Profession of locomotive driving safety and risk factors of cardiovascular disease development
I Osipova1, O Antropova1, E Vorobyova1, I Kurbatova2, K Golovina1
1Altay State Medical University, Barnaul, Russian Federation, 2Departmental Clinical Hospital, Barnaul, Russian Federation
Topic: Risk factors and risk prediction
the purpose of the study was to estimate influence of engine driver and assistant of engine driver professions, connected with psychoemotional working strain on the risk factors of cardiovascular disease (CVD) development in subjects of operator professions. 750 males at the age of 25–55 years old were included in the study. According to professional stress they were divided into 2 groups: 500subjects of operator professions formed the 1st group, 250 subjects of low-stress professions formed the 2nd group. Among the 1st group subjects 303 males did not have any CVD, 197 had arterial hypertension (AH). 118 males from the 2nd group did not CVD, but 132 males also had AH. All subjects were estimated age, smoking, family history, office blood pressure, heart rate (HR) at rest. Serum lipids were detected by enzymatic methods using the reagent set “Human” (Germany) and biochemical analyzer “EPOLL-20”. the most prevailing risk factors among the subjects without CVD in both groups were smoking (74.3 % and 52.5%) and dyslipidemia (49.2% and 44.1%), then follows family history of early CVD (26.4% and 20.3%) and abdominal obesity (18.5% and 10.2%). In comparison with the 2nd group there were over 21.8% (x2=18.5, p=0.001) more smokers among the males of operator professions. they had abdominal obesity over 8.3% (x2=4.2, p=0.04) and triglycerides increasing over 8.3% (x2=11.9, p=0.006). 23.8% operators without CVD had HR over 80 bpm, in the 2nd group 14.4% subjects had tachycardia, thus it met over 9.4% (x2=4.5, p=0.03) more frequently among the 1st group subjects. Risk factors analysis in patients with AH revealed that smoking (72.1% and 69.7% in 1st and 2nd groups) and family history of early CVD (65.5% and 60.6% in 1st and 2nd groups) met equally frequent. Dyslipidemia was registered in 81.2% and 50.8% subjects from the 1st and 2nd groups, where among the 1st group males it met over 30.4% more frequently. Among the subjects with professional stress triglycerides increased over 11.3% (x2=4.8, p=0.03), low-density lipoproteins (LDP) increased over 12.4% (x2=4.9, p=0.03). Metabolic syndrome was diagnosed over 15.7% (x2=7.3, p=0.007) more frequently in 1st group subjects. HR over 80 bmp was registered over 13.5% (x2=9.2, p=0.002) more frequently in 1st group subjects in comparison with the 2nd group subjects. Consequently, chronic stress at working place negatively influence modified risk factors of CVD development, leads to increasing of triglycerides, tachycardia, frequency of metabolic syndrome and additionally leads to increasing of LDL in patients with AH.
P538
Prevalence of high blood pressure among Armenian population
D Andreasyan, S Grigoryan
National Institute of Health, Yerevan, Armenia
Topic: Risk factors and risk prediction
National Institute of Health
Purpose: the main aim of this study is the detection of high blood pressure among (HBP) Armenians 15 years and above decomposed by sex, age and household prosperity.
Methods: A multilevel stratified self-weighting cluster sampling was used. Stratification was done. the sample is representative for the entire country as well as for Yerevan-urban-rural desegregation. the number of respondents was 1600. During the survey blood pressure and pulse of respondents were measured twice, once for each arm (the systolic pressure > 140 and diastolic > 90 values were taken into account as an indicator of high blood pressure).
Results: For studying the prevalence of high arterial blood pressure, measurements were taken directly from consenting adults during the 2007 and 2009 Health System Performance Assessment surveys. the results showed a small but significant decrease in the prevalence of high blood pressure (defined as greater than 140/90 mmHg) in the two years between surveys (13.4% to 11.9%). In 2009, high blood pressure was more prevalent among females (11.7%) than males (9.4%). the prevalence of the condition also increases markedly after age 40, being roughly 10% for adults age 4049, close to 20% for those age 5059 and over 40% for those age 60 and older. the prevalence was highest in the poorest wealth quintile (15.2%), decreasing to 5.8% in the richest wealth quintile.
