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Papers by Michel Romanens

Schweizerische Ärztezeitung

Schweizerische Ärztezeitung =, Mar 8, 2022

Schweizerische Ärztezeitung, 2014

Social Science Research Network, 2022

Bulletin des Médecins Suisses

Preventive Medicine

A large number of cardiovascular events occur in seemingly healthy individuals. Atherosclerosis i... more A large number of cardiovascular events occur in seemingly healthy individuals. Atherosclerosis imaging can improve the outcome and treatment regime of such subjects. We aim to assess the predictive value of atherosclerosis imaging beyond traditional risk calculators in subjects aged 40-65 years. We compared PROCAM, SCORE and FRAM with carotid ultrasound (total plaque area, TPA) and arterial age (AA) was calculated in subjects without known cardiovascular diseases. Follow-up was obtained by phone or mail. In 2842 subjects (age 50 ± 8, 38% women) 154 (5.4%) cardiovascular events occurred (ASCVD: 41 myocardial infarctions, 16 strokes or TIA, 21 CABG, 41 PTCA, 35 coronary artery disease defined by invasive angiography) during a mean follow-up time of 5.9 (1-12) years. PROCAM risk was 5 ± 6%, SCORE risk 1.3 ± 1.6% and FRAM 10 ± 6%. Both for the primary outcome (AMI, STROKE/TIA, CABG) and the secondary outcome (adding CAD and PTCA) hazards increased significantly for TPA tertiles and AA groups between 1.4 (0.1-16.1) and 21.4 (2.8-163.6) after adjustment for risk factors (age, smoke, sex, systolic BP, lipids, BMI, medication in Model 1) and after adjustment for results from PROCAM, SCORE and FRAM (Model 2). Model performance was statistically improved regarding model fit in all models using TPA and AA. Net reclassification improvement (NRI) for PROCAM and SCORE using TPA tertiles or AA age groups increased significantly between 30% to 48%. TPA and AA added prognostic information to conventional risk equations, supporting the assessment of ASCVD risk with carotid ultrasound in subjects aged 40-65 years.

Swiss Medical Weekly, 2022

BACKGROUND In Switzerland, risk for acute myocardial infarction (AMI) has been considered as equi... more BACKGROUND In Switzerland, risk for acute myocardial infarction (AMI) has been considered as equivalent to risk for atherosclerotic cardiovascular disease (ASCVD). This may lead to an underestimation of ASCVD risk and prevent adequate preventive measures. METHODS We calculated correction factors for AMI risk to obtain ASCVD risk, tested predicting abilities of PROCAM/AGLA, SCORE, HerzCheck® and carotid plaque imaging (TPA) for ASCVD events in this cohort study and calculated survival curves, calibration and discrimination for ASCVD outcomes derived from PROCAM/AGLA, SCORE and TPA. RESULTS In 2842 subjects (age 50 ± 8, 38% women), 154 (5.4%) cardiovascular events occurred (ASCVD: 41 myocardial infarctions, 16 strokes or TIAs, 21 CABG, 41 PTCA, 35 coronary artery disease [CAD]defined by invasive angiography) during a mean follow-up time of 5.9 (1-12) years. AGLA-AMI risk was well calibrated for AMI (15% underreported risk for the risk of AMI), but was poorly calibrated for ASCVD (stroke, CABG, PTCA or CAD, which contributed to the secondary outcome variables) with underreported risk resulting in a correction factor of 3.45. Discrimination was comparable for all risk calculators, but TPA outperformed risk calculators for survival using Cox proportional survival functions. Net reclassification improvement for PROCAM and SCORE using TPA tertiles groups increased significantly between 30% to 48%. CONCLUSIONS PROCAM-derived risk calculators are well calibrated for the risk of AMI. PROCAM-AMI should be multiplied by a factor of 4 to obtain ASCVD. PROCAM-AMI does not represent global cardiovascular risk. Corresponding adjustments in the AGLA communication of risk appear necessary.

European Journal of Cardiovascular Prevention & Rehabilitation, 2007

Background Both an impaired capacity to increase heart rate during exercise testing (chronotropic... more Background Both an impaired capacity to increase heart rate during exercise testing (chronotropic incompetence), and a slowed rate of recovery following exercise (heart rate recovery) have been shown to be associated with all-cause mortality. It is, however, unknown which of these responses more powerfully predict risk, and few data are available on their association with cardiovascular mortality or how they are influenced by b-blockade. Methods Routine symptom-limited exercise treadmill tests performed on 1910 male veterans at the Palo Alto Veterans Affairs Medical Center from 1992 to 2002 were analyzed. Heart rate was determined each minute during exercise and recovery. Chronotropic incompetence was defined as the inability to achieve Z 80% of heart rate reserve, using a population-specific equation for age-predicted maximal heart rate. An abnormal heart rate recovery was considered to be a decrease of < 22 beats/min at 2 min in recovery. Cox proportional hazards analyses including pretest clinical data, chronotropic incompetence, heart rate recovery, the Duke Treadmill Score (abnormal defined as < 4), and other exercise test responses were performed to determine their association with cardiovascular mortality. Results Over a mean follow-up of 5.1 ± 2.1 years, there were 70 deaths from cardiovascular causes. Both abnormal heart rate recovery and chronotropic incompetence were associated with higher cardiovascular mortality, a lower exercise capacity, and more frequent occurrence of angina during exercise. Both heart rate recovery and chronotropic incompetence were stronger predictors of risk than pretest clinical data and traditional risk markers. Multivariately, chronotropic incompetence was similar to the Duke Treadmill Score for predicting cardiovascular mortality, and was a stronger predictor than heart rate recovery [hazard ratios 3.0 (95% confidence interval 1.9-4.9), 2.8 (95% confidence interval 1.7-4.8), and 2.0 (95% confidence interval 1.1-3.5) for abnormal Duke Treadmill Score, chronotropic incompetence, and abnormal heart rate recovery, respectively]. Having both chronotropic incompetence and abnormal heart rate recovery strongly predicted cardiovascular death, resulting in a relative risk of 4.2 compared with both responses being normal. Beta-blockade had minimal impact on the prognostic power of chronotropic incompetence and heart rate recovery. Conclusion Both chronotropic incompetence and heart rate recovery predict cardiovascular mortality in patients referred for exercise testing for clinical reasons. Chronotropic incompetence was a stronger predictor of cardiovascular mortality than heart rate recovery, but risk was most powerfully stratified by these two responses together. The simple application of heart rate provides powerful risk stratification for cardiovascular mortality from the exercise test, and should be routinely included in the test report. Eur J Cardiovasc Prev Rehabil

scopri.ch

... Circulation. 1996;94:11751192. 18 Anthony Mascola, MD, John Ko, BS, Hamid Bakhsheshi, BS, an... more ... Circulation. 1996;94:11751192. 18 Anthony Mascola, MD, John Ko, BS, Hamid Bakhsheshi, BS, and Matthew J. Budoff, MD. Electron Beam To-mography Comparison of Culprit and Non-Culprit Coronary Arteries in Patients With Acute Myocardial Infarction. AJC 2000;85:1357. ...

Bulletin des médecins suisses, May 17, 2022

Background and Purpose Current definitions of drug resistance are shaped by the pharmacotherapeut... more Background and Purpose Current definitions of drug resistance are shaped by the pharmacotherapeutic fields they occurred in. They usually mention various contributing factors and refer either to the clinical or the biomarker level. Particular attention has been attracted by antiplatelet resistance, a phenomenon with clinical, cellular and pharmacogenetical contributors. However, the impact of every single factor to antiplatelet resistance in outpatients under prescribed antiplatelet therapy has not been comprehensively evaluated so far, neither has the temporal pattern of drug intake been studied as a possible contributor. Methods We propose generally applicable definitions of drug resistance, therapy failure and a classification of contributing factors to drug resistance. We introduce a study design with the use of blisterpacks in a target population (i.e. patients with a prescription of antiplatelet drugs), filled with the entire oral medication regimen, and equipped with electronic multidrug compliance monitoring (e-MCM) allowing thus to evaluate in a stepwise way the impact of the contributing factors (e.g. potential drug-drug interactions, genetic polymorphism) on biomarker outcome (i.e. in vitro platelet aggregation), with proven intake of the polytherapy.

Swiss Medical Weekly, 2020

Sozial- und Präventivmedizin SPM, 1981

Résumé Une enquÊte concernant la consommation de médicaments a été menée en 1980 à l'aide d&... more Résumé Une enquÊte concernant la consommation de médicaments a été menée en 1980 à l'aide d'un questionnaire anonyme chez un échantillon de 50% des écoliers de Bâle âgés de 13 à 18 ans. Des analgésiques étaient pris par 60% des jeunes, ce pourcentage augmentant en relation avec l'âge et les demandes de l'école. Dans les raisons pour la consommation des

European Journal of Cardiovascular Prevention & Rehabilitation, 2006

Introduction: Menopause is an independent risk factor for cardiovascular disease (CVD). Physical ... more Introduction: Menopause is an independent risk factor for cardiovascular disease (CVD). Physical exercise and soybean diets have been suggested to reduce the risk of CVD in postmenopausal women. The purpose of this study was to investigate the effects of combined resistance and endurance (RE) training and soy extract (SOY) supplementation, both known to improve endothelial function, on expression of the eNOS gene in the heart of ovariectomized (OVX) rats. Material and methods: Fifty female Wistar rats were divided into five groups: 1) sham (SHAM); 2) ovariectomy (OVX); 3) ovariectomy with soy extract supplementation (OVX + SOY); 4) OVX with RE training (OVX + RE); 5) and ovariectomy plus RE training with soy extract supplementation (OVX + RE + SOY). RE training and soy extract supplementation were administered alone or in combination for 6 weeks. The effects of these treatments on cardiac eNOS expression were measured using real-time PCR. Results: Ovariectomy down-regulated cardiac eNOS gene expression; however, 6 weeks of SOY treatment or RE training reversed this effect (p ≤ 0.05). The combination of SOY plus RE was greater than RE or SOY alone in reversing estrogen-deficiency-caused eNOS down-regulation (p ≤ 0.05). Conclusions: Our data suggest that the combinatory regimen of soy extract supplementation and regular RE training may be more beneficial to cardiovascular disease risk in a menopause rat model than either exercise or soy supplementation alone.

European Journal of Cardiovascular Prevention & Rehabilitation, 2008

Resistance training (RT) is safe and practicable in low-risk populations with coronary artery dis... more Resistance training (RT) is safe and practicable in low-risk populations with coronary artery disease. In patients with left ventricular (LV) dysfunction after an acute ischaemic event, few data exist about the impact of RT on LV remodelling. In this prospective, randomized, controlled study, 38 patients, after a first myocardial infarction and a maximum ejection fraction (EF) of 45%, were assigned either to combined endurance training (ET)/RT (n=17; 15 men; 54.7+/-9.4 years and EF: 40.3+/-4.5%) or to ET alone (n=21; 17 men; 57.0+/-9.6 years and EF: 41.9+/-4.9%) for 12 weeks. ET was effectuated at an intensity of 70-85% of peak heart rate; RT, between 40 and 60% of the one-repetition maximum. LV remodelling was assessed by MRI. No statistically significant differences between the groups in the changes of end-diastolic volume (P=0.914), LV mass (P=0.885) and EF (P=0.763) were observed. Over 1 year, the end-diastolic volume increased from 206+/-41 to 210+/-48 ml (P=0.379) vs. 183+/-44 to 186+/-52 ml (P=0.586); LV mass from 149+/-28 to 155+/-31 g (P=0.408) vs. 144+/-36 to 149+/-42 g (P=0.227) and EF from 49.1+/-12.3 to 49.3+/-12.0% (P=0.959) vs. 51.5+/-13.1 to 54.1% (P=0.463), in the ET/RT and ET groups, respectively. Peak VO2 and muscle strength increased significantly in both groups, but no difference between the groups was noticed. RT with an intensity of up to 60% of the one-repetition maximum, after an acute myocardial infarction, does not lead to a more pronounced LV dilatation than ET alone. A combined ET/RT, or ET alone, for 3 months can both increase the peak VO2 and muscle strength significantly.

European Heart Journal, 2012

Deaths from diseases of the heart are decreasing. Cardiovascular diseases (CVD) will be the main ... more Deaths from diseases of the heart are decreasing. Cardiovascular diseases (CVD) will be the main cause of morbidity and mortality in 2015 according to a WHO report. The main problem is related to the long-time delay between the start of the development of atherosclerosis in young adults and the manifestation many decades later. Despite a recent decline in a CVD mortality rate in men and women, the main problem is related to the acute manifestation as the acute coronary syndrome, which leads 30-50% of subjects to sudden and fatal outcomes. In addition, about 20% of first and recurrent acute myocardial infarctions are silent. The lifetime risk of coronary artery disease after 40 years is 49% for men and 32% for women. That means, we are confronted with a major health care problem. This is even more obvious, when the rate of coronary heart disease deaths out of the hospital are taken into account which amount to 70% in 2007. These data are confirmed for Europe despite a strong decline of hospital deaths. Another problem is related to the fact that the number of sudden cardiac death amounts to .300 000 in the general US population. It is about 10 times higher than in those patients who are defined as prone to sudden death due to low ejection fraction, ventricular arrhythmias, and acute myocardial infarction. For cardiologists, this general topic becomes even more obvious, because even well-known cardiologists experienced early (≤65 years) sudden cardiac deaths such as RW Campbell, JM Isner, PA Poole-Wilson, H Drexler, and recently the paediatric cardiologist from Hannover, A Wessels. These events underline again what has been emphasized 15 years ago by the MONICA study that two-thirds of patients die outside the hospital and that we have to concentrate on primary and secondary prevention, also in memory of these colleagues. This review will demonstrate the potential value of coronary artery calcification screening which can be used as a sign of subclinical coronary arteriosclerosis for improved risk prediction, the first step to prevention. Subclinical atherosclerosis represents the vessel memory of risk factor exposure.

