Renin-angiotensin system inhibition prevents type 2 diabetes mellitus. Part 1. A meta-analysis of randomised clinical trials.

in Diabètes & Métabolism (2004), 30(6), 487-96

Most individuals with arterial hypertension or congestive heart failure are insulin-resistant and at a higher risk of developing type 2 diabetes (T2DM). The inhibition of the renin-angiotensin system (RAS ... [more ▼]

Most individuals with arterial hypertension or congestive heart failure are insulin-resistant and at a higher risk of developing type 2 diabetes (T2DM). The inhibition of the renin-angiotensin system (RAS), using an angiotensin converting enzyme inhibitor (ACEI) or a selective angiotensin receptor AT1 blocker (ARB), may exert favourable metabolic effects capable of preventing T2DM in high risk individuals. We performed a meta-analysis of randomised clinical trials (RCTs) assessing the effects of RAS inhibition on the incidence of new cases of T2DM in patients with arterial hypertension or congestive heart failure. Ten RCTs with cardiovascular prognosis as primary endpoints analysed the incidence of T2DM as secondary endpoints or as post-hoc analysis after a mean follow-up of 1 to 6 years: five with an ACEI and five with an ARB, compared with a placebo (n=4) or a reference drug (beta-blocker or diuretic: n=5; amlodipine: n=2). Eight RCTs concerned hypertensive patients: STOP Hypertension-2 (lisinopril or enalapril vs beta-blocker or diuretic), CAPPP (captopril vs thiazide or beta-blocker), HOPE (ramipril vs placebo), ALLHAT (lisinopril vs chlorthalidone and lisinopril vs amlodipine), LIFE (losartan vs atenolol), SCOPE (candesartan vs placebo), ALPINE (candesartan vs placebo) and VALUE (valsartan vs amlodipine). Two RCTs concerned patients with congestive heart failure: SOLVD (enalapril vs placebo) and CHARM-overall programme (candesartan vs placebo). Overall, 2 675 new cases of T2DM (7.40%) were observed in the group of 36 167 patients receiving a treatment with ACEI or ARA as compared with 3 842 events (9.63%) in the group of 39 902 control patients. A mean weighed relative risk reduction of new T2DM of 22% (95% CI: 18, 26; p<0.00001) was observed after RAS inhibition. The beneficial effect was similar with ACEIs and with ARBs as well as in patients with hypertension and in those with heart failure, and was also present whatever the comparator (placebo or beta-blockers/diuretics or amlodipine). The number needed-to-treat to avoid one new case of T2DM averaged 45 patients over 4-5 years. In conclusion, RAS inhibition consistently and significantly reduces the incidence of T2DM in individuals with arterial hypertension or with congestive heart failure. Considering the pandemic of T2DM, such pharmacological approach deserves further attention among the strategies aiming at preventing T2DM. [less ▲]

RENO, a European Postmarket Surveillance Registry, confirms effectiveness of coronary brachytheraypy in routine clinical practice.

in International Journal of Radiation, Oncology, Biology, Physics (2003), 55(4), 1019-1026

Purpose: To assess, by a European registry trial, the clinical event rate in patients with discrete stenotic lesions of coronary arteries (de novo or restenotic) in single or multiple vessels (native or ... [more ▼]

Purpose: To assess, by a European registry trial, the clinical event rate in patients with discrete stenotic lesions of coronary arteries (de novo or restenotic) in single or multiple vessels (native or bypass grafts) treated with -radiation. Methods and Materials: Between April 1999 and September 2000, 1098 consecutive patients treated in 46 centers in Europe and the Middle East with the Novoste Beta-Cath System were included in Registry Novoste (RENO). Results: Six-month follow-up data were obtained for 1085 patients. Of 1174 target lesions, 94.1% were located in native vessels and 5.9% in a bypass graft; 17.7% were de novo lesions, 4.1% were restenotic, and 77.7% were in-stent restenotic lesions. Intravascular brachytherapy was technically successful in 95.9% of lesions. Multisegmental irradiation, using a manual pullback stepping maneuver to treat longer lesions, was used in 16.3% of the procedures. The in-hospital rate of major adverse cardiac events was 1.8%. At 6 months, the rate was 18.7%. Angiographic follow-up was available for 70.4% of the patients. Nonocclusive restenosis was seen in 18.8% and total occlusion in 5.7% of patients. A combined end point for late (30–180 days) definitive or suspected target vessel closure was reached in 5.4%, but with only 2% of clinical events. Multivariate analysis was performed for major adverse cardiac events and late thrombosis. Conclusion: Data obtained from the multicenter RENO registry study, derived from a large cohort of unselected consecutive patients, suggest that the good results of recent randomized controlled clinical trials can be replicated in routine clinical practice. © 2003 Elsevier Science Inc. [less ▲]

La renonciation

in Moreau, Pierre (Ed.) Libéralités et successions (2012)

Le renouveau cosaque

in Transitions : Ex-Revue des Pays de L'est (1994), 35-1

Le renouveau éthique. Fondation d’une éthique du futur et réinvention d’une nouvelle anthropologie de l’homme et de la nature: réflexion à partir de l’œuvre de Hans Jonas

in Najar, Sihem (Ed.) L’anthropologie face aux nouveaux enjeux éthiques (2011)

Renouveler la rapport du travail à la nature

in Revue Nouvelle (2007), (1-2), 46-49

Depuis un siècle et demi, la modernisation du monde rural, marquée par une rationalisation croissante, s’est faite au détriment de la gestion en commun. La bureaucratisation du vivant transforme les ... [more ▼]

Depuis un siècle et demi, la modernisation du monde rural, marquée par une rationalisation croissante, s’est faite au détriment de la gestion en commun. La bureaucratisation du vivant transforme les agriculteurs d’artisans en techniciens. À condition de mener une réflexion sur le travail et la nature, l’économie sociale peut apporter un projet à un monde rural qui associerait marché, consommation et action publique [less ▲]

Renouvellement des pédagogies musicales. Analyse et développement des innovations dans les cours d'instruments semi-collectifs

in Site du Ministère de la Communauté française de Belgique (2002)

Rénovation de rites : de la critique du vers au vers critique

in Balises, Cahiers de poétique des Archives et musée de la littérature (2003), 3-4

Rénovation et efficacité énergétique : approche multicritères

Report (2007)

In France, just like in much of European countries, the park of old buildings available, potentially improvable and prone to restoration is rather important. The energy stakes of planet and the ... [more ▼]

In France, just like in much of European countries, the park of old buildings available, potentially improvable and prone to restoration is rather important. The energy stakes of planet and the considerable share of the consumption of energy required by the requirements of comfort of the habitat must question the projects promoter and the owners when they approach the restoration of existing buildings. The objective of this project is to develop methods and tools of decision-making aid making it possible a person receiving benefits in energy restoration to determine the best possible scenarios of restoration, i.e. those answering as well as possible waitings of the various actors concerned. This project relates to the individual residential buildings. By energy restoration of a building, one understands the whole of the actions carried out on the frame (insulation, air tightness, etc) and the systems energy (heating, medical warm water, ventilation, etc), aiming at improving his energy performance. The energy assessment of a building takes again all the contributions and the losses of heat to which it is subjected. [less ▲]

La rénovation officielle

in Education Populaire (1987), 2