Conclusion: the prevalence of high blood pressure is concentrated among women after age 40 and households in the poorest wealth quintiles. Unless aggressively addressed, this pattern will have significant long term implications for the health status of people with relatively limited means.
Prevalence of HBP by income groups, 2009
P539
Ethnical variations in health hehaviour of school children in Slovakia
V Regecova1, P Simurka2, F Hruba3
1Institute of Normal and Pathological Physiology, Bratislava, Slovak Republic, 2Paediatric Clinic of the Faculty Hospital, Trencin, Slovak Republic, 3Regional Authority of Public Health, Banska Bystrica, Slovak Republic
Topic: Public health
Introduction: the influence of different living conditions and genetic prerequisites leads to uneven health potential of the Romani (Gypsy) as compared to the majority population.
Aim: the aim of this multicentric study was to evaluate the physical activity, nutritition and well being of school children in Slovakia with respect to their ethnical status.
Methods: the data of 12 918, 11 years old apparently healthy children, including 880 children of the Romani minority (R), were collected in the frames of the project the primary prevention of atherosclerosis inchildren and adolescents'. Our questionnaire monitored their health behaviour and nutritional habits. Differences in prevalence were tested by chi square tests, and for major risk factors the odds ratios and 95% confidence intervals were calculated as well.
Nourishment: According to health records, most of the children were breast fed during less than 3 months − 61% of majority population (M) and 56% of R (p<0.01), but 5% of M and 8% of R were not suckling at all. At the time of the investigation, 45% of M children did not drink milk daily, 7% ate fruits or vegetables rarely (weekly or less), but on the other hand 16 % reported a daily consummation of crackers or sweets. the respective frequencies in R were higher − 68%, 22% and 33% (p<0.001).
Experience with smoking admitted 11.4% of boys (B) and 4% of girls (G) as compared with 17% B (30% of them daily) and 8% G in R (p<0.001). Alcohol tried 41% of B and 37% of G in M, but only” 38% B and 29% G in R. Some of the children did not brush their teeth daily (8% in M vs 24% in R, p<0.001).
Physical activity was higher in B (p<0.001) in both subgroups, daily exercises reported 47% B and 33% G in M but 36% B and 22% G in R, sedentary way of life declared 9% B, 13% G in M and 23% B, 33% G in R (p<0.001).
Well being: In spite of that disabled subjects were not included in this study, 4% in M vs 12% in R felt “not healthy”. Most of the complaints (at least weekly even in children feeling quite healthy) concerned headache (12%) and abdominalgia (9%), less frequent, were backaches, dizziness, sleep distresses or feeling down. All these problems were declared 2–3 times more frequently in R.
Conclusions: Relatively high frequencies of adverse health behaviour among school children were found in both subgroups. this may disturb their physical and emotional development and predicts severe diseases in adulthood. these findings might be included in prevention programs and should be taken into account as early as possible, with a special emphasis on Romani minority, which is more predisposed to risk attitude.
P540
Echocardiographic evaluation of healthy aged long-term endurance cross-country skiers in different age groups
J Grimsmo11 I Grindvold1, S Maehlum2, H Arnesen1
1University of Oslo Faculty Division, Ulleval Hospital, Oslo, Norway, 2the Norwegian School of Sport Sciences, Oslo, Norway
Topic: Sports cardiology
Purpose: Data on echocardiographic findings in the old athletes are limited, and there are diverging results in the literature on whether long-term endurance training leads to irreversible changes later in life. the aim of this echocardiographic study was to evaluate the effects of long-term endurance training on cardiac structure and function in three different age groups of 48 healthy middle-aged and old former or still active male endurance cross-country skiers.
Methods: thirty years ago 122 skiers participated in a former study. All of the men were recruited from the 58 km long Norwegian Birkebeiner cross-country race and had been among the best quartile in each age group several times. Out of the original 122 subjects, 37 had died during the period from 1976 to 2006, with 1/35 in group I, 8/48 in group II and 28/39 in group III. In this present study we included 48 healthy (of 78 still living) life-long master athletes (23 in age group I: age 58.6 ± 2.2 yrs; 21 in age group II: age 74.9 ± 2.2; 4 in age group III: age 89.5 ± 1.9). All subjects with cardiac or pulmonary diseases and subjects on cardio active medication, which could interfere with the echocardiographic findings, were excluded (10 subjects from group I, 16 from group II and 4 from group III). Complete two-dimensional, M-mode and Doppler recordings at rest were obtained using standard echocardiographic methods. the two oldest age groups were combined and the echocardiographic results were compared with the results in age group I.
