The Italian Health Examination Survey: time trends of CVD risk factors
S Giampaoli1, C Lo Noce1, L Iacoviello2, D Vanuzzo3, L Palmieri1, C Donfrancesco1, J Stamler4
1Instituto Superiore di Sanita, Rome, Italy, 2Catholic University of the Sacred Heart, Campobasso, Italy, 3Center for Cardiovascular Prevention, Udine, Italy, 4Northwestern University, Feinberg School of Medicine, Chicago, United States of America
Topic: Risk factors and risk prediction
Purpose: A periodic Health Examination Survey (HES)-Osservatorio Epidemiologico Cardiovascolare (OEC) has been implemented in Italy. the aim of this analysis is to present initial results for 2008–09 and compare them with those collected in 1998, the previous HES.
Methods: Randomized population samples stratified by age and sex were examined (participation rate 63%). Risk factor data were collected using MONICA Project standardized methodologies; biochemical levels were assayed in a central laboratory. In 1998, about 10,000 men and women ages 35–74 years were enrolled throughout the country (200 persons from each 1,5 million of resident population). the new screening is enrolling the same sample size, age range 35–79 years. All data are age-standardized using the European standard population.
Results: Data here are from 7 regions, for a total of 1,454 men and women in 1998 and 1,864 persons in 2008–09. Data comparison shows a decrease for systolic blood pressure (men: from 139 to 135 mmHg; women: from 130 to 125 mmHg) and diastolic blood pressure (men: from 87 to 82 mmHg; women: from 82 to 78 mmHg); an increase for serum total cholesterol (men: from 209 to 217 mg/dl; women: from 206 to 218 mg/dl), while HDL-cholesterol remained stable (men: 52 and 51 mg/dl; women: 59 and 60 mg/dl); body mass index also was stable for men and women (average 28 kg/m2 and 27kg/m2); glycemia increased in both genders (men: from 92 to 97 mg/dl; women: from 87 to 89 mg/dl). Prevalence of obesity increased from 21% to 26% in men, and did not change in women (26%); prevalence of diabetes did not change in men (12%) and decreased slightly in women (from 8% to 7%); smoking habit decreased in men (from 33% to 26%) but not in women (22% in both surveys).
Conclusions: Although these are only preliminary results, HES trends show troublesome increases in total cholesterol, glycemia, and obesity; improvements in blood pressure. In combination with other information sources, the OEC can contribute greatly to evaluation of the efficacy of community actions (the Italian smoking ban regulation, introduction of risk assessment in clinical practice) and to elaboration of needed next efforts.
P191
Coronary heart disease risk estimation across ten European countries in the MOR-GAM project
A Borglykke1, AH Andreasen1, K Kuulasmaa2, D Vanuzzo3, J Baumert4, H Tunstall-Pedoe5, T Jorgensen1
1Glostrup Hospital, Research Center for Prevention and Health, Glostrup, Denmark, 2National Institute for Health and Welfare, Helsinki, Finland, 3Centre for Cardiovascular Prevention, ASS4 “Medio Friuli”, Udine, Italy, 4Helmholtz Center of Munich, Institute of Epidemiology, Neuherberg, Germany, 5University of Dundee, Dundee, United Kingdom
Topic: Risk factors and risk prediction
the MORGAM Project
Purpose: To develop a stepwise risk estimation model for the estimation of ten-year risk of coronary heart disease in ten different countries across Europe.
Methods: Using data from the MOnica Risk, Genetics, Archiving and Monograph (MORGAM) Project, sex-specific models for estimating ten year risk of fatal and nonfatal CHD were developed using Cox regression model with age as underlying timescale stratified by country and including modelling of competing risks. Models were developed in a stepwise approach assessing the ability of the model using only data from questionnaires (diabetes, treatment for high blood pressure and smoking), and then adding data from physical examinations (BMI, systolic and diastolic blood pressure) and finally with biological data from blood samples (total and HDL serum cholesterol). the model was validated using bootstrap sampling methods.
Results: During 1,289,197 years of observation 6568 incident fatal and non-fatal events of CHD were registered in 98,972. the model showed good calibration comparing observed and expected number of events. the discrimination of the model varied between sex and country but increased with increasing number of variables with each step (AUC for all countries combined between 0.74 and 0.78 in men and 0.82 and 0.85 in women) (Table 1).
Conclusion: It is possible to develop a stepwise risk estimation model for CHD, tailored clinical settings of diverse resources, and still obtain valid measures of risk estimation and discrimination even in the simplest form of the model. the performance of the model varied between countries, and risk estimation models that are able to asses risk in several populations are to be preferred.
Model
Observed
Predicted
AUC
P
Men
Q
2367
2317.07
0.742
N=39 824
Q+E
2367
2311.47
0.754
>0.01
Q+E+B
2367
2311.53
0.779
>0.01
Women
Q
725
715.8
0.826
N=34 087
Q+E
725
713.19
0.833
>0.01
Q+E+B
725
711.69
0.846
>0.01
aQ Data from questionnaires, E data from physical examinations, B data from blood samples. Performance of the model comparing observed and predicted number events and discrimination measured by AUC
P192
Stroke risk estimation across nine European countries in the MORGAM project
A Borglykke1, AH Andreasen1, S Sans2, M Ferrario3, J Karvanen4, P Ducimetiere5, T Jorgensen1
1Glostrup Hospital, Research Center for Prevention and Health, Glostrup, Denmark, 2Institute of Health Studies, Department of Health, Barcelona, Spain, 3University of Insubria, Varese, Italy, 4National Institute for Health and Welfare, Helsinki, Finland, 5National Institute of Health and Medical Research, Paris, France
Topic: Risk factors and risk prediction
the MORGAM Project
Purpose: To develop a stepwise risk estimation model for the estimation of ten-year risk of stroke in nine different countries across Europe.
Methods: Using data from the MOnica Risk, Genetics, Archiving and Monograph (MORGAM) Project, sex specific models for estimating ten year risk of fatal and nonfatal stroke were developed using Cox regression model with age as underlying timescale stratified by country and including modelling of competing risks. Models were developed in a stepwise approach assessing the ability of the model using only data from questionnaires (diabetes, treatment for high blood pressure and smoking), and then adding data from physical examinations (BMI and systolic and diastolic blood pressure) and finally with biological data from blood samples (total and HDL serum cholesterol). the model was validated using bootstrap sampling methods.
Results: During 1,176,296 years of observation 2928 incident fatal and non-fatal events of stroke were registered in 88,290 individuals. the model showed good calibration. However the discrimination of the model varied between the sexes and countries but increased with increasing number of variables (AUC for all countries combined between 0.77 and 0.79 in men and 0.75 and 0.80 in women) (Table 1).
Conclusion: It is possible to develop a stepwise model estimating ten year risk of stroke, tailored for clinical settings of diverse resources, and still obtain valid measures of prediction and discrimination even in the simplest form of the model. the performance of the model varied between countries especially regarding discrimination. Risk prediction models able to asses risk in several populations are to be preferred.
Modela
Observed
Predicted
AUC
P
Men
Q
682
692.93
0.771
N=36,107
Q+E
682
689.82
0.789
>0.01
Q+E+B
682
689.62
0.791
0.01
Women
Q
406
421.08
0.785
N=30,342
Q+E
406
420.19
0.801
>0.01
Q+E+B
406
419.71
0.801
0.79
aQ Data from questionnaires, E data from physical examinations, B data from blood samples. Performance of the model comparing observed and predicted number events and discrimination measured by AUC
P193
Inadequate awareness of own personal cardiovascular risk factors among Turkish physicians
M Kayikcioglu, OO Ozdogan, HK Kultursay
Ege University, Faculty of Medicine, Izmir, Turkey
Topic: Risk factors and risk prediction
Cardiovascular (CV) disease is the leading cause of death worldwide. Although the unequivocal evidence enforces the management of risk factors as the most effective preventive strategy against CV disease, there is a gap between established recommendations of prevention guidelines and their application in clinical practice. the aim of this survey was to investigate physicians’ knowledge of and attitude towards their own CV risk factors.
Methods: A self-administered questionnaire was used to determine the awareness of their own, personal risk factor profile among 300 Turkish physicians. the questionnaire was composed of 30 questions about the presence of CV disease, hyperlipidemia, hypertension, obesity, diabetes, and family history. Also physicians were asked if they had ever measured waist circumference and to report their own serum lipid and fasting glucose levels (FBG). Also information on the exercise and dietary habit was collected.
Results: A total of 281 physicians (mean age: 38±11, range: 21–73 years; 33% women) survey was valid. 1/3 of them were cardiologists and endocrinologists. Two percent had CV disease. Four percent reported to have diabetes, %13 to have hypertension, 20% to have hyperlipidemia, and 17% to have obesity. 20% were habitual smokers and 11 % were ex-smokers. For LDL levels, 55% was aware of the serum LDL levels, 34% had measured however did not remember, and 11% have never measured lipid levels. 29% did not remember own personal FBG levels meanwhile 10% had never measured the FBG levels. 56% of the physicians have never measured their own waist circumference and 54% had sedentary life style. %41 was not paying attention to heart-healthy dietary recommendations.
Conclusion: Most of the Turkish physicians do not pay attention to their own personal CV risk factors and do not take any measures to prevent CV disease which could explain the gap between the prevention guidelines and clinical practice. there is still a great need for information and training-programs for Turkish physicians to make the CV disease prevention strategies work efficiently.
