{"id":8476,"date":"2023-07-07T12:12:20","date_gmt":"2023-07-07T09:12:20","guid":{"rendered":"https:\/\/urbancare.clinic\/black-women-with-hypertensive-disorders-of-pregnancy-more-at-risk-of-stroke-study-shows\/"},"modified":"2023-07-07T12:12:20","modified_gmt":"2023-07-07T09:12:20","slug":"selon-une-etude-les-femmes-noires-souffrant-de-troubles-hypertensifs-de-la-grossesse-sont-plus-a-risque-daccident-vasculaire-cerebral","status":"publish","type":"post","link":"https:\/\/urbancare.clinic\/fr\/selon-une-etude-les-femmes-noires-souffrant-de-troubles-hypertensifs-de-la-grossesse-sont-plus-a-risque-daccident-vasculaire-cerebral\/","title":{"rendered":"Les femmes noires atteintes de troubles hypertensifs de la grossesse sont plus \u00e0 risque d'AVC, selon une \u00e9tude"},"content":{"rendered":"
<\/div>\n

Aux \u00c9tats-Unis, les troubles hypertensifs exposent les femmes noires \u00e0 un risque accru d'accident vasculaire c\u00e9r\u00e9bral par rapport \u00e0 leurs homologues blanches, selon une nouvelle \u00e9tude.<\/p>\n

Des chercheurs de l'\u00c9cole de m\u00e9decine Chobanian et Avedisian de l'Universit\u00e9 de Boston et du Slone Epidemiology Center ont men\u00e9 une \u00e9tude r\u00e9cemment publi\u00e9e qui a analys\u00e9 les donn\u00e9es collect\u00e9es sur une p\u00e9riode de 25 ans aupr\u00e8s de 59 000 femmes noires, qui ont particip\u00e9 \u00e0 l'\u00e9tude sur la sant\u00e9 des femmes noires (BWHS).<\/p>\n

L'\u00e9tude, publi\u00e9e dans la revue Preuve NEJM<\/a>, a r\u00e9v\u00e9l\u00e9 que les femmes noires qui ont souffert de troubles hypertensifs de la grossesse (HDOP) ont un risque d'accident vasculaire c\u00e9r\u00e9bral \u00e0 long terme 66% plus \u00e9lev\u00e9 que celles qui n'ont pas souffert de cette maladie.<\/p>\n

Le lien entre les ant\u00e9c\u00e9dents d\u2019HDOP et le risque d\u2019accident vasculaire c\u00e9r\u00e9bral a \u00e9t\u00e9 constat\u00e9 chez les femmes plus jeunes et plus \u00e2g\u00e9es, quel que soit leur statut pond\u00e9ral au d\u00e9but de l\u2019\u00e2ge adulte.<\/p>\n

"Nos r\u00e9sultats peuvent expliquer, en partie, l'incidence disproportionnellement \u00e9lev\u00e9e d'accidents vasculaires c\u00e9r\u00e9braux chez les femmes noires par rapport \u00e0 d'autres populations", a d\u00e9clar\u00e9 l'auteur correspondant de l'\u00e9tude, Shanshan Sheehy, MD, ScD, professeur adjoint de m\u00e9decine \u00e0 l'\u00e9cole et chercheur au Slone Epidemiology Center. , dit Express M\u00e9dical. <\/a><\/p>\n

Les chercheurs se sont r\u00e9f\u00e9r\u00e9s \u00e0 la base de donn\u00e9es du BWHS, examinant 42 924 cas de grossesse sans ant\u00e9c\u00e9dents d'incidence cardiaque. Gr\u00e2ce \u00e0 des questionnaires biennaux, les auteurs de l'\u00e9tude recueillent des informations aupr\u00e8s des participants sur diverses affections, notamment la pr\u00e9\u00e9clampsie, l'hypertension gestationnelle et les accidents vasculaires c\u00e9r\u00e9braux.<\/p>\n

Pour d\u00e9terminer la v\u00e9racit\u00e9 des cas d'accident vasculaire c\u00e9r\u00e9bral autod\u00e9clar\u00e9s, les chercheurs ont consult\u00e9 des dossiers m\u00e9dicaux et les ont fait examiner par des neurologues.<\/p>\n

Entre 1995 et 2019, 1\u00a0555 accidents vasculaires c\u00e9r\u00e9braux ont \u00e9t\u00e9 signal\u00e9s au total, dont 310 cas survenus chez 4\u00a0938 femmes ayant des ant\u00e9c\u00e9dents d'accident vasculaire c\u00e9r\u00e9bral. HDOP<\/a>. On estime que les femmes ayant des ant\u00e9c\u00e9dents d'HDOP pr\u00e9sentent un risque d'accident vasculaire c\u00e9r\u00e9bral 1,66 fois plus \u00e9lev\u00e9 que celles qui n'ont pas connu ces complications de grossesse. Pour les personnes ayant des ant\u00e9c\u00e9dents de pr\u00e9\u00e9clampsie, le risque estim\u00e9 \u00e9tait 1,53 fois plus \u00e9lev\u00e9.<\/p>\n

La pr\u00e9\u00e9clampsie est une affection qui survient au cours d'environ 2 \u00e0 81 TP3T de grossesses et constitue une cause majeure de d\u00e9c\u00e8s maternels dans le monde. Chez les femmes noires aux \u00c9tats-Unis, le risque de pr\u00e9\u00e9clampsie est 60% plus \u00e9lev\u00e9 que chez les femmes blanches (70 cas pour 1\u00a0000 accouchements en 2014 pour les femmes noires, contre 43 cas pour 1\u00a0000 pour les femmes blanches). Il y a eu une augmentation des cas graves de pr\u00e9\u00e9clampsie chez les femmes noires ces derni\u00e8res ann\u00e9es.<\/p>\n

"Notre \u00e9tude fournit la preuve que les ant\u00e9c\u00e9dents de grossesse peuvent \u00eatre un facteur important pour l'\u00e9valuation du risque et la pr\u00e9vention des accidents vasculaires c\u00e9r\u00e9braux \u00e0 long terme", a d\u00e9clar\u00e9 Sheehy. "Les recommandations en mati\u00e8re de d\u00e9pistage cardiovasculaire pour les femmes noires, en particulier, devraient tenir compte des ant\u00e9c\u00e9dents d'HDOP."<\/p>\n

Publi\u00e9 par Medicaldaily.com<\/p>\n

Source quotidienne m\u00e9dicale<\/a><\/p>\n

","protected":false},"excerpt":{"rendered":"

<\/div>\n

Aux \u00c9tats-Unis, les troubles hypertensifs exposent les femmes noires \u00e0 un risque accru d'accident vasculaire c\u00e9r\u00e9bral par rapport \u00e0 leurs homologues blanches, selon une nouvelle \u00e9tude.<\/p>\n

Des chercheurs de l'\u00c9cole de m\u00e9decine Chobanian et Avedisian de l'Universit\u00e9 de Boston et du Slone Epidemiology Center ont men\u00e9 une \u00e9tude r\u00e9cemment publi\u00e9e qui a analys\u00e9 les donn\u00e9es collect\u00e9es sur une p\u00e9riode de 25 ans aupr\u00e8s de 59 000 femmes noires, qui ont particip\u00e9 \u00e0 l'\u00e9tude sur la sant\u00e9 des femmes noires (BWHS).<\/p>\n

L'\u00e9tude, publi\u00e9e dans la revue Preuve NEJM<\/a>, a r\u00e9v\u00e9l\u00e9 que les femmes noires qui ont souffert de troubles hypertensifs de la grossesse (HDOP) ont un risque d'accident vasculaire c\u00e9r\u00e9bral \u00e0 long terme 66% plus \u00e9lev\u00e9 que celles qui n'ont pas souffert de cette maladie.<\/p>\n