Results: No significant differences in left atrial or ventricular dimensions between these two age groups were found. A high proportion of enlarged left atrial dimensions were found among all subjects with 80 % exceeding upper reference limit of 40 mm in diameter (LADs) and 94 % exceeding upper reference limit of 20 cm in area (LAAs). Mean values for LADs (mm) and LAAs (cm) were; Group I: 41.9 ± 4.7 and 24.7 ± 3.3; group II: 43.5 ± 4.8 and 25.2 ± 3.7; group III: 44.5 ±4.7 and 25.8 ± 3.7. Left ventricular diastolic diameter exceeded upper reference limits of >54 mm in 20 subjects among all. the groups had preserved systolic and age-related diastolic function.
Conclusion: In conclusion we have found that healthy long-term endurance master crosscountry skiers have enlarged left atrial dimensions. there was no difference in dimensions between an age group of 59 years and an age group almost twenty years older. Enlarged left atrial dimension may be a possibility for the increased prevalence of atrial fibrillation observed among endurance athletes.
P541
Effects of systolic and diastolic blood pressure control on cardiovascular and all-cause mortality among Finnish adults
NC Barengo1, R Antikainen2, JO Tuomilehto1
1University of Helsinki, Helsinki, Finland, 2Imperial College London, London, United Kingdom
Topic: Hypertension
Purpose: To investigate whether there are differences in cardiovascular disease (CVD) and all-cause mortality among subgroups of hypertensive patients by control of systolic (SBP) and/or diastolic (DBP) blood pressure independent of other CVD factors.
Methods: Prospective follow-up of 12 213 men and 13 439 women aged 25–64 years living in eastern and south-western Finland within the framework of the FINRISK studies. CVD risk factors and life-style habits were assessed by a self-administered questionnaire, BP and laboratory measurements. the participants were classified into four groups according to their BP status: (i) normotensive, (ii) treated, hypertensive patients with SBP and DBP controlled, (iii) treated hypertensives with SBP controlled and DBP uncontrolled (iv) treated hypertensives with SBP uncontrolled and DBP controlled and (v) hypertensive uncontrolled patients. the cutoff levels for hypertension were systolic blood-pressure <140 mmHg and diastolic blood-pressure <90 mmHg. the data on mortality were obtained by computerised record linkage to the nationwide death register using the unique national personal identification number.
Results: During a median follow-up time of 19.8 years, the number of deaths was 722 in men and 330 in women and those due to CVD were 220 in men and in 71 women. All-cause mortality was significantly higher in the subgroup with only DBP controlled and the group with the hypertensive uncontrolled patients compared to the normotensive group when adjusted for the common CVD risk factors in both men and women. Treated hypertensive man with controlled DBP but uncontrolled SBP had a HR of 1.60 (95% CI 1.15–2.22) and women a HR of 1.57 (95% CI 1.18–2.10). the respective figures for the subgroups with controlled DBP but uncontrolled SBP in regard CVD mortality were 2.69 (95% CI 1.64.4.40) in men and 2.11 (95% CI 1.30–3.43) in women, respectively. Treated hypertensives with either SBP controlled or both SBP and DBP controlled had no increased risk of all-cause or CVD mortality compared to the normotensive group.
Conclusions: Control of SBP seems to be the key element in hypertension control regardless of DBP. thus, blood pressure control should aim at controlling SBP.