P194
Explaining the decline in coronary heart disease mortality in Poland between 1991 and 2005
P Bandosz1, M O’ Flaherty2, W Drygas3, J Koziarek3, B Wyrzykowski1, K Bennett4, T Zdrojewski1, S Capewell2
1Department of Hypertension and Diabetology, Medical University in Gdansk, Gdansk, Poland, 2Department of Public Health, University of Liverpool, Liverpool, United Kingdom, 3Department of Epidemiology, CVD Prevention and Health Promotion, Institute of Cardiology, Warsaw, Poland, 4Trinity Centre for Health Sciences, St James Hospital, Dublin, Ireland
Topic: Risk factors and risk prediction
Purpose: Coronary heart disease (CHD) mortality has declined substantially in Poland over the last two decades. the purpose of this study was to determine what proportion of this decline could be associated with changes in CHD risk factors from 1991–2005.
Methods: the validated IMPACT model was used in all calculations. We included data describing population size, and CHD mortality and risk factor trends in adults aged 25–85 years old between 1991 and 2005. Regression coefficients and relative risks from the published literature quantified the relationship between population changes for a specific CHD risk factor (i.e., smoking, diabetes, systolic blood pressure, total cholesterol, and obesity) and CHD mortality. the outcome of interest was the number of deaths prevented or postponed (DPPs) associated with changes in each specific CHD risk factor.
Results: From 1991–2005, the overall CHD mortality rate in Poland fell from 280 to 159 deaths per 100,000 inhabitants, resulting in an estimated 35 176 fewer CHD deaths in 2005. Changes in CHD risk factors produced a total of 12 008 CHD deaths (minimum estimate 11 268; maximum estimate 12 798) in Poland. Such reduction accounted for approximately 34% of the total decrease in CHD mortality. the largest contributing risk factor to lower mortality was the substantial fall in cholesterol (30%), followed by the increase in physical activity (10%) and reduction in smoking (8%). However, increases in some of risk factors had a negative impact on mortality: diabetes prevalence (–4%), and BMI (–5%) and population systolic blood pressure (–5%), with increasing levels in men aged 45 and older, while women and young men showing decreasing trends. Research is currently underway to estimate the contribution of treatments to a) the reduction in blood pressure and cholesterol and b) the decrease in case fatality in CHD patients in Poland.
Conclusions: thirty four percent of the large fall in CHD mortality between 1991 and 2005 was attributable to reductions in major cardiovascular risk factors. However, adverse trends in blood pressure, obesity and diabetes are worrying. More aggressive food policies may therefore be needed to decrease future CHD deaths.
P195
Prevalence of classical risk factors in Polish women with premature coronary artery disease
B Lubiszewska1, E Ksiezycka1, G Broda2, M Kruk1, T Zielinski3, R Ploski4, P Kurjata2
1Institute of Cardiology, Department of Coronary Heart Disease, Warsaw, Poland, 2Institute of Cardiology, Department of CVD Epidemiology & Prevention & Health Promotion, Warsaw, Poland, 3National Institute of Cardiology, Warsaw, Poland, 4Medical University of Warsaw, Warsaw, Poland
Topic: Risk factors and risk prediction
Background: It is commonly suggested that in perimenopausal women (before 55 years of age) other than classical risk factors play significant role in the incidence of coronary artery disease (CAD).
Objectives: To determine the prevalence of 5 classical risk factors (cigarette smoking, hypertension, diabetes, hyperlipidemia and obesity) among women with premature CAD.
Patients and methods: We performed a standardized, single-center, case-control study of premature coronary artery disease (CAD) in women (below 55 years) with established CAD. 330 cases were enrolled between April 2005 and January 2008, and 347 age-matched healthy women from a similar region selected from the National Health Survey WOBASZ study (Polish Multicenter Population Health Survey) designed to assess the cardiovascular risk in Polish adult population).
Results: In women with premature CAD comparing to age-matched healthy controls very high prevalence of traditional risk factors was found. Patients had the highest prevalence of hypercholesterolemia (82 vs 68%) followed by smoking (current and former) (81 vs 48%), hypertension (68 vs 42%), and menopause (69.7 vs 40.6). the highest prevalence ratio was calculated for diabetes (4.3), menopause (1.72), smoking (1.68), and hypertension (1.63). At least 1 of the 5 classical risk factors was present in 98.8% of patients comparing to 89% in controls (p>0.001), while 10% of patients vs 1.4% of controls had all 5 classical risk factors (p>0.001).
Conclusions: Premature CAD in women was related mainly to cigarette smoking hypercholesterolemia and hypertension. In contrast with traditional thinking almost 99% of patients with CAD have classical risk factors.
Number of CAD classical risk factors
No. of risk factors
Cases N-323 (%)
Controls N-347 (%)
0
4 (1.24)
35 (10.09)
1
22 (6.81)
85 (24.5)
2
94 (29.1)
132 (38.0)
3
107 (33.1)
69 (19.9)
4
63 (19.5)
21 (6.05)
5
33 (10.2)
5 (1.44)
P196
Assessment of leading CVD risk-factors in Tbilisi - capital of Georgia
N Metreveli, R Tataradze, L Baramidze, V Barbaqadze, D Trapaidze, K Liluashvili, L Sturua, M Danelia
CINDI Georgia Team, Tbilisi, Republic of Georgia
Topic: Risk factors and risk prediction
Reducing Burden of Preventable NCD - Priority 4 of Biennial Collaborative Agreement between the Ministry of LHSA of Georgia and WHO Europe
Purpose: Non-communicable diseases risk-factors survey 2007 was carried out for estimation of current health risk profile in capital of Georgia- Tbilisi, with special emphasis on identification of leading CVD risk-factors, including behavioral risk-factors (tobacco, physical inactivity, diet, alcohol), as well as the biological risk-factors (hypertension, hypercholesterolemia, hyperglykemia, overweight and obesity).
Used methodology was in compliance with CINDI health monitor approach. One of the Tbilisi's districts was defined as a study area. Only permanent households were included. the Rapid Survey method was used in observational study, utilizing the random selection of population (totally 2472, Male 1212 & Female 1260) according to Probability Proportional-to-size on the first stage and using “door to door” principle till the cluster (minimum 7 respondents) was completed. Besides the behavioral variables, questionnaires data provided the information for computation of socioeconomic and demographic variables.
the Results of risk-factors survey have shown that the prevalence of risk-factors and their determinants are very high (ever smoking daily M-77.9%, overweight 34.9%, obesity 26.8%, cholesterol in 45–54 age group =190mg/dl − 83.2%, awareness of hypercholesterolemia − 6.5%, glucose =126 mg/dl in 55–65 age group − 20.9%, hypertensive's =140/90mm/Hg − 33.9%), simultaneously with significant lack of preventive interventions (Blood glucose and cholesterol measurements during the last year in 0.6% of respondents, those without any recommendations 80–90%). Resulted indicators of risk-factors appeared higher as compared with the similar risk-factors data 2001 & 2004.
Conclusion: the threats of CVD risk-factors are rising and preventive interventions don't meet them. these results are in compliance with existing significant role of CVD in health threats in terms of mortality and disease burden, as well as in health inequality between Georgia and Western European countries. the significant issue of future analysis remains the identification of health inequality between the low and high social groups due to social determinants within Georgia, emphasizing CVD and considering of continuing transition period in Georgia.
P197
Analysing the coronary heart disease mortality decline from 1988 to 2005 in Spain: Modelling study
G Flores-Mateo1, M Grau2, M O'flaherty3, R Ramos1, R Elosua2, C Violan-Fors1, J Marrugat2, S Capewell3
1Institut d Investigaciœ en Atenciœ Primaria Jordi Gol, Barcelona, Spain, 2Institut Municipal d Investigaciœ Modica, Barcelona, Spain, 3University of Liverpool, Liverpool, United Kingdom
Topic: Public health
Background: the “Mediterranean Paradox” means that countries such as Spain, Italy and France experience lower cardiovascular mortality than Northern Europe or the USA given similar levels of cardiovascular risk factors. Cardiovascular mortality has been decreasing for several decades, but the contributory factors remain unquantified.
Objective: We examined the extent to which the decrease in Coronary Heart Disease (CHD) mortality rates in Spain between 1988 and 2005 could be explained by changes in cardiovascular risk factors and by the use of medical and surgical treatments.
Methods: We used a previously validated IMPACT model to combine and analyze data on risk factor prevalence trends, and uptake and effectiveness of evidence-based cardiac treatments among adult men and women aged 35–74 years. Main data sources included official mortality statistics, results of longitudinal studies, national surveys, randomized controlled trials and meta-analyses. the difference between observed and expected CHD deaths in 2005 was then partitioned among treatments and risk factors. We also performed a sensitivity analysis to quantify the potential effect of parameter uncertainty.
Results: From 1988 to 2005, the age-adjusted CHD mortality rates in Spain fell by almost 40% among persons aged 35 to 74 years, resulting in 8,528 fewer CHD deaths in 2005. Approximately 48% of the fall in deaths was attributed to treatments and approximately 51% to changes in risk factors. the major treatment contributions came from initial therapy for acute coronary syndromes (explaining approximately 12% of the mortality fall), secondary prevention (10%) and heart failure (4%). Decreases in total cholesterol, systolic blood pressure and smoking prevalence explained approximately 37%, 24% and 16% of the mortality fall, respectively. However, important gender differences in risk factor trends were noted: diabetes and obesity increasing in men and smoking prevalence rose in young women.
Conclusions: Approximately half of the CHD mortality fall in Spain between 1988 and 2005 was attributable to reductions in major risk factors, and half to evidence-based therapies. these results increase understanding of past trends and will help to inform planning future prevention and treatment strategies in low-risk populations.
P198
Improving lipid profiles and increasing use of lipid-lowering therapy in England: results from a national cross-sectional survey, 2006
JS Mindell1, P Zaninotto1, E Falaschetti2, M Aresu1, N Poulter3
1University College London, London, United Kingdom, 2University College London, Institute of Child Health, London, United Kingdom, 3St. Marys Hospital and Imperial College, International Centre for Circulatory Health, London, United Kingdom
Topic: Public health
Purpose: this study evaluates recent initiatives to improve previously inadequate control of hypercholesterolaemia in England.
