epidemiology of cv disease in central and eastern europe renata cífková center for cv prevention,...
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Epidemiology of CV diseaseEpidemiology of CV diseasein Central and Eastern Europein Central and Eastern Europe
Renata CRenata Cíífkovfkováá
Center for CV Prevention, Charles University Medical School Center for CV Prevention, Charles University Medical School && Thomayer University Hospital Thomayer University HospitalDepartment of Medicine II, Charles University Medical SchoolDepartment of Medicine II, Charles University Medical School
Department of Preventive CardiologyDepartment of Preventive Cardiology, IKEM, IKEMPrague, Czech RepublicPrague, Czech Republic
Death by causeDeath by causeEuropeEurope
Men WomenMen Women
All CVD deaths 43%All CVD deaths 43% All CVD deaths 54%All CVD deaths 54%
European CVD Statistics 2008European CVD Statistics 2008
Death by causeDeath by causeEuropean UnionEuropean Union
Men WomenMen Women
All CVD deaths 38%All CVD deaths 38% All CVD deaths 45%All CVD deaths 45%
European CVD Statistics 2008European CVD Statistics 2008
Russian Fed.Russian Fed.BulgariaBulgariaRomaniaRomaniaHungaryHungary
PolandPolandArgentinaArgentina
Czech RepublicCzech RepublicChina-RuralChina-Rural
ColombiaColombiaChina-UrbanChