This is the first study to report a poorer general prognosis of patients with proximal (aortoiliac) PAD compared with those with more distal PAD, independent of risk factors and comorbidities.

This first population study in Central Africa highlights the high prevalence of PAD in the older population, and emphasizes specificities regarding the risk factors, being different from data published in Western countries.

International audienceBackgroundIn the western countries, a high prevalence of lower-extremities peripheral artery disease (LE-PAD) is reported in the elderly. The epidemiological transition in the developing countries might also involve this affection, but data regarding LE-PAD in Sub-Saharan Africa are unknown. We sought to determine the prevalence and risk factors for LE-PAD in the general elder population in 2 Sub-Saharan African countries: Congo and Central African Republic.MethodsWe performed 2 cross-sectional studies in the populations aged >65 years in two representative districts of Brazzaville, Congo and Bangui, Central African Republic. Demographic data, as well as medical history, were collected along with clinical and biological data to determine the traditional cardiovascular disease risk factors. The ankle-brachial index (ABI) was used to define LE-PAD, when ABI <0.90. An ABI >1.40 was considered to define medial calcinosis (MC).ResultsAmong the 997 participants (age 73.6+6.5 yrs, 40.7% males), 239 (24.0%) had LE-PAD, while 69 (6.9%) had MC. Adjusted for age, gender and study site, factors significantly associated with LE-PAD were hypertension (OR=1.75, 95%CI: 1.24-2.48, p=0.002) and daily alcohol consumption (OR=0.72, 95%CI: 0.53-0.98, p=0.04). A borderline association was found with a body-mass index >30kg/m2 (OR=1.56, 95%CI: 0.95-2.58, p=0.08). Of note, neither smoking nor diabetes were found as significant associated risk factors. Adjusted for age, gender and study site, factors significantly associated with MC were schooling (vs. no school education, OR=3.20, 95%CI: 1.69-6.04, p=0.0003) and hypertension (OR=0.38, 95%CI: 0.22-0.66, p=0.0006), while alcohol consumption (OR=0.63, 95%CI: 0.37-1.07, p=0.09) and heart rate (OR=1.23, 95%CI: 0.98-1.56, p=0.07) presented a borderline association.ConclusionsIn this first population study in Central Africa, we found a very high prevalence of LE-PAD in the elderly, and highlight particularities regarding the associated risk factors, different from data published in western countries

The clinical and electrocardiographic features of 11 patients with ventricular parasystole in acute myocardial infarction are described. This arrhythmia always appeared within the first 24 hours after the beginning of the pain, and lasted usually a few hours. Only one patient received digitalis before the appearance of the arrhythmia; the others did not receive any drug of known arrhythmic potential. The treatment was mainly with lignocaine intravenously, the response to which was usually very good. There was no relation between this arrhythmia and the plasma potassium levels. The electrocardiographic finding of fusion beats, coupling, retrograde conduction, interectopic interval, ectopic cycle length, and exit block were analysed. Two of the cases were examples of intermittent parasystole. The relation between this arrhythmia and the slow idioventricular rhythm was discussed. It appears that this is a benign arrhythmia, easily controlled by treatment, produced perhaps by the same mechanisms as ventricular tachycardia, but with the existence of exit block.

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