of the reduction of four cardiovascular risk ... [more ▼]

In the June 28, 2003 issue of the British Medical Journal, an extensive literature survey based on various large meta-analyses of the efficacy and safety of the reduction of four cardiovascular risk factors (cholesterol, arterial blood pressure, platelet aggregation, homocysteine) leads to the conclusion that a combined pharmacological intervention should reduce ischaemic heart disease events by 88% and strokes by 80% in at risk individuals. Therefore, a new paradigm is proposed for the prevention of cardiovascular diseases. This new strategy would consist in the systematic prescription to people with a history of heart attack or stroke, those with any form of obliterative atherosclerotic vascular disease or diabetes, and everyone aged 55 and older of a fixed combination of 6 pharmacological agents independently of initial risk factor profile.... Such pharmacological formulation, called "polypill", should contain a statin, three blood pressure lowering drugs (each at half standard dose), aspirin (75 mg/day) and folic acid (0.8 mg/day). We discuss the pros and cons of this new paradigm. However, the efficacy of such "polypill" remains to be demonstrated in a large controlled clinical trial as well as its superiority as compared to a classical approach of cardiovascular prevention based upon the individual optimal correction of each risk factor thanks a dose titration of each pharmacological compound. [less ▲]

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See detailPersistent negative T waves in the infarct-related leads as an independent predictor of poor long-term prognosis after acute myocardial infarction
Lancellotti, Patrizio ULg; Gerard, P. L.; Kulbertus, Henri ULg et al

in American Journal of Cardiology (2002), 90(8), 833-837

This study sought to determine the long-term prognostic significance of persistent or transient, negative T waves in infarct-related leads. After acute myocardial infarction (AMI), QRS and T wave ... [more ▼]

This study sought to determine the long-term prognostic significance of persistent or transient, negative T waves in infarct-related leads. After acute myocardial infarction (AMI), QRS and T wave alterations may resolve. No clinical study has investigated the prognostic importance of persistent versus transient negative T waves. We studied 147 consecutive patients with first AMI and greater than or equal to2 negative T waves in the infarct-related leads on the electrocardiogram. One hundred twenty patients developed Q waves. Patients were followed clinically for 60 +/- 21 months. T-wave normalization was observed early (before hospital discharge) in 34 patients and late (at 4 +/- 1 months) in 65. Thirty patients had Q-wave regression. Adverse outcome occurred in 57 patients. There were 23 hard events (cardiac death in 12 patients and nonfatal AMI in 11). Patients with early or late T-wave normalization had similar event-free survival curves that diverged rapidly from that of patients with persistent negative T waves, who had a worse outcome (p <0.0001). Patients with or without Q-wave regression had similar survival curves. Using multivariate Cox regression analysis, higher end-systolic volume (hazard ratio [HR] 1.01, p = 0.007), the presence of multivessel disease (HR 3.33, p = 0.009), and persistent negative T waves (HR 2.92, p = 0.024) predicted hard events. Persistent negative T waves 4 months after first AMI were independently associated with a worse outcome, whereas Q-wave regression has no long-term prognostic importance. (C) 2002 by Excerpta Medica, Inc. [less ▲]

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See detailDes doutes nes apres le 11 septembre aux espoirs places dans l'euro....
Kulbertus, Henri ULg; Scheen, André ULg

in Revue Médicale de Liège (2002), 57(1), 1-2

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See detailEcueils et chausse-trapes.
Kulbertus, Henri ULg; Scheen, André ULg

in Revue Médicale de Liège (2002), 57(5), 249

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See detailL'etude clinique du mois. La MRC/BHF Heart Protection Study.
Kulbertus, Henri ULg; Scheen, André ULg

in Revue Médicale de Liège (2002), 57(9), 613-6

20,536 adults (15,454 men and 5,082 women, aged 40-80 years) with coronary heart disease, other occlusive arterial disease or diabetes mellitus were randomly allocated to receive 40 mg simvastatin daily ... [more ▼]