Le lien entre les ant\u00e9c\u00e9dents d\u2019HDOP et le risque d\u2019accident vasculaire c\u00e9r\u00e9bral a \u00e9t\u00e9 constat\u00e9 chez les femmes plus jeunes et plus \u00e2g\u00e9es, quel que soit leur statut pond\u00e9ral au d\u00e9but de l\u2019\u00e2ge adulte.<\/p>\n

"Nos r\u00e9sultats peuvent expliquer, en partie, l'incidence disproportionnellement \u00e9lev\u00e9e d'accidents vasculaires c\u00e9r\u00e9braux chez les femmes noires par rapport \u00e0 d'autres populations", a d\u00e9clar\u00e9 l'auteur correspondant de l'\u00e9tude, Shanshan Sheehy, MD, ScD, professeur adjoint de m\u00e9decine \u00e0 l'\u00e9cole et chercheur au Slone Epidemiology Center. , dit Express M\u00e9dical. <\/a><\/p>\n

Les chercheurs se sont r\u00e9f\u00e9r\u00e9s \u00e0 la base de donn\u00e9es du BWHS, examinant 42 924 cas de grossesse sans ant\u00e9c\u00e9dents d'incidence cardiaque. Gr\u00e2ce \u00e0 des questionnaires biennaux, les auteurs de l'\u00e9tude recueillent des informations aupr\u00e8s des participants sur diverses affections, notamment la pr\u00e9\u00e9clampsie, l'hypertension gestationnelle et les accidents vasculaires c\u00e9r\u00e9braux.<\/p>\n

Pour d\u00e9terminer la v\u00e9racit\u00e9 des cas d'accident vasculaire c\u00e9r\u00e9bral autod\u00e9clar\u00e9s, les chercheurs ont consult\u00e9 des dossiers m\u00e9dicaux et les ont fait examiner par des neurologues.<\/p>\n

Entre 1995 et 2019, 1\u00a0555 accidents vasculaires c\u00e9r\u00e9braux ont \u00e9t\u00e9 signal\u00e9s au total, dont 310 cas survenus chez 4\u00a0938 femmes ayant des ant\u00e9c\u00e9dents d'accident vasculaire c\u00e9r\u00e9bral. HDOP<\/a>. On estime que les femmes ayant des ant\u00e9c\u00e9dents d'HDOP pr\u00e9sentent un risque d'accident vasculaire c\u00e9r\u00e9bral 1,66 fois plus \u00e9lev\u00e9 que celles qui n'ont pas connu ces complications de grossesse. Pour les personnes ayant des ant\u00e9c\u00e9dents de pr\u00e9\u00e9clampsie, le risque estim\u00e9 \u00e9tait 1,53 fois plus \u00e9lev\u00e9.<\/p>\n

La pr\u00e9\u00e9clampsie est une affection qui survient au cours d'environ 2 \u00e0 81 TP3T de grossesses et constitue une cause majeure de d\u00e9c\u00e8s maternels dans le monde. Chez les femmes noires aux \u00c9tats-Unis, le risque de pr\u00e9\u00e9clampsie est 60% plus \u00e9lev\u00e9 que chez les femmes blanches (70 cas pour 1\u00a0000 accouchements en 2014 pour les femmes noires, contre 43 cas pour 1\u00a0000 pour les femmes blanches). Il y a eu une augmentation des cas graves de pr\u00e9\u00e9clampsie chez les femmes noires ces derni\u00e8res ann\u00e9es.<\/p>\n

"Notre \u00e9tude fournit la preuve que les ant\u00e9c\u00e9dents de grossesse peuvent \u00eatre un facteur important pour l'\u00e9valuation du risque et la pr\u00e9vention des accidents vasculaires c\u00e9r\u00e9braux \u00e0 long terme", a d\u00e9clar\u00e9 Sheehy. "Les recommandations en mati\u00e8re de d\u00e9pistage cardiovasculaire pour les femmes noires, en particulier, devraient tenir compte des ant\u00e9c\u00e9dents d'HDOP."<\/p>\n