Methods: Cross-sectional survey of nationally representative sample of 14,142 adults = 16years living in non-institutionalised households in England 2006 (compared with 1998 and 2003). Demographic and health-related data from interview combined with measurements and blood analytes data.
Results: Mean total and HDL-cholesterol concentrations were 5.3 (SE 0.02) and 1.3 (0.01) mmol/L respectively among men and 5.4 (0.02) and 1.6 (0.01) mmol/L among women. Of 7,471 adults with valid measurements, 59% had total cholesterol =5mmol/L and 5% had total: HDL-cholesterol ratio =6. Overall 12% of men and 10% of women used lipid-lowering therapy, of whom 71% and 61% respectively had total cholesterol >5mmol/L (27% and 16% respectively >4mmol/L). Over three-quarters of those with established coronary heart disease, stroke or diabetes but fewer than one-quarter of hypertensive patients and those with =20% estimated 10year cardiovascular risk took lipid-lowering drugs. Control rates were higher among men than women overall and in those with CVD or diabetes.
Mean total cholesterol levels fell over time: treatment rates with lipid-lowering agents increased four- to five-fold and control rates (to >5mmol/L) more than doubled between 1998 and 2006.
Conclusions: Lipid levels among English adults in 2006 were improved compared with previous surveys but most remained suboptimal. Since 1998, the use of lipid lowering agents increased dramatically among the highest risk populations, but not those with high estimated cardiovascular risk. Among those with established CVD or diabetes, cholesterol levels >4mmol/L were achieved by about one-third of those treated.
P199
Estimating cardiovascular mortality reduction with different food policy options in UK
G Flores-Mateo1, M O'flaherty2, K Nnoaham3, F Lloyd-Williams2, M Rayner3, S Capewell2
1Institut d Investigaciœ en Atenciœ Primaria Jordi Gol, Barcelona, Spain, 2University of Liverpool, Liverpool, United Kingdom, 3University of Oxford, Oxford, United Kingdom
Topic: Public health
Objective: To estimate the reduction in UK cardiovascular (CVD) mortality potentiallyachievable by decreasing saturated fat, transfat and salt consumption andincreasing fruit and vegetable consumption.
Methods: CVD mortality reductions were calculated by synthesising data on population, diet, cholesterol levels, blood pressure, and mortality rates. Contemporarymortality and dietary data among UK adults 25 to 84 years old were obtained from official statistics. We obtained the aetiological effects of specificdietary factors on cholesterol levels, blood pressure, and CVD mortality from systematic reviews and meta-analyses of epidemiological studies. the number of deaths from cardiovascular disease was estimated for a variety of dietarypolicy scenarios reducing saturated fat, trans fat, and salt consumption and increasing fruits and vegetables. A probabilistic sensitivity analysis was thenconducted. Using Monte-Carlosimulation, best, maximum and minimum estimates were calculated. Results werestratified by sex and ten year group age and sex.
Results: Reducing1% saturated fat, 1% transaturated fat, and 1g/day salt consumption and increasing1 portion per day of fruits and vegetable intake would result in 21,587 fewerdeaths from CVD. Approximately 8% of themortality decrease would be attributed to decreased saturated fat consumption, 54%to decreased transaturated fat consumption,8%to decreased salt consumption and 31% to increased fruits and vegetables consumption. there would be 8,374(minimum estimate 7,057, maximum estimate 9,836) fewer coronary heart diseasedeaths among men and 6,564 (minimum estimate 5,503, maximum estimate 7,591) fewer coronary heart disease deaths among women, with 2,580 (minimum estimate2,164, maximum estimate 2,963) fewer stroke deaths in men, 4,069 in women (minimumestimate 3,475, maximum estimate 4,741).
Conclusions: the cardiovascular disease burden attributable to saturated fat, transaturatedfat, salt and, fruit and vegetable consumption is substantial. Food policies resulting in even small dietarychanges could result in approximately 20,000 fewer cardiovascular deaths each year. this would represent a 14% reduction in UK cardiovascular mortality.
P200
Evidence among older men for reversal of traditional regional patterns in CHD incidence within Great Britain- reversal partly attributable to HDL cholesterol
R W RichardMorris1, S G Wannamethee1, L T Lennon1, M C thomas1, P H Whincup2
1University College London, London, United Kingdom, 2St George's University of London, London, United Kingdom
Topic: Public health
Purpose: In previous analyses, CHD mortality rates in Great Britain have been higher in Scotland and northern England than in southern England. We examined regional patterns among participants of a prospective cohort study of British men in later life.
Methods: 7735 men were recruited in 1978–80 from 24 towns across Britain, and 4252 attended a follow-up examination in 1998–2000 when aged 60–79 years; 4196 were examined in the original town from which they were recruited. Data on established coronary risk factors were collected by questionnaire, physical examination and blood sampling. Follow-up for incidence of CHD was carried out through regular medical record reviews and tagging with the Office for National Statistics until June 2008. Poisson regression was carried out, accounting for follow-up time, with multi-level modelling to assess the degree of variance in incidence among the towns before and after adjustment for established risk factors, and to compare the broad regions of Great Britain: South England (7 towns), Midlands of England (4 towns), North of England (10 towns), Scotland (3 towns).
Results: Over an average 8.84 years, 392 first events of major CHD occurred (incidence 1.06% pa). CHD incidences in South, Midlands, North and Scotland were 0.93, 1.23, 1.15 and 0.85% pa respectively. After adjustment for age, rate ratios compared with South were 1.40 (95%CI 1.03–1.91), 1.24(0.96–1.60) and 0.94(0.63–1.42) for Midlands, North and Scotland respectively. Of all the risk factors considered, the greatest observed variation between the 24 towns was for HDL cholesterol (intra-town correlation=0.047). Mean (SD) HDL was 1.34 (0.34) mmol/l in South, compared with 1.23 (0.32), 1.35 (0.35) and 1.31 (0.32) in Midlands, North and Scotland respectively. Variations in HDL cholesterol explained 28% of the variance in incidences among the towns. Regional variations in total cholesterol, systolic blood pressure, cigarette smoking and physical activity did not obviously mirror regional variation in disease incidence.
Conclusions: Recent patterns of CHD incidence in older British men suggest that incidence has fallen in Scotland relative to England, but within England, traditional patterns applied. the only established risk factor explaining an appreciable part of the CHD incidence between towns was HDL cholesterol. Further comparisons of recent public health initiatives in the two countries and their impacts are warranted.
P201
Adult awareness of heart attack symptoms and its determinants in Poland
G Kopec1, B Sobien1, M Podolec2, H Dziedzic1, M Sobien3, M Brozda3, A Pajak4, P Podolec5
1Department of Cardiac and Vascular Diseases, John Paul II Hospital in Krakow, Krakow, Poland, 2John Paul II Hospital, Krakow, Poland, 3Jagiellonian University, Krakow, Poland, 4Jagiellonian University, Medical School, Epidemiology and Population Studies Department, Krakow, Poland, 5Department of Cardiac and Vascular Diseases, Jagiellonian University, Medical College, Krakow, Poland
Topic: Public health
Purpose: Timely access to advanced treatment in acute myocardial infarction depends partly on early recognition of heart attack (HA) symptoms and immediate call to emergency medical service (EMS). As in Poland the time from the onset of symptoms to first medical contact reaches > 2 h we aimed to assess in adults the knowledge of HA symptoms and of the appropriate response when they appear, and the determinants of this knowledge.
Methods: A questionnaire survey was conducted among a random sample of 942 men (48%) and women (52%) aged 50–74 selected from population registers in the city of Cracow. the responders were asked to choose which of the suggested symptoms were the symptoms of HA, which first thing they would do if someone was having HA, and what was the EMS phone number. We also gathered information of age, sex, education level, presence of coronary artery disease (CAD) and whether responders had ever talked with a doctor about HA symptoms; these variables were included as confounding factors into regression models.
Results: Most participants (90%) recognized chest pain or discomfort as HA symptom. Fewer responders identified: shortness of breath (72%), feeling week, light-headed or faint (45%), pain in the jaw, neck or back (30%) and pain or discomfort in the arm or shoulder (27%). Only 5,4% participants indicated well all the symptoms and 4% did not recognize any of them. Most persons (87%) indicated that they would call the EMS if someone was having HA but fewer of the them (74%) would call the EMS if they were suspecting HA in themselves. Relatively few participants (68%) knew the EMS phone number. Most responders (89%) had never talked with a doctor about HA We found that participants who had previously talked with a doctor about HA (vs. those who did not) and patients with diagnosed CAD (vs. those without CAD) classified correctly more symptoms (3.1±1.1 vs. 2.6±1.2, p>0.0001 and 2.9±1.2 vs. 2.6±1.2, p>0.0001 respectively); men more often than women would phone EMS if they were suspecting HA in themselves (79% vs. 71%, p=0.004) but not in someone else (87% vs 86.5%, p = 0.6); patients with medium or high level of education knew the EMS phone number more often than those with lower level of education (69% vs. 58%, p=0.03); these results were was also true after adjustment of confounding factors.
Conclusions: there is a need to improve patients knowledge about HA especially in women (response to own symptoms) and subjects with lower education level (knowledge of EMS phone number). Advice from the doctor improves awareness of HA symptoms, however doctors rarely talk about them with their patients.