Circulation, 2006

We read with great interest the report by Schmermund et al 1 that failed to demonstrate a differe... more We read with great interest the report by Schmermund et al 1 that failed to demonstrate a difference in progression of coronary calcium (CAC) in asymptomatic, nondiseased subjects when treated with 10 mg versus 80 mg atorvastatin for 12 months. The authors expected that in 471 patients, a significantly lower progression of CAC scores and differences between groups of patients treated with 10 mg versus 80 mg atorvastatin could be observed. The study by Schmermund et al 1 was carried out in a low-risk to intermediate-risk population. Based on previous studies, it is possible that a much larger population would have been required to detect any differences. In addition, the study was not placebocontrolled but tried to discover differences between 2 groups of patients having low-density lipoprotein cholesterol reductions of 30.1% (10 mg) versus 43.1% (80 mg). Most important, however, the authors calculated a sample size of nϭ190, necessary to detect a CAC difference of 10%. The authors reference Callister et al 2 for their estimate of the CAC score standard deviation (SD). Callister et al 2 observed SDs of mean CAC of greater than 100% (ranging from Ϯ118% to Ϯ203%). The SDs of the mean CAC differences within a group were between Ϯ107% and Ϯ212%. When we use the median of the SDs given by Callister et al (Ϯ171%), then we calculate a sample size of several thousand subjects to detect a difference of 10% (Pϭ0.05, power of 0.90). However, Schmermund et al choose an SD of Ϯ30% for their subsequent power calculation. This has a dramatic effect on the sample size necessary to detect such small differences. In Table 2, Schmermund et al confirmed high SDs in their own data (median, Ϯ144%) but did not take this information into account when performing their power calculations. We do not know whether the CAC score data were normally distributed or not; the mean and median values differed greatly, however, suggesting that the data are skewed. If this assumption is correct, then it would have been more appropriate to transform the data or use nonparametric statistical tests. Thus, in our opinion, the study by Schmermund et al does not allow one to draw the conclusion that CAC score might not be a reliable predictor of cardiac events. 3 Prospective studies involving large numbers of patients will be necessary to answer this question. Disclosures None.

Cardiovascular Drugs and Therapy, 2009

Background The Swiss national guidelines for the prevention of cardiovascular events have been pu... more Background The Swiss national guidelines for the prevention of cardiovascular events have been published in 2005 by the Swiss Society of Cardiology (SGK) and the working group on lipids and atherosclerosis (AGLA). An agreement for global cardiovascular risk assessment and indications for cholesterol lowering among the international (IAS-AGLA) and the European (ESC score) guidelines is unknown. Material and methods Subjects aged ≥45 years were recruited using newspaper announcements for the participation in our free of charge cardiovascular prevention program of the Vascular Risk Foundation (Varifo). The data served to calculate cardiovascular 10 year risk and to compare IAS-AGLA und ESC score with respect to risk and lipid lowering indications. Results The primary prevention group included 713 subjects aged 55±6 years of which 47% were women. The mean 10-year risk ± standard deviation was low (IAS-AGLA: 3.9%±4.4% for myocardial infarction; ESC score: 1.7%±1.8% for cardiovascular death). In those subjects qualifying for a lipid lowering intervention, according to the IAS-AGLA score or the ESC score, the percentage of agreement between both scores was only 18% (kappa value 0.31 [95%CI: 0.22-0.39], p<0.0001). Conclusions Our study shows, that the agreement for the available Swiss guidelines (IAS-AGLA, ESC score) for initiation of a lipid lowering therapy is low in our primary prevention group of subjects aged 45-65 years. According to the PROCAM study, about 30% of myocardial infarctions occur in persons with an intermediate risk. Therefore an improved risk stratification strategy is necessary.