Publi\u00e9 par Medicaldaily.com<\/p>","protected":false},"author":2,"featured_media":8477,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"Default","format":"standard","meta":{"fifu_image_url":"https:\/\/urbancare.clinic\/wp-content\/uploads\/2023\/07\/black-women-with-hypertensive-disorders-of-pregnancy-more-at-risk-of-stroke-study-shows.jpg","fifu_image_alt":"","footnotes":""},"categories":[27],"tags":[],"class_list":["post-8476","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blog"],"yoast_head":"\nBlack Women With Hypertensive Disorders Of Pregnancy More At Risk of Stroke, Study Shows - Urban Care Clinic<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/urbancare.clinic\/fr\/selon-une-etude-les-femmes-noires-souffrant-de-troubles-hypertensifs-de-la-grossesse-sont-plus-a-risque-daccident-vasculaire-cerebral\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Black Women With Hypertensive Disorders Of Pregnancy More At Risk of Stroke, Study Shows - Urban Care Clinic\" \/>\n<meta property=\"og:description\" content=\"Hypertensive disorders put Black women in the U.S. at a heightened risk of stroke compared to their white counterparts, a new study has found.Researchers from the Boston University Chobanian & Avedisian School of Medicine and the Slone Epidemiology Center conducted a recently published study that analyzed data collected over a span of 25 years from 59,000 Black women, who participated in the Black Women's Health Study (BWHS).The study, which was published in the journal NEJM Evidence, revealed Black women who have experienced hypertensive disorders of pregnancy (HDOP) have a 66% higher long-term risk of stroke compared to those who didn't experience this condition.The link between HDOP history and stroke risk was found in both younger and older women, regardless of their weight status during young adulthood."Our results may explain, in part, the disproportionately high incidence of stroke in Black women relative to other populations," the study corresponding author Shanshan Sheehy, MD, ScD, assistant professor of medicine at the school and an investigator at the Slone Epidemiology Center, told Medical Express. Researchers referred to the database of the BWHS, examining 42,924 pregnancy cases without a history of cardiac incidence. Through biennial questionnaires, the study authors collect information from participants about various conditions, including preeclampsia, gestational hypertension, and stroke, among others.To determine the veracity of self-reported stroke cases, researchers sought medical records and had them reviewed by neurologists.Between 1995 and 2019, there were a total of 1,555 reported strokes, with 310 cases occurring among 4,938 women with a history of HDOP. Women, who had a history of HDOP, were estimated to have a 1.66 times higher risk of stroke compared to those, who had not experienced these pregnancy complications. For those with a history of preeclampsia, the estimated risk was 1.53 times higher.Preeclampsia is a condition that occurs in about 2-8% of pregnancies and is a major cause of maternal deaths worldwide. Among Black women in the U.S., the risk of preeclampsia is 60% higher than for white women (70 cases per 1,000 deliveries in 2014 for Black women, compared to 43 cases per 1,000 for white women). There has been an increase in severe cases of preeclampsia among Black women in recent years."Our study provides evidence that pregnancy history may be an important factor for risk assessment and prevention of long-term stroke," said Sheehy. "Cardiovascular screening recommendations for Black women, in particular, should take the history of HDOP into account."Published by Medicaldaily.com\" \/>\n<meta property=\"og:url\" content=\"https:\/\/urbancare.clinic\/fr\/selon-une-etude-les-femmes-noires-souffrant-de-troubles-hypertensifs-de-la-grossesse-sont-plus-a-risque-daccident-vasculaire-cerebral\/\" \/>\n<meta property=\"og:site_name\" content=\"Urban Care Clinic\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/urbancarezanzibar\" \/>\n<meta