P202
Major cardiovascular event rates in patients with established vascular disease reflect national economic/health system characteristics
E M Mahoney1, K Wang1, A Porath2, R Corbalan3, PG Steg4, DL Bhatt5
1Mid America Heart Institute, Kansas City, United States of America, 2Ben Gurion University of the Negev, Beer Sheva, Israel, 3Catholic University School of Medicine, Santiago, Chile, 4AP-HP-Hospital Bichat-Claude Bernard, Paris, France, 5VA Boston Healthcare System and Brigham and Women's Hospital, Boston, United States of America
Topic: Public health
REACH Registry Investigators
Background and Objectives: the REACH Registry is an international prospective registry of outpatients at risk of atherothrombosis due to established coronary artery (CAD), cerebro-vascular (CVD) and/or peripheral arterial disease (PAD), or >= 3 risk factors. REACH enrolled 67,888 patients from 44 countries. We examined the influence of country-level economic and health system characteristics on 2-year rates of major cardiovascular events (cardiovascular (CV) death/non-fatal MI/non-fatal stroke) in patients with established vascular disease, after adjusting for patient-level characteristics and country.
Methods: Hierarchical generalized linear models were used to examine the influence of the following factors on CV event rates: % gross domestic product spent on health (GDP-HEALth), government health expenditure as percentage of total health expenditure (GOVT-HEALth), out-of-pocket health expenditure as percentage of private health expenditure (OOP-HEALth), and World Health Organization indices of health system achievement (WHO-ACHIEVE) and performance/efficiency (WHO-PERFORM). All models were adjusted for patient demographic and clinical characteristics; country was included as a random effect.
Results: Higher GDP-Health (OR:0.77; 95% CI:0.61,0.96), WHO-ACHIEVE (OR:0.67; 95% CI:0.54,0.82), and WHO-PERFORM (OR:0.72; 95% CI:0.58,0.90), were associated with a lower rate of CV death/MI/stroke. Higher OOP-HEALth (OR:1.57; 95% CI:1.31,1.89) was associated with a higher rate of CV death/MI/stroke.
Conclusions: Country-level economic indicators and health system characteristics are associated with rates of major cardiovascular events in patients with established vascular disease. Higher out-of-pocket health expenditures are associated with higher rates of cardiovascular events.
2-Year CV Death/MI/Stroke by WHO-ACHIEVE
P203
Blood pressure awareness in Austria: any changes in the last 30 years?
S Steiner-Boeker, T Dorner, A Rieder
Medical University of Vienna, Vienna, Austria
Topic: Public health
Background: High blood pressure (BP) is an established and modifiable cardiovascular risk factor and its control has been found to be one of the most cost-effective health interventions available. the aim of our study was to re-evaluate public awareness, understanding and misconception on hypertension nationwide in Austria in comparison to previous poll results from 1978 and 1998.
Design: In accordance with the previously performed surveys of 1978–1998 representative samples of the Austrian general population were selected by the so-called quota procedure. the survey was conducted by an empirical social research organization comprising approximately 1000 randomly selected men and women older than 15 years of age balanced for demographic characteristics such as region, age, sex and education. Face-to-face interviews were used to complete a questionnaire about blood pressure awareness, knowledge and perception of the dangers of hypertension and treatment options, in particular the role of lifestyle interventions.
Results: Amongst the population sampled (45 +/– 13 years, mean age +/– SD) 15% identified themselves as hypertensives (age group 30–49 years: 8%, over 50 years: 30%), which represents a small increase compared to 1998 (12%) an 1978 (10%). the percentage of the population, who recalled having their blood pressure measured during the last three months was 39%, which is higher compared to 1998 (34%) but lower than in 1978 (49%) after a nationwide educational BP campaign. Almost two-thirds (61%) thought hypertension had clearly identifiable signs or symptoms. Regarding the understanding of the consequences of high blood pressure, the majority was highly aware of the association between hypertension and heart attack (highly related: 78%, somehow related: 20%) and stroke (highly related: 75%, somehow related: 21%) but less aware of the association to kidney disease (highly related: 14%, somehow related: 36%) and dementia (highly related: 10%, somehow related: 27%). For lifestyle issues affecting hypertension a high association was identified by 69% of all respondents for overweight, by 63% for mental stress, by 48% for smoking and by 41% for genetic factors. Only 34% of the participants considered high sodium intake to be highly associated with hypertension.
Conclusion: these results suggest that there is still a need for further public education on BP and nationally agreed hypertension guidelines in Austria. No improvement in BP awareness can be noted over the last 30 years. People should be motivated to take an interest in their blood pressure.
P204
Second episode of acute coronary syndrome: better risk factor control but worse prognosis
R Baptista, E Jorge, R Teixeira, P Mendes, F Goncalves, P Monteiro, M Freitas, LA Providencia
Hospital and Medical School, Coimbra, Portugal
Topic: Pharmacoepidemiology
Background: Coronary artery disease in responsible for an important amount of morbidity and mortality in developed countries.
Objectives: We sought to compare, among patients with more than 1 admission in our coronary care unit with acute coronary syndrome (ACS), the characteristics of the 1st ACS episode with the 2nd ACS episode.
Populations and Methods: Among 1468 admissions on our centre between May 2004 and December 2006, 110 were re-admissions, that were studied regarding clinical, laboratorial and echocardiographic variables.
Results: On average, 6.1 months passed between the first (1st) and the second (2nd) ACS admission. When admitted for a 2nd time, patients had better lipid profile values (total cholesterol 159.1 vs. 204.2 mg/dL, p>0.001), LDL (105.7 vs. 131.4 mg/dL, p>0.001), apolipoprotein B (89.1 vs. 109.8 mg/dL, p>0.001) and triglycerides (168.6 vs. 189.0 mg/dL, p=0.003) and blood pressure (systolic 132 vs. 141, p=0.03; diastolic 70 vs. 73, p=0.127), except for HDL, that was lower (37.3 vs. 39.8 mg/dL, p=0.016). they had worse creatinine clearance (57.1 vs. 71.5 ml/min, p=0.017) and lower hemoglobin (13.2 vs. 13.4 g/dL, p=0.001). No differences were elicited regarding left ventricular ejection fraction (47.7 vs. 46.0%, p=0.37) and weight (73.2 vs. 72.6 kg, p=0.27), but patients on their 2nd admission had higher TIMI scores (4.0 vs. 3.1, p>0.001) and a lower number of significantly diseased vessels on coronary angiography (1.5 vs. 1.8, p=0.051). Regarding drug therapy, and as expected, there was a moderate agreement between the medication prescribed at discharge (from the 1st admission) and the medication in use at the 2nd admission (aspirin 78.8%, clopidogrel 79.8%, beta-blocker 85.9%, ACE inhibitors 89.9% and statins 89.9%). the ACS type with higher agreement between the 1st and 2nd admission was unstable angina (kappa 0.332) followed by NSTEMI (kappa 0.256) and STEMI (kappa 0.202). In-hospital mortality on the 2nd admission was 8.2% (versus 6.0% in 1st admissions).
Conclusions: When admitted with a 2nd ACS, patients tend to have better lipid and blood pressure prolife, but do not lose weight, demonstrating how difficult is to control this important risk factor. Conversely, therapeutic adhesion rates are good. the mortality rate is superior to the average of the 1st admission, reflecting the seriousness of a new ACS on this already high-risk population.
P205
EUROASPIRE III ROMANIA follow-up: primary care cannot achieve targets
L Craciun1, A Avram2, S Iurciuc1, C Avram3, M Iurciuc1, C Sarau1, D Gaita1, S Mancas1
1Victor Babes University of Medicine and Pharmacy, Timisoara, Romania, 2Medicover, Timisoara, Romania, 3West University, Timisoara, Romania
Topic: Lipids and atherosclerosis
Purpose: To investigate the lipid profile improvement according to ESC 2007 Prevention Guidelines in asymptomatic high risk patients (without a history of coronary or other atherosclerotic disease, who have been prescribed one or more of the following medications: antihypertensive and/or lipid lowering and/or anti-diabetes treatments – diet and/or oral hypoglycaemics and/or insulin) included in the first EuroAspire III Follow-Up.
Methods: We followed-up 325 patients (age 56±9 years, 62% women) out of 503 asymptomatic high risk patients included in EuroAspire III Romania Primary Care. these patients were evaluated every 6 months for a period of 18 months of follow-up by general practitioners that participated in a professional training performed by diabetologists and cardiologists and have been advised to reinforce lifestyle changes and to optimize hipolipemiant drug therapy in order to reach the targets mentioned in the current guidelines.
Results: A significant improvement was observed between baseline evaluation and 18 month intervention, for total cholesterol (235.11+52.98mg/dl versus 203.82+42.25mg/dl, p>0.001), LDL-cholesterol (167.53+39.99mg/dl versus 118.47+35.50mg/dl, p>0.001), HDL-cholesterol (46.38+10.54mg/dl versus 52.22+14.14mg/dl, p>0.001) and serum tryglicerides (178.16+135.90mg/dl versus 159.13+114.29mg/dl, p=0.04). the percentage of patients reaching lipid targets increased between 2 times for total cholesterol (17.5% versus 62%, p>0.001), LDL-cholesterol (8.8% versus 48.4%, p>0.001), HDL-cholesterol (58.1% versus 80.8%, p>0.001) and serum tryglicerides (31.3% versus 58.6%, p>0.001), but continued to be sub-optimal.
Conclusions: Preventive intervention, conducted by general practitioners, improved the lipid profile in dyslipidemic patients, even though the guidelines targets are far from being achieved. the datas are similar with real life lipid management and highlited that it is a strong need to intensificate preventive intervention in primary care.
P206
Effect of therapeutic lifestyle change on patients with metabolic syndrome
SH Sang-HyunKim1, WC Chung1, JH Zo1, MA Kim1, HS Kim2, JB Seo1, HL Lee1
1Hospital Boramae, Seoul, Republic of Korea 2Seoul National University, Seoul, Republic of Korea
Topic: Lipids and atherosclerosis
Purpose: Metabolic syndrome is characterized by clustering of several cardiovascular risk factors. “therapeutic Life Style Change (TLC)” is composed of diet control, body weight management and encouraging physical activity. Among these interventions, TLC diet has been primarily focused on lowering LDL cholesterol levels, and the effect on patients with metabolic syndrome is not well established. therefore, this study was designed to evaluate the effect of 4 weeks TLC diet on lipid profile in patients with metabolic syndrome.