20,536 adults (15,454 men and 5,082 women, aged 40-80 years) with coronary heart disease, other occlusive arterial disease or diabetes mellitus were randomly allocated to receive 40 mg simvastatin daily or matching placebo. In addition to being randomized to compare simvastatin vs placebo, all patients were also randomized to compare antioxidant vitamin supplementation (vitamin E 600 mg/day, vitamin C 250 mg/day and betacarotene 20 mg/day) vs placebo in a "2 x 2 factorial" design. Duration of the study was 5 years. All-cause mortality was significantly reduced among patients allocated to simvastatin (-12.3%) due to a highly significant (-18%) reduction in the coronary death rate, a marginally significant reduction in other vascular deaths and a non-significant reduction in non-vascular deaths. There were highly significant reductions (of about one-quarter) in the first event rate for non-fatal myocardial infarction and coronary death (combined), for non-fatal and fatal stroke and for coronary or non-coronary revascularization. The beneficial effect of simvastatin was seen in all sub-categories which were studied and, particularly: women vs men; patients aged > 70 years vs those aged < 70 years; patients with LDL cholesterol < vs > 116 mg/dl, or total cholesterol < vs > 193 mg/dl. The treatment was well tolerated and the annual risk of myopathy was 0.01%. All comparisons between antioxidant vitamin supplementation and placebo failed to reveal any difference in favour or against the supplementation which was otherwise well tolerated. These important results and their implications will be briefly discussed. [less ▲]

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See detailL'etude clinique du mois. L'etude PROSPER (PROspective study of pravastatin in the elderly at risk).
Kulbertus, Henri ULg; Scheen, André ULg

in Revue Médicale de Liège (2002), 57(12), 809-13

Statins reduce coronary and cerebrovascular mortality and morbidity in middle-aged individuals. Until recently, their efficacy and safety in elderly people had not yet been firmly established. PROSPER was ... [more ▼]

Statins reduce coronary and cerebrovascular mortality and morbidity in middle-aged individuals. Until recently, their efficacy and safety in elderly people had not yet been firmly established. PROSPER was a controlled, randomised study involving 2,804 men and 3,000 women aged 70-82, with a history of, or risk factors for cardiovascular disease. Their baseline cholesterol level was 135-350 mg/dl; they were randomised to either 40 mg pravastatin per day, or matching placebo. Average follow-up was 3.2 years. The primary endpoint was a composite of coronary death, non-fatal myocardial infarction, and fatal or non-fatal stroke. Pravastatin lowered LDL-cholesterol (-34%), and reduced the incidence of the primary endpoint (-15%; CI 95%: 3-26%; p = 0.014). Coronary death and non-fatal myocardial infarction risk was also reduced (-19%; p = 0.006), and mortality from coronary disease fell by 24% (p = 0.043). The risk for stroke, however, was unaffected (p = 0.8), whereas the incidence of transient ischemic attacks was reduced by 25%, which was (marginally) insignificant (p = 0.051). Pravastatin had no effect on cognitive functions or incapacity. New cancers were more frequent amongst pravastatin-treated individuals (+25%; p = 0.020). However incorporation of this new data in a meta-analysis of all pravastatin and all statin trials revealed no overall increase of cancer risk. [less ▲]

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See detailExercice physique et sport: du meilleur au pire.
Scheen, André ULg; Kulbertus, Henri ULg

in Revue Médicale de Liège (2001), 56(4), 193-4

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See detailDiagnostic et traitement de l'insuffisance cardiaque
Pierard, Luc ULg; Kulbertus, Henri ULg

in Revue Médicale de Liège (2000), 55(4), 271-7

The incidence of heart failure is consistently progressing among our population; it now represents a major problem of public health and is extremely costly for our health system. Over recent years ... [more ▼]

The incidence of heart failure is consistently progressing among our population; it now represents a major problem of public health and is extremely costly for our health system. Over recent years, several well controlled studies have been devoted to heart failure. They allow to propose guidelines which fulfill all the requirements of Evidence-Based Medicine. These recommendations, however, are not always easy to apply in the individual patient. Guidelines for the sometimes difficult diagnosis of heart failure will be reviewed. On the basis of the results of large controlled clinical trials, we shall envisage the comprehensive treatment of a heart failure patient taking into account the functional class as well as some individual characteristics (age, presence of hypertension, atrial fibrillation, renal insufficiency). The different pharmacologic agents which have demonstrated efficacy will be reviewed and the strategies to avoid the potential pitfalls of their simultaneous use will be indicated. The key role of the general practitioner in the surveillance and titration of heart failure therapy will be emphasized. [less ▲]

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