property=\"article:published_time\" content=\"2023-07-07T09:12:20+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/urbancare.clinic\/wp-content\/uploads\/2023\/07\/black-women-with-hypertensive-disorders-of-pregnancy-more-at-risk-of-stroke-study-shows.jpg\" \/>\n<meta name=\"author\" content=\"Urban Care Clinic\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:image\" content=\"https:\/\/urbancare.clinic\/wp-content\/uploads\/2023\/07\/black-women-with-hypertensive-disorders-of-pregnancy-more-at-risk-of-stroke-study-shows.jpg\" \/>\n<meta name=\"twitter:label1\" content=\"\u00c9crit par\" \/>\n\t<meta name=\"twitter:data1\" content=\"Urban Care Clinic\" \/>\n\t<meta name=\"twitter:label2\" content=\"Dur\u00e9e de lecture estim\u00e9e\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\/\/urbancare.clinic\/black-women-with-hypertensive-disorders-of-pregnancy-more-at-risk-of-stroke-study-shows\/#article\",\"isPartOf\":{\"@id\":\"https:\/\/urbancare.clinic\/black-women-with-hypertensive-disorders-of-pregnancy-more-at-risk-of-stroke-study-shows\/\"},\"author\":{\"name\":\"Urban Care Clinic\",\"@id\":\"https:\/\/urbancare.clinic\/#\/schema\/person\/f286c4d84be896d302aceda3ed7e789c\"},\"headline\":\"Black Women With Hypertensive Disorders Of Pregnancy More At Risk of Stroke, Study Shows\",\"datePublished\":\"2023-07-07T09:12:20+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\/\/urbancare.clinic\/black-women-with-hypertensive-disorders-of-pregnancy-more-at-risk-of-stroke-study-shows\/\"},\"wordCount\":415,\"publisher\":{\"@id\":\"https:\/\/urbancare.clinic\/#organization\"},\"image\":{\"@id\":\"https:\/\/urbancare.clinic\/black-women-with-hypertensive-disorders-of-pregnancy-more-at-risk-of-stroke-study-shows\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/urbancare.clinic\/wp-content\/uploads\/2023\/07\/black-women-with-hypertensive-disorders-of-pregnancy-more-at-risk-of-stroke-study-shows.jpg\",\"articleSection\":[\"Medical Daily\"],\"inLanguage\":\"fr-FR\"},{\"@type\":\"WebPage\",\"@id\":\"https:\/\/urbancare.clinic\/black-women-with-hypertensive-disorders-of-pregnancy-more-at-risk-of-stroke-study-shows\/\",\"url\":\"https:\/\/urbancare.clinic\/black-women-with-hypertensive-disorders-of-pregnancy-more-at-risk-of-stroke-study-shows\/\",\"name\":\"Black Women With Hypertensive Disorders Of Pregnancy More At Risk of Stroke, Study Shows - 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Urban Care Clinic","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/urbancare.clinic\/fr\/selon-une-etude-les-femmes-noires-souffrant-de-troubles-hypertensifs-de-la-grossesse-sont-plus-a-risque-daccident-vasculaire-cerebral\/","og_locale":"fr_FR","og_type":"article","og_title":"Black Women With Hypertensive Disorders Of Pregnancy More At Risk of Stroke, Study Shows - Urban Care Clinic","og_description":"Hypertensive disorders put Black women in the U.S. at a heightened risk of stroke compared to their white counterparts, a new study has found.Researchers from the Boston University Chobanian & Avedisian School of Medicine and the Slone Epidemiology Center conducted a recently published study that analyzed data collected over a span of 25 years from 59,000 Black women, who participated in the Black Women's Health Study (BWHS).The study, which was published in the journal NEJM Evidence, revealed Black women who have experienced hypertensive disorders of pregnancy (HDOP) have a 66% higher long-term risk of stroke compared to those who didn't experience this condition.The link between HDOP history and stroke risk was found in both younger and older women, regardless of their weight status during young adulthood.