Methods: this study was a single arm trial including subjects with metabolic syndrome. Participants were screened if they (1) had a diagnosis of systemic hypertension, diabetes, or dyslipidemia; (2) had abdominal obesity (>90 cm in men, >80 cm in women); and (3) were more than 20 years old. Metabolic syndrome was defined as the presence of at least 3 out of 5 risk factors according to the NCEP-ATP III guidelines. One session of individualized education was done and brochure that described detailed information about TLC diet was given to the participants. Blood chemistry profiles including lipid and various anthropometric data were collected before and after TLC diet.
Results: Sixty seven subjects with metabolic syndrome were enrolled. Changes in body weight after therapeutic lifestyle intervention were not statistically significant. Fasting blood glucose levels were not changed significantly (from 111.8±11.7 to 110.1±18.4 mg/dL, P=NS). With regard to lipid profile, TLC diet did not resulted in significant changes in total cholesterol (from 229.6±21.1 to 226.5±26.3mg/dL, P=NS) and triglyceride level (from 168.2±56.6 to 177.0±73.4mg/dL, P=NS). But, 4 weeks TLC diet led to significant reduction in LDL cholesterol levels (from 161.1±21.2 to 147.6 ± 25.1mg/dL, P>0.001, –6.6% reduction), and significant increase in HDL cholesterol levels (from 37.7±6.8 to 41.8±8.4mg/dL, P=0.001, 12.1% elevation).
Conclusions: Four weeks TLC diet intervention, which was provided after one session of individualized education, improved lipid profile (especially HDL cholesterol) in subjects with metabolic syndrome. this indicates that the importance of inexpensive and easily accomplishable, individualized education should be emphasized from the early stage of intervention, and should not be underestimated.
P207
Decreased stroke incidence and improved case fatality 1985–2006. the Northern Sweden MONICA study
M Eriksson, E-L Glader, P-G Wiklund, B Stegmayr
Umea University, Department of Public Health and Clinical Medicine, Umea, Sweden
Topic: Cardiovascular epidemiology
Purpose: To explore long-term time trends in stroke incidence and case fatality in northern Sweden.
Methods: Stroke events in northern Sweden has been continuously monitored since 1985, using the same criteria for diagnosis (WHO MONICA). Between 1985 and 2006, 11,114 men and 6,929 women aged 25–74 years suffered a stroke. Subarachnoid haemorrhages were excluded.
Results: the incidence was reduced by approximately 30% in both men and women (p>0.001). In men, the yearly incidence decreased from 330 per 100,000 in 1985–86 to 218 in 2005–06. In women, the corresponding incidence per 100 000 decreased from 224 to 153. Both first ever and recurrent events decreased significantly. the most rapid decrease was observed in men and women in the oldest age group, 65–74 years, while the incidence remained at a constant low level in the youngest age group, 25–54 years.
the 28-day case fatality decreased from 19.2% to 9.7% in men and from 21.7% to 11.6% in women between 1985–86 and 2005–06. the average annual decrease in 28-days case fatality was 3.2% (p>0.001). the positive trend did not differ significantly between men and women, different age groups, or between first and recurrent strokes.
Conclusions: During this 22-year period, the incidence decreased by a third and the 28-day case fatality was halved. Together this implies a markedly reduced stroke mortality in the ages 25–74 years in northern Sweden.
P208
Income, cardiovascular diseases and self-rated health in an ageing population in post-transitional Russia
S Malyutina1, S Soboleva2, M Bobak3, A Peasey3, D Denosiva1, E Veryovkin1
1Institute of Internal Medicine SB RAMS, Novosibirsk, Russian Federation, 2Institute of Economics & Industrial Engineering, SB of the Russian Academy of Medical Sciences, Novosibirsk, Russian Federation, 3University College London, London, United Kingdom Topic: Cardiovascular epidemiology
the HAPIEE Group
Background: the recent fluctuations of cardiovascular (CVD) mortality during societal transition in Russia suggest a strong impact of socioeconomic factors. We examined the relationship between individual-level economic indicators, CVD and self-rated health (SRH) after more than a decade of societal transition.
Methods: In the second wave of the HAPIEE Project, a representative population sample of men and women aged 48–72 was surveyed in 2006–2007 (n=3575) in Novosibirsk (Russia). Structured interview was used to collect economic data (economic activity, personal and household income including benefits, informal transfers and non-monetary income in the last 12 months, wealth's indicators), from which we estimated the monthly household and per capita household income. the history of hospitalized IHD and stroke was assessed by questionnaire; hypertension (HT) was defined as BP>140/90 or being on antihypertensive treatment; and a composite CVD indicator included any of the three. SRH was used as a dichotomised outcome (very poor/poor health versus good health) for logistic regression.
Results: the history of hospitalized IHD/stroke and HT were major contributors to poor health (odds ratios 4.5 and 1.8, respectively). the mean monthly household income was 17,300 roubles (approximately 700$), the average income per household member was 6,600 roubles (approximately 260$). the prevalence of CVD was inversely associated with income level; the adjusted prevalence of CVD in the bottom quartile of household/per capita income were 30% and 50%, respectively, higher than in the top quartile (p=0.031 and 0.002) the excess risk of CVD in the bottom income group was only partly explained by age, socioeconomic and behavioural factors. the inverse relationship between income and SRH was steeper then for CVD; the adjusted odds ratios for poor health in the lowest vs. highest income category was 2.9 (95% CI 2.17–3.96) for household income and 2.6 (95% CI 1.99–3.37) for per capita household income.
Conclusion: the data from Novosibirsk suggest an independent relationship between income and prevalent CVD and poor SRH. Our results confirm the impact on health and CVD in particular of economic hardship and low income in Russian ageing population during transition. the study was conducted with grants from the Wellcome Trust (064947/Z/01/Z) and the NIA (1R01 AG23522–01). the present analysis was assisted by grant from RGSF (08–06–0–00667).
P209
Long-term time trends in cardiovascular risk factors 1986 – 2009. the Northern Sweden MONICA study
M Eriksson1, M Eliasson2, J-H Jansson3, é Johansson1, B Stegmayr1
1Umea University, Department of Public Health and Clinical Medicine, Umea, Sweden, 2Sunderby Hospital, Department of Internal Medicine, Lulea, Sweden, 3Skelleftea Hospital, Department of Medicine, Skelleftea, Sweden
Topic: Cardiovascular epidemiology
Purpose: To investigate changes in risk factors for cardiovascular disease in northern Sweden during a period of 23 years.
Methods: Since 1986, six population surveys have been carried out in northern Sweden using standardized WHO MONICA procedures. At each survey, a random sample of 2000–2500 men and women, stratified by sex and age group, were invited to participate (25–64 years 1986 and 1990, 25–74 years 1994, 1999, 2004 and 2009). Trends in risk factors were analyzed using generalized linear models assuming a linear time trend.
Results: Blood pressure levels have decreased in men and women of all ages during the study period 1986–2009, but the change was most pronounced in the oldest, 65–74 years, (−1.0 mmHg per year). Since 1994, there has been a rapid increase in the use of blood-pressure lowering drugs, most evident among the oldest (+3.5% per year), but there was also increased use among men of younger age, >65 years (+2.7% per year).
Regular smoking has declined dramatically in the population below 65 years of age. Cigarette smoking was approximately twice as common in 1986 compared to 2009. In the survey 2004, a shift from cigarette smoking to moist snuff (snus) was observed as compared to previous surveys. However, in the last survey, 2009, also the total use of tobacco had decreased for both men and women.
One in five men and women aged 25–64 years, were obese in 2009 which is twice as many as in 1986. During that period BMI increased by 1.5 kg/m2 which corresponds to a weight gain of approximately 4 kg. the oldest age group, 65–74 years, experienced a similar increase in BMI until the survey 2004; thereafter an opposite trend was observed until 2009.
The total serum cholesterol levels have decreased similarly in men and women. A decrease of 1 mmol/L was noted in the oldest age group, 65–74 years, since 1994. the use of lipid-lowering agents has followed the same pattern as that of blood-pressure lowering medication, with a rapid increase since 1994. More than one-third of men and one-fourth of women in the oldest age group used lipid-lowering agents in 2009.
the prevalence of known diabetes has not changed significantly during the study period. Conclusions: Significant improvement of three major cardiovascular risk factors, cigarette smoking, blood-pressure levels and cholesterol levels, was observed in northern Sweden 1986–2009.
P210
Recent reversion of unfavourable changed coronary heart disease mortality rates among young adults
I Vaartjes1, M O'flaherty2, DE Grobbee1, ML Bots1, S Capewell2
1University Medical Center Utrecht – Julius Centre for Health Sciences and Primary Care, Utrecht, Netherlands, 2University of Liverpool, Liverpool, United Kingdom
Topic: Cardiovascular epidemiology
Background: In several Western countries, unfavourable trends in coronary heart disease mortality rates among young adults have been observed. these changes may be a result of changes in the pattern for major cardiovascular risk factor trends. We examined trends in age-and gender-specific coronary heart disease mortality rates in the Netherlands. Methods: Coronary heart disease deaths in 1972 to 2007 were identified in the Cause of Death Register. Time trend analysis was performed using joinpoint regression.
