University of Minnesota

Pierre Ducimetiere on early CVD epidemiology in France

At the end of the 1960s, Prof. D.Schwartz was used to saying that no CVD epidemiological work had ever been done before in France. He meant “professional epidemiological work” but that was also true for epidemiology in many other sectors of medicine – except for infectious diseases and . . cancer. In fact, nearly all that clinical cardiology leaders had published at the time were papers on the public health burden of CVD, following the particular stimulus of early Framingham papers. This was the case for those early involved: Professors P. Broustet in Bordeaux, R. Froment in Lyon, H. Warembourg in Lille, and A. Jouve in Marseille… all distinguished colleagues of the national cardiological leader, Prof. J. Lenègre from Hospital Boucicaut in Paris.

Several early papers were published, mainly in French in French journals, that contained, at best, descriptive data gathered from the clinic. For instance, Prof. Froment published in 1959 in Acta Cardiol (Supp ; 8: 39-59) a paper, “Modern data on French coronary pathologies; principally statistical studies” and another in 1960 in Rev Atheroscl 2: 113-117 “Personal data on the frequency of coronary atherosclerosis.” As far as I know, the only exception, apart from the Lenegre-Schwartz team in Paris, was that of Prof. Jouve in Marseille who began some “real” epidemiological work — CVD screening — in occupational groups (“Epidemiological survey of atherosclerosis in the Provence area” Union Med Canada 1969; 98: 7616).

Interestingly, he also launched in Marseille a relatively small, early prospective study reported as, “First results of a prospective survey on cardiovascular diseases in a large enterprise” Arch Mal Coeur Vaiss 1973; 66: 25-33, with interesting results on CVD risk associated with Behavior Pattern A (published later). Prof. Jouve was the only cardiology leader of that generation who was invited to speak at the INSERM Orsay Colloquium which took place in Orsay in 1973, in conjunction with the Orsay 10-day Seminar, which was considered the “official” start of CVD epidemiology in France.

The main strength of the Paris team (Groupe d’Etude sur l’Epidémiologie de l’Atherosclerose – GREA) formed in 1965 was its multidisciplinary composition, including clinicians (Prof. J.Lenegre, for a short period only, sadly, Prof. J.Himbert), biologists (Professors JL Beaumont, JR Claude, and JM. Warnet), epidemiologists and biostatisticians (Professors D.Schwartz, J. Lellouch, and Dr. E.Eschwege). The operations were managed by Dr JL Richard assisted by P.Ducimetiere. At that time, the “Institut National d’Hygiene – (INH),” which was responsible for medical research and public health studies in France, had expanded greatly from its beginning in 1941. In 1964 it became the well-known “Institut national de la santé et de la recherche médicale (INSERM). Dr JL Richard was appointed there as chief of the cardiology section responsible for public health affairs. P.Ducimetiere was appointed to the Research Unit 21 (“Unite de Recherche Statistique”) in Villejuif, directed by Prof. D.Schwartz.

An unique characteristic of INH and INSERM of that era was division in two departments : medico-social and medical research, which resulted in many fruitful collaborations and improved the status of public health and especially population studies at the national level. However this organizational feature could not resist the exponential development of biological research and the medico-social department was dissolved in 1975.

Following reports from a number of cross sectional studies on coronary heart disease and its risk factors in various occupational groups, and the first results of the Paris Prospective Study launched in 1967 among the Paris Police, GREA gave a communication at the Academie Nationale de Medecine in 1975 which officially introduced CVD epidemiology to the larger French medical and academic world: J Di Matteo (the successor to the late Prof. J Lenègre) presented with collaborators this landmark report: Evaluation du risque de future cardiopathie ischémique. Application à
une politique de prévention. Bull Acad Nat Med – Séance du 14 octobre 1975. (“Evaluating the Risk of Ischemic Cardiopathie. Implications for Prevention Policy”)

Interestingly, the most renowned medical leaders in France at that time raised during the Academy’s discussion of that paper a number of practical issues which remain topical in the field of CVD prevention:

“… To insist upon hygienic measures which unhappily are currently not accepted by a public which is badly informed …” (Prof. G Laroche) –

“… Still more important is prevention at the beginning of life… ” (Prof. R Debre) –

“… To underline the importance of risk factor screening and the major role of the general practitioner…” (Prof. X Leclainche).

Clearly, 35 years later, much remains to be learned and to be done in the field in general–and in France. (Pierre Ducimetiere)