\"Our results may explain, in part, the disproportionately high incidence of stroke in Black women relative to other populations,\" the study corresponding author Shanshan Sheehy, MD, ScD, assistant professor of medicine at the school and an investigator at the Slone Epidemiology Center, told Medical Express. Researchers referred to the database of the BWHS, examining 42,924 pregnancy cases without a history of cardiac incidence. Through biennial questionnaires, the study authors collect information from participants about various conditions, including preeclampsia, gestational hypertension, and stroke, among others.To determine the veracity of self-reported stroke cases, researchers sought medical records and had them reviewed by neurologists.Between 1995 and 2019, there were a total of 1,555 reported strokes, with 310 cases occurring among 4,938 women with a history of HDOP. Women, who had a history of HDOP, were estimated to have a 1.66 times higher risk of stroke compared to those, who had not experienced these pregnancy complications. For those with a history of preeclampsia, the estimated risk was 1.53 times higher.Preeclampsia is a condition that occurs in about 2-8% of pregnancies and is a major cause of maternal deaths worldwide. Among Black women in the U.S., the risk of preeclampsia is 60% higher than for white women (70 cases per 1,000 deliveries in 2014 for Black women, compared to 43 cases per 1,000 for white women). There has been an increase in severe cases of preeclampsia among Black women in recent years.\"Our study provides evidence that pregnancy history may be an important factor for risk assessment and prevention of long-term stroke,\" said Sheehy. \"Cardiovascular screening recommendations for Black women, in particular, should take the history of HDOP into account.\"Published by Medicaldaily.com","og_url":"https:\/\/urbancare.clinic\/fr\/selon-une-etude-les-femmes-noires-souffrant-de-troubles-hypertensifs-de-la-grossesse-sont-plus-a-risque-daccident-vasculaire-cerebral\/","og_site_name":"Urban Care Clinic","article_publisher":"https:\/\/www.facebook.com\/urbancarezanzibar","article_published_time":"2023-07-07T09:12:20+00:00","og_image":[{"url":"https:\/\/urbancare.clinic\/wp-content\/uploads\/2023\/07\/black-women-with-hypertensive-disorders-of-pregnancy-more-at-risk-of-stroke-study-shows.jpg","type":"","width":"","height":""}],"author":"Urban Care Clinic","twitter_card":"summary_large_image","twitter_image":"https:\/\/urbancare.clinic\/wp-content\/uploads\/2023\/07\/black-women-with-hypertensive-disorders-of-pregnancy-more-at-risk-of-stroke-study-shows.jpg","twitter_misc":{"\u00c9crit par":"Urban Care Clinic","Dur\u00e9e de lecture estim\u00e9e":"2 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/urbancare.clinic\/black-women-with-hypertensive-disorders-of-pregnancy-more-at-risk-of-stroke-study-shows\/#article","isPartOf":{"@id":"https:\/\/urbancare.clinic\/black-women-with-hypertensive-disorders-of-pregnancy-more-at-risk-of-stroke-study-shows\/"},"author":{"name":"Urban Care Clinic","@id":"https:\/\/urbancare.clinic\/#\/schema\/person\/f286c4d84be896d302aceda3ed7e789c"},"headline":"Black Women With Hypertensive Disorders Of Pregnancy More At Risk of Stroke, Study Shows","datePublished":"2023-07-07T09:12:20+00:00","mainEntityOfPage":{"@id":"https:\/\/urbancare.clinic\/black-women-with-hypertensive-disorders-of-pregnancy-more-at-risk-of-stroke-study-shows\/"},"wordCount":415,"publisher":{"@id":"https:\/\/urbancare.clinic\/#organization"},"image":{"@id":"https:\/\/urbancare.clinic\/black-women-with-hypertensive-disorders-of-pregnancy-more-at-risk-of-stroke-study-shows\/#primaryimage"},"thumbnailUrl":"https:\/\/urbancare.clinic\/wp-content\/uploads\/2023\/07\/black-women-with-hypertensive-disorders-of-pregnancy-more-at-risk-of-stroke-study-shows.jpg","articleSection":["Medical Daily"],"inLanguage":"fr-FR"},{"@type":"WebPage","@id":"https:\/\/urbancare.clinic\/black-women-with-hypertensive-disorders-of-pregnancy-more-at-risk-of-stroke-study-shows\/","url":"https:\/\/urbancare.clinic\/black-women-with-hypertensive-disorders-of-pregnancy-more-at-risk-of-stroke-study-shows\/","name":"Les femmes noires souffrant de troubles hypertensifs de la grossesse sont plus \u00e0 risque d'accident vasculaire c\u00e9r\u00e9bral, selon une \u00e9tude - 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