Results: Between 1972 and 2007, the age-adjusted coronary heart disease mortality rates decreased overall by 75.6% in men and 75.7% in women. Men aged 35–54 years showed flattening between 1993 and 1999, the annual percent change (APC) for that period was –2.5 (95% CI –5.0 to 0.0). Women aged 35–54 years showed flattening between 1989 and 2000; the APC for that period was –0.1 (95% CI –1.5 to +1.3). However, after the period of flattening, CHD mortality further decreased in both men and women.
Conclusions: Slowing or flattening of CHD mortality rates in young adults has also been reported in the US and some other Western countries. However, this is the first study demonstrating a further decline of CHD mortality rates after a period of flattening. Stabilisation of obesity prevalence and decreased smoking prevalence may explain the further decline in CHD mortality rates after a period of flattening. Further investigation into the underlying causes of unfavourable risk factor changes may provide valuable information for those countries where mortality flattening is still ongoing.
P211
Longitudinal trends in the prevalence of the metabolic syndrome in the Czech population from 1997–8 to 2006–9. the Czech post-MONICA Study
R Cifkova, Z Skodova, J Bruthans, V Adamkova, M Jozifova, R Poledne, P Stavek, V Lanska
Institute for Clinical and Experimental Medicine, Prague, Czech Republic
Topic: Cardiovascular epidemiology
the Czech Republic, unlike most of the other East European countries, has seen a decrease in total and cardiovascular (CV) mortality in particular; still CV disease accounts for 50% of total mortality. the aim of our study was to assess longitudinal trends in the prevalence of MS and its components in a representative sample of the Czech population.
Methods: three cross-sectional surveys of CV risk factors (a 1% random sample aged 25–64 years, mean age 45 years) were conducted within the post-MONICA study in nine Czech districts in 1997–8 (n=3,204), 2000–1 (n=3,275), and 2006–9 (n=3,609). the response rate never fell below 60% (61–65%). We used a recent harmonizing definition of MS (IDF, NHLBI, AHA, WHF, IAS, and IASO), i.e., presence of any 3 elevated components out of 5 in total (see table).
Results: If a stricter definition of elevated waist circumference was used (M = 94 cm; F = 80 cm), the prevalence of MS rose substantially (M: 49.3, 44.8, and 45.2%; F: 35.2, 31.2, and 29.3%, respectively). the most frequent component of MS in both genders was elevated BP increasing over time.
Conclusions: Since 1997–8, there has been no change in the prevalence of MS in the Czech male population whereas the prevalence rates of MS in Czech females have decreased significantly.
Prevalence of MS and its components
Parameter
1997–8
2000–1
2006–9
p for trend
Males, n
1,535
1,609
1,735
Waist circumference = 102 cm, n (%)
396 (25.8)
528 (32.7)
658 (38.0)
0.001
Triglycerides = 1.7 mmol/l, n (%)
776 (50.6)
769 (47.8)
706 (40.7)
0.001
HDL-chol < 1.0 mmol/l, n (%)
301 (19.7)
355 (22.1)
339 (19.7)
n.s.
BP = 130/85 mmHg or AH med, n (%)
894 (58.1)
990 (60.8)
1,109 (63.9)
0.001
Fasting glucose = 5.6 mmol/l or drugs, n (%)
843 (54.8)
543 (33.7)
710 (41.1)
0.001
Metabolic syndrome, n (%)
585 (38.3)
572 (35.9)
642 (37.6)
n.s.
Females, n
Waist circumference = 88 cm, n (%)
616 (36.9)
640 (37.9)
818 (43.7)
0.001
Triglycerides = 1.7 mmol/l, n (%)
464 (27.8)
467 (28.0)
405 (21.6)
0.001
HDL-chol < 1.3 mmol/l, n (%)
517 (31.0)
518 (31.2)
366 (20.0)
0.001
BP = 130/85 mmHg or AH med, n (%)
659 (39.4)
732 (43.2)
847 (45.2)
0.001
Fasting glucose = 5.6 mmol/l or drugs, n (%)
617 (39.6)
299 (17.9)
429 (23.0)
0.001
Metabolic syndrome, n (%)
496 (29.7)
445 (26.9)
474 (25.9)
0.05
AH med = antihypertensive medication
P212
Trends in long-term prognosis after hospital admission for AMI 1987 to 2006 in 361,166 Swedish patients
K Dudas, G Lappas, A Rosengren
Sahlgrenska University Hospital, Gothenburg, Sweden
Topic: Cardiovascular epidemiology
Purpose: this study examines age and gender-specific trends in cardiovascular (CV) and non-CV mortality after admission for a first acute myocardial infarction (AMI).
Methods: Data from the Swedish hospital discharge and death registries were used to record all first-ever hospital admissions with AMI 1987 to 2006 and subsequent mortality for up to 5 years. All Swedish patients (n= 361,166) aged 35 to 84 years and admitted with a first AMI between 1987 and 2006 were included.
Results: During the period 28-day case fatality was reduced by almost two thirds in patients up to age 75 years, similar in men and women, and by more than half in patients aged 75 to 84 years. Among patients followed for 5 years, all-cause mortality decreased less than 28-day mortality, however, CV mortality decreased by two thirds among patients aged below 55 years, by half among those aged 55 to 74 years, and by a third among those aged 75 to 84 years. Final estimates for mortality from all causes after the first month post-MI among patients admitted in 1999 to 2002, expressed as deaths per 1000 person years, was 10.4 and 10.5 in men and women aged >55 years, 23.6 and 24.0 for those aged 55 to 64, 59.5 and 54.0 for men and women aged 65 to 74, respectively, and 147.6 and 132.0 among men and women aged 75 to 84 years.
Conclusion: With changing criteria for AMI, and improved management, short- and long-term death rates after AMI have dropped considerably.
P213
Gender difference and risk factors of elevated C-reactive protein in Korean rural general population: Atherosclerosis RIsk of Rural Area in koreaN General population (ARIRANG) study
JK Sung, YJ Yoon, NS Lee, SH Lee, JH Yoon, KH Choe, JY Kim, JW Lee
Wonju College of Medicine, Yonsei University, Division of Cardiology, Department of Internal Medicine, Wonju, Republic of Korea
Topic: Cardiovascular epidemiology
ARIRANG cohort study group
Purpose: Elevated C-reactive protein (CRP) is a well known surrogate marker of coronary heart disease. However, gender difference and influencing risk factors of high CRP in general population is not well studied, especially Korean. We examined gender difference and contributing risk factors to elevated CRP in Korean rural general population.
Methods: We performed a cohort study (ARIRANG cohort) conducted on a Korean adult (age > 40 years) population with 10,111 subjects (6,021 women and 4,090 men) without history of cardiovascular disease or cancer. All subjects were measured hs-CRP by turbidimetric immunoassay (TIA) methods. We compared the median value of CRP and influencing risk factors to high CRP between male and female group.
Results: Mean age was 56.4 ± 8.1. the median CRP level of all subjects was 0.82 mg/L (interquartile range; 0.42–1.78). the median CRP value of men was significantly higher than that of women [median (interquartile range); 0.99 (0.51–2.12) vs. 0.72 (0.37–1.56) mg/L; p>0.01]. CRP concentration was significantly correlated gamma-glutamyl transpeptidase, fasting glucose, post-prandial glucose, alanine transaminase, Homa-IR in men and women. Otherwise, systolic blood pressure, total cholesterol, high density lipoprotein, low density lipoprotein, body mass index were significantly correlated with CRP in only women. In multivariate regression model, the independent risk factors that elevate CRP level were age (OR: 1.033, 95% CI: 1.023–1.044), fasting glucose (OR: 1.003, 95% CI: 1.001–1.006), waist circumference (OR: 1.013, 95% CI: 1.003–1.024), and creatinine (OR: 2.198, 95% CI: 1.303–3.707) in man, whereas age (OR: 1.017, 95% CI: 1.008–1.027), systolic blood pressure (SBP, OR: 1.005, 95% CI: 1.001–1.009), low density lipoprotein (LDL, OR: 1.004, 95% CI: 1.002–1.007), waist circumference (OR: 1.041, 95% CI: 1.032–1.05), alanine transaminase (ALT, OR: 1.011, 95% CI: 1.003–1.019), and gamma-glutamyl transpeptidase (OR: 1.005, 95% CI: 1.002–1.007) in women.
Conclusion: CRP was higher in men than women with different risk factors. the independent risk predictors of elevated CRP were age, fasting glucose, waist, circumference, creatinine in man and age, SBP, ALT, waist circumference, LDL, gamma-glutamyl transpeptidase in women.
P214
Continuing decrease in coronary heart disease mortality in Sweden
J Berg1, L Bjorck1, G Lappas1, M O'flaherty2, S Capewell2, A Rosengren1
1Sahlgrenska University Hospital, Gothenburg, Sweden, 2University of Liverpool, Liverpool, United Kingdom
Topic: Cardiovascular epidemiology
Objective: the mortality from coronary heart disease (CHD) has been decreasing in most Western countries over the last few decades. However, a flattening of the mortality decrease has been reported among younger age groups in some countries including the USA, UK and Australia. the objective of this study was to detect whether the decrease in CHD mortality is also flattening among Swedish adults.
Design: Retrospective quantitative population based study.
Main outcome measure: Trends in CHD mortality in Sweden between 1987 and 2006.
Methods: We used CHD mortality data from the Swedish National Register on Cause of Death. ICD-9 codes 410 to 414 were used for deaths occurring until 1996, and from 1997 and onwards ICD-10 codes I20 to I25 were used. Annual percent changes in rates were examined using Joinpoint software.
Results: Overall, CHD mortality rates decreased by 60% in men and 57% in women. Among men 35–54 years there was an early modest attenuation from a very marked initial decrease. the annual percentage change (APC) was –8.0 (95% confidence interval (CI) –4.9 to –10.9) from 1987 until 1991 and –4.0 (95% CI –3.5 to –4.6) from 1991 to 2001. In women 35–54 years the APC was –3.2 (95% CI –2.5 to –3.9) from 1987 until 2006. In all other age groups the mortality rates decreased at a steady rate in both men and women, with APC:s ranging from –3.2 to –6.3%.