P542
Options for simplifying risk estimation
A Dudina, MT Cooney, IM Graham
Cardiology, Adelaide and Meath Hospital, Tallaght, Dublin, Ireland
Topic: Cardiovascular epidemiology on behalf of SCORE investigators and FINRISK group
Background: Total cardiovascular disease (CVD) risk estimation is an important element in primary prevention of CVD. SCORE (Systematic COronary Risk Evaluation), the risk estimation system recommended by the European guidelines on CVD prevention, estimates 10 year risk of fatal CVD based on age, gender, total cholesterol, systolic blood pressure and smoking status. Recently, attention has moved to simplifying risk estimation by including only easily measured non-laboratory variables. Here we evaluate possibilities for extending this concept by removing the blood pressure variable also. this would eliminate the need for any medical equipment, and has the potential to be used by the genral public for self-assessment of risk.
Objective: To derive and internally validate two simplified risk estimation systems which include only easily ascertained variables. the first, called SCORE BMI, contains age, gender, smoking status and BMI category. the second incorporates resting heart rate (RHR) in addition.
Methods: the SCORE dataset (12 European prospective cohort studies:111,633 men and 82,076 women) was used for deriving the SCORE BMI function. the National FINRISK study (prospective study of general population: 14,997 men and 15,861 women included here), was used for deriving the simple function which included RHR. Cox proportional hazards model was used to derive both functions. the area under receiver operating characteristic curve (AUROC) was calculated for each function. the net reclassification index (NRI) was used to calculate the improvement in risk classification afforded by the addition of RHR. Simple charts, similar in format to the SCORE charts, for estimating 10 year risk of CVD mortality are presented.
Results: Internal validation of SCORE BMI demonstrated good discrimination, with AUROCs of 0.85 in women and 0.78 in men. this was only slightly inferior to the discrimination of the original SCORE function; AUROCs were 0.86 and 0.80 in women and men respectively. Incorporation of RHR into the second function resulted in an improvement in discrimination (0.855 to 0.867, p=0.018 in women and 0.812 to 0.820, p=0.036 in men) and risk classification, with a NRI of 0.14, p<0.01.
Conclusions: Useful risk estimation is possible using only simple, non laboratory variables; two options for simplifying risk estimation are presented here. these systems have potential to improve the accessibility and cost-effectiveness of risk estimation.
(W) P543: Predicting outcomes in weight management by readiness for nutrition change and self-efficacy with the eating stage score
WA Firth, NB Giacomantonio
QEII HSC Community Cardiovascular Hearts in Motion Program, Halifax, Canada Topic: Nutrition
Community Cardiovascular Hearts in Motion Research Team
Purpose: Researchers and practitioners are now considering evidence-based evaluations when selecting a theory of behavior change for research and practice. Readiness to change has shown predictive potential for health behavior and dietary fat but has not been consistent with other nutrient factors. It is proposed that when readiness for change is paired with confidence in goal setting related to multiple nutrient factors, weight management outcomes can be predicted.
Methods: Patients with vascular risk (including coronary artery disease, stroke, peripherial artery disease and high risk primary prevention) participate in a 3 month multi-vascular program called the Community Cardiovascular Hearts in Motion (CCHIM). A multi-disciplinary team provides nutrition intervention, weekly exercise, and risk factor management. the dietitian assesses each patient and provides education, evaluating nutrition progress during the program and at 6 and 12 month follow-up. the Eating Stage Score was developed to incorporate readiness to change and confidence in five key nutrition categories. Anthropometric measures, clinical data and behavior interventions are measured at baseline, program completion, 6 and 12 months.
Results: 445 patients completed the CCHIM program with one year follow up data. Average weight lost at 3 months was 3.5% which was sustained at 12 months (p=0.0001). Readiness to change and confidence in nutrition factors improved at 3 months and was sustained at 12months. Action readiness for Low Fat (p= 0.02) and Portion Control (p= 0.001) was statistically correlated with weight loss. Patients with a high readiness to change and a high confidence in eating goals for all nutrition factors, were more successful in attaining and sustaining weight loss. Seventy two percent of patients with the highest eating stage score had weight loss at 3 months (p=0.05) with continued weight loss noted in 61% of those patients at 6 months (p=0.05). Fifty nine percent continued to show weight loss at 1 year (p=0.05).
Conclusions: Nutrition interventions that incorporate motivational enhancement for self-efficacy, with readiness and confidence to change, improves adoption and maintenance of important eating behaviors and can help to predict weight management outcomes. Such findings can help in planning patient program interventions with potential for vascular risk factor management and overall improved health.
