Données épidémiologiques des maladies cardiovasculaires et prise en charge des accidents cardiovasculaires

Cardiovascular diseases (CVD) will be responsible for most deaths in the world in 2010. Their incidence increases in all countries, although their treatment is regularly improved. Nutritional modifications and smoking are the main causes of this increase, but France is a particular case with a relatively low mortality by CVD (the “French paradox”). The development of atherosclerosis takes a large part in the pathophysiology of CVD, particularly for acute coronary syndrome (ACS). 43.7 % of deaths in the world in 2003 were related to acute myocardial infarction, 32.9 % were related to stroke and 23.4 % to arterial hypertension (AHT) or to other CVD such as pulmonary embolism (PE) and causes of heart failure (HF). Risk factors of cardiovascular accidents are age, male sex, smoking, HT, increase in LDL-cholesterol and type 2 diabetes; other risk factors predispose to CVD: familial antecedents, lack of physical training, android obesity, menopause… We can now identify a true metabolic syndrome with HT, obesity, diabetes and dyslipidemia, related to a high CVD risk and its incidence increases in the whole world. The biochemical markers take a particular place in the diagnosis of cardiovascular damages, in risk stratification and in both hygienic-dietetic and drug therapy of these diseases. The physician, most often a cardiologist, must cope with various situations which sometimes bring life prognosis into play at short term. The diagnosis needs both clinical examination and standardized complementary tests, such as T or I troponin for ACS diagnosis and prognosis, BNP or NT-proBNP for HF diagnosis and therapy management, and D-dimers in the differential diagnosis of PE. Radiological tests have now the advantage of important progresses on both materials and training of specialized staffs.