Conclusions: In Sweden, a continuing decrease in CHD mortality is observed. Death rates continue to decline in men and women across age groups. this is reassuring. However, further research is urgently required to a) establish whether other Nordic countries are equally fortunate, and b) clarify the underlying mechanisms which harm young adults in the USA and the UK but apparently protect them in Sweden.
P215
Trends in self-reported prevalence and management of hypertension, dyslipidaemia and diabetes in adults in Switzerland, 1992–2007
P Marques-Vidal, D Estoppey, F Paccaud
University Institute of Social and Preventive Medicine Lausanne (IUMSP), Lausanne, Switzerland
Topic: Cardiovascular epidemiology
Purpose: To assess the trends of self-reported prevalence of reported cardiovascular risk factors (CV RFs: hypertension, dyslipidaemia, diabetes) and their management in the Swiss population. Methods:4 National health interview surveys conducted for period 1992–2007 (63782 subjects).
Results: prevalence of all CV RFs increased between 1992 and 2007, see table. Although the self-reported prevalence of treatment among subjects with CV RFs increased, and this was confirmed by multivariate analysis: OR for hypocholesterolaemic treatment relative to 1992: 0.64 [0.52–0.78]; 1.39 [1.18–1.65] and 2.00 [1.69–2.36] for 1997, 2002 and 2007, respectively. Still, in 2007, circa 40% of hypertensive, 60% of dyslipidaemic and 50% of diabetic subjects weren't treated. Conversely, an adequate control of CV RFs was reported by treated subjects, with an increase during the study period. this increase was further confirmed by multivariate analysis. Conclusion: the self-reported prevalence of hypertension, dyslipidaemia and diabetes increased between 1992 and 2007 in the Swiss population. Despite a good control of treated subjects, still a significant percentage of subjects with CV RFs are not treated.
Trends in reported CV RFs in Switzerland
1992
1997
2002
2007
Hypertension
_ Prevalence (%)
-
22.1
22.4
24.1
_ OR for prevalence [95% CI]
-
1 (ref.)
1.00 [0.951.06]
1.12 [1.061.19]
_ Treatment (% of hypertensives)
-
52.1
53.8
60.4
_ Control (% of treated)
38.5
70.4
-
88.0
Hypercholesterolaemia
_ Prevalence (%)
7.2
11.9
14.7
17.4
_ OR for prevalence [95% CI]
1 (ref.)
1.73 [1.59–1.88]
2.15 [2.00–2.32]
2.67 [2.48–2.88]
_ Treatment (% of
22.4
18.5
32.2
38.8
hypercholesterolaemics)
_ Control (% of treated)
-
56.0
-
84.7
Diabetes
_ Prevalence (%)
-
3.4
3.9
4.7
_ OR for prevalence [95% CI]
-
1 (ref.)
1.24 [1.10–1.40]
1.44 [1.28–1.63]
_ Treatment (% of diabetics)
-
50.0
-
53.3
_ Control (% of treated)
-
52.2
-
74.6
-, data not available; OR, odds ratio; CI, confidence interval.
P216
3ST-POL therapeutic management and risk factors in primary medical care in Poland
D Sliz1, M Naruszewicz2, K Filipiak3, J Siebert4, A Mamcarz1
1Medical University of Warsaw, 3rd Department of Internal Medicine and Cardiology, Warsaw, Poland, 2Medical University of Warsaw, Department of Pharmacognosy and Molecular Basis of Physiotherapy, Warsaw, Poland, 3Medical University of Warsaw, 1st Department of Cardiology, Warsaw, Poland, 4Medical University of Gdansk, Department of Family Medicine, Gdansk, Poland
Topic: Cardiovascular epidemiology
Objectives: 3ST-POL surveyed people in general practice in Poland. the aim was to determine whether the 2007 ESC and PCS guidelines on cardiovascular disease prevention, specially lipid lowering pharmacotherapy, are being followed in clinical practice.
Methods: this survey was undertaken in Poland. Consecutive patients, men and women < 90 years of age, treated with statin and/or antihypertensive and/or anti-diabetes treatments and/or other treatment if necessary. Data collection was based on a review of patient's medical notes, prospective interview examination and lipid profile determination at least six months after the identification of dyslipidemia and at least 2 months after starting statin pharmacotherapy.
Results: the study tested 49950 (53%- female) ambulatory patients from Poland. 46.8% of tested individuals had coronary artery disease, 20.1% had an episode of myocardial infarction; 9.9% had temporary ischaemic atacks, 32.8 had diabetes mellitus type 2. Overall 16.8% had a blood pressure < 140/90 mmHg (< 130/80 in people with diabetes mellitus), 10.8% had a total cholesterol < 5 mmol/l (>4.5 mmol/l in people with the highest cardiovascular risk), 16.6% had LDL >3mmol/l (>4.5 mmol/l in people with the highest cardiovascular risk). 42.41% had TG >1.7mmol/l. the use of hypotensive medication was 84.2%: beta-blockers 54.7%; ACE inhibitors 58.2%; ARB 25.58%; calcium channel blockers 21.9%; fibrates 23.3%. All patients used statins.
Conclusion: the 3ST-POL survey shows that risk factor management in individuals being treated in general practice is a major cause for concern. Treatment of main cardiovascular risk factors is completely inadequate with a vast majority of patients not achieving the targets defined in the ESC and PCS prevention guidelines. Effectiveness of the primary medical care in Poland needs to be improved.
P217
Carotid plaque burden in the REFINE Reykjavik Study and the European telephone number for cardiovascular health
T Aspelund, B thorsson, V Gudnason
Icelandic Heart Association, Kopavogur, Iceland
Topic: Cardiovascular epidemiology
Purpose: the European Heart Health Charter expresses goals to improve cardiovascular disease (CVD) health across Europe. the targets to be reached are no smoking, physical activity equivalent to at least 3 km of daily walking, five portions of fruit and vegetables a day, blood pressure >140/90mmHg, total cholesterol < 5.0 mmol/l, low density lipoprotein-cholesterol < 3.0 mmol/l, and no diabetes. this action can be represented as a European Telephone Number for Cardiovascular Health: 0–3–5–140–90–5–3–0. Here we study the association of having evidence of carotid plaque with adhering to the 8 components of the phone number, in a population based cohort in Iceland recruited 2006–2009.
Methods: the REFINE Reykjavik Study is a population based study where the objective is to refine cardiovascular risk evaluation with novel measures of atherosclerotic markers in addition to classical risk factors. To date 4025 subjects (51% women) of age 35–69 have been recruited since 2006 from a random sample stratified by sex and age from the Reykjavik Area, with 70% response. A detection of at least moderate carotid plaque using ultrasound was used as an indicator for the presence of plaque. All components of the European phone numbers were measured except for 5 portions fruit and vegetable a day. this component was replaced by being less than 5 kg above normal weight. Diabetes was defined from history or a fasting glucose of 7 (mmol/L) or higher. 3650 subjects not using statins (91%) were used for the analysis.
Results: All components were inversely associated with presence of carotid plaque. the median number of components adhered to was 5. the component for cholesterol was hardest to control: only 39.4% had cholesterol < 5. the prevalence and the odds ratio for having plaque by number of components in control is shown in the Table (age and sex adjusted).
Conclusions there is a clear trend towards lower prevalence of carotid plaque as more components of the European telephone number for cardiovascular health are in control.
Components in control
0–2
3
4
5
6
7
8
Population prevalence
2.5
7.6
20.1
23.2%
22.0%
16.3
8.3
Prevalence of plaque
19.9%
10.1%
7.5%
5.2%
4.2%
3.3%
3.2%
Odds Ratio for plaque
7.5
3.4
2.4
1.7
1.3
1.0
1.0 (ref)
Components in control of the European telephone number for cardiovascular health in relation to carotid plaque prevalence
P218
Risk factors for cardiovascular disease in the general population of Ghent, Belgium: status praesens and comparison to the historical MONICA surveys
K Van Herck, E Clays, D De Bacquer, G De Backer
Ghent University, Ghent, Belgium
Topic: Cardiovascular epidemiology
Purpose: the MONICA Project extensively studied prevalence and time trends of risk factors for cardiovascular disease (CVD) at population level. We used the MONICA methodology to resurvey the population of the city of Ghent (Flanders, Belgium) in 2009. this study describes the current results and compares them to pooled data from the 3 previous MONICA surveys (1985–87; 1988–89; 1990–92) for our centre.
Methods: In 2009, a cross-sectional, age- and sex-stratified random sample of 2200 adults aged 25–64 years was selected from the population register of Ghent. Eligible subjects were invited by mail to complete a questionnaire on lifestyles and medical antecedents. Participants subsequently visited the research centre for standardized bio-clinical examinations (FEB-SEP 2009). the procedures for drawing and analysing blood samples and for the bio-clinical examinations used methods similar to those used previously.
Results: In total, 845 subjects participated (40,8% of the eligible subjects). Age, gender and educational level of participants were in line with those in the previous surveys. the mean total cholesterol level significantly decreased from 5.84 ± 1.19 mmol/L previously to 5.29 ± 1.01 mmol/L.
Mean systolic (from 123±16 to 127±16 mmHg) and diastolic (from 77±10 to 78±10 mmHg) BP levels have changed little until present. Currently, 24.7% of participants (was 18.5%) have a BP =140/90 mmHg and 7.1% have =160/95 mmHg (was 6.2%). Mean BMI level (currently 25.6±4.6 kg/·) and prevalence of overweight (49.1% with BMI =25 kg/·) and obesity (14.8% with BMI =30 kg/·) did not change significantly. the proportion of smokers markedly dropped from 32.0% to 24.3% overall, with a still highly significant difference between males (31.1%) and females (18.1%).
Of the 11.7% of participants taking antihypertensive drugs, 52.5% reached 140/90 mmHg goal and 87.9% reached the 160/95 mmHg goal. Of the 10.9% using lipid-lowering drugs, 53.3% meet the 5 mmol/L, and 93.5% the 6.5 mmol/L goal.
Conclusions: Current results demonstrate major improvements in total cholesterol levels and in proportion of smoking as compared to the 1980s and 1990s. A substantial rise in proportions of overweight, obesity, or hypertension is not observed. Older targets for antihypertensive or lipid-lowering drug treatment are met by the vast majority, but only just over half are currently at goal. To which extent these results can explain current and predict future trends in cardiovascular events requires coupling these data with the existing CVD registry, and will be the subject of further analyses.
P219
the trends in mortality of ischemic heart diseases in a Lithuanian population aged 25–64 years during 1987–2007
G Bernotiene, R Radisauskas, D Rastenyte, M Baceviciene, L Jancaityte, A Tamosiunas1, J Kirvaitiene2, D Sidlauskiene1
1Kaunas University of Medicine, Institute of Cardiology, Kaunas, Lithuania, 2Kaunas Medical University, Kaunas, Lithuania
Topic: Cardiovascular epidemiology
Purpose: the aim of the study was to evaluate the trends in mortality of ischemic heart diseases (IHD) in a population aged 25–64 years during 1987 to 2007.
Methods: the source of the data is the population-based ischemic heart disease (IHD) register. the methods used for the data collection were those applied by the WHO MONICA project. the object all permanent residents aged 25–64 years who died from IHD in 1987–2007. the age-standardized rates were calculated by the direct method and using the Segi's world population as a standard. Trends were analyzed using the method of linear regression on logarithms of the age-standardized annual rates.
Results: According to the data of IHD register, among men aged 25–64 years the average mortality rate of IHD was 160.9, among women 25.5/100,000 persons in 1987–2007. Biggest mortality rate of IHD among men was in 1994 and accounted 240.7/100,000 men, for women in 1995 and was 43.3/100,000 women. Lowest mortality rate of IHD among men was in 1999 and accounted 97.9/100,000 men, for women in 2003 and was 13.0/100,000 women. From 1987 to 2007 the mortality of IHD among both men and women significantly decreased, respectively, in averaged by 2.2% per year, p=0.008 and in averaged by 2.7% per year, p=0.01.
Conclusions: the mortality of IHD during the past twenty years significantly decreased among middle-aged men and women.
P220
Cardiovascular risk factors trends in Poland between 1997 and 2003–2007
P Bandosz1, G Broda2, M Rutkowski1, M Polakowska2, A Ignaszewska-Wyrzykowska1, W Drygas2, B Wyrzykowski1, T Zdrojewski1
1Medical University in Gdansk – Department of Hypertension and Diabetology, Gdansk, Poland, 2Department of Epidemiology, CVD Prevention and Health Promotion, Institute of Cardiology, Warsaw, Poland
Topic: Cardiovascular epidemiology
Objective: Poland is experiencing sharp decrease in cardiovascular mortality since 1991. the aim of this analysis is to assess actual trends in classic cardiovascular risk factors accompanied with observed decreasing mortality.
Material and Methods: three independent country-representative random samples of Polish adults aged 20+ were used. Studies were performed in 1997 (n=1 576), 2002 (n=2 956) and 2003–2007 (n=15 543). Main classic cardiovascular diseases risk factors were assessed using questionnaire, anthropometric and blood pressure measurements, fasting glucose and cholesterol measurements (except 1997 study). Age adjusted mean values and proportions were reported.
Results: Modest decrease in mean systolic blood pressure was observed, except middle aged and older men. Prevalence of hypertension fell between 2002 and 2003–2007 from 23.4% to 18.6% (p>0.001) in men and from 23.9% to 19.2% (p>0.001) in women. Not significant decrease in mean serum cholesterol level was observed in men and women between 2002 and 2003–2007. Higher decrease was observed in better educated people, i.e. in best educated women absolute difference was 9.7 mg/dl (p>0.05). there was a substantial decrease in smoking prevalence between 1997 and 2003–2007, from 46.0% to 38.2% in men (p>0.001) and from 31.6% to 23.1% in women (>0.001). this decrease was much lower in poorly educated people. Mean BMI values increased in men from 26.2 kg/· to 26.7 kg/· (p>0.05) and in women from 26.0 kg/· to 26.3 kg/· (p>0.01) in 1997 and 2003–2007 respectively. this increase was accompanied by increase in self-reported diabetes or fasting glycaemia =100 mg/dl.
Conclusions: We observed decreasing trends in most of classic cardiovascular risk factors. However, our data show increase in mean values of BMI and diabetes prevalence. Observed trends seem to be more favorable in better educated people.
P221
Factors associated with metabolic syndrome in Polish population. WOBASZ study
E Sygnowska, A Piwonska, A Waskiewicz, W Drygas
Institute of Cardiology, Department of CVD Epidemiology & Prevention & Health Promotion, Warsaw, Poland
Topic: Cardiovascular epidemiology
Introduction: the metabolic syndrome, characterised by abdominal obesity, glucose, lipid metabolism disturbances and high blood pressure, increases the risk of cardiovascular diseases. Purpose: To examine the impact of sociodemographic and healthy factors on prevalence of metabolic syndrome.
Material and methods: In 2003–2005 in the frame of Nationale Multicenter Health Survey (WOBASZ) a representative sample of Polish residents aged 20–74 were examined. Data on sociodemographic factors, antropometric parameters, blood pressure, lipid and glucose measurements and medical history were collected. the metabolic syndrome was defined using NCEP-ATPIII 2005 criteria. Data were obtained for 6189 men and 6979 women.
Results: the metabolic syndrome (MetS) were diagnosed in 1600 (25.8%) men and 1666 (23.9%) women. Only in 1225 (19.8%) men and 2145 (30.7%) none of MetS criteria were observed, and at least 4 criteria were observed in 693 (11.2%) men and 779 (11.2%) women. the prevalence of MetS increased significantly with age in men, from 10% in age group 20–35 to 37% in age group 65–74, in women respectively from 4% to 51%. the increase in prevalence of MetS was associated with income per capita in family in both genders (from 24.2% when the income was 500 PLN to 31.3% when the income was greater than 1000 PLN in men and respectively from 22.7% to 25.8% in women) and in men with increase of size of community (from 22.6% to 27.9%). In men the significant increase of person with MetS was observed with higher education level (from 26.7% for primary to 29.3% for university education) but among women there was observed decrease in prevalence of MetS with higher education (from 31.1% to 12.8%). In both genders MetS was significantly more often found in persons after cardiovascular events (39.5% vs 23.8% in persons without CV events in men and 50.9% vs 21.6% in women), persons with ischaemic heart disease (42.1% vs 24.1% in persons without IHD in men and 49.1% vs 23.0% in women), and in persons with self-rated health as bad (37.9% vs 20.6 in persons with good self-rated health in men and 42.1% vs 15.4% in women).
Conclusion: In Polish population aged 20–74 there was observed relatively high frequencies of persons with metabolic syndrome and it's prevalence was related to some socidemographic and healthy factors.
P222
Health school at working place as effective method of cardiovascular diseases prevention in males of stressful professions
I Osipova1, O Antropova1, E Vorobyova1, T Belousova2, K Golovina1
1Altay State Medical University, Barnaul, Russian Federation, 2Departmental Clinical Hospital, Barnaul, Russian Federation
Topic: Occupational health
the aim of the study was to analyze the efficiency of ‘Health school at working place” in cardiovascular (CV) risk factors correction and total coronary risk in subjects of operator professions (locomotive crew workers).
Material and methods: 100 engine-drivers and their assistants (males) at the age 23–55 years old were examined. the examination included questioning, clinical observation, performing Holter monitoring of blood pressure (BP) and ECG, detecting of total cholesterol, cholesterol of low-density (LDL) and high-density lipoproteins (HDP), triglyceride, serum glucose and glucose tolerance test. the diagnosis of essential hypertension and metabolic syndrome was determined according to main criteria of National Guidelines of Arterial Hypertension (2004) and Metabolic Syndrome (2007). Total coronary risk was estimated according to PROCAM and SCORE scales. the program of ‘Health school at working place” agreed the recommendations of State Research centre of preventive medicine. the subjects were given self-control diary. the studies were held during 20 min once a week at working place. Average amount of subjects at each study was 70–100. the duration of the “Health school” program was 3.5 months. Subjects questioning with estimating total coronary risk was performed before the beginning of ‘Health school” program, after the finishing the program, and then 12 months later.
Results: 52% of engine-drivers and their assistants had metabolic syndrome that is possibly connected with long psychoemotional strain at working place. According to SCORE scale total coronary risk was low and moderate in all subjects but this scale does not take into consideration risk factors changing and other lipoproteins than total cholesterol. Due to wide spread of metabolic syndrome among the subjects estimating of total 10-year risk of CV events according to PROCAM scale was performed. It was revealed that 5% subjects had high risk, 23% had medium risk and 72% had low risk. 12 months later after finishing educational program “Health school” increasing of physical activity, lowing of BP and abdominal obesity, decreasing smoking and alcohol abuse, keeping diet and weigh control, decreasing total coronary risk (since 6.8± 1.01 till 4.4±0.62, ?>0.05) and the rank of cholesterol of LDL and triglyceride, increasing of cholesterol of HDL was registered. Also 18–37% subjects refused smoking.
Conclusion: Educational program “Health school” at working place is an effective method of correction of CVD risk factors, decreases metabolic disorder and total coronary risk in males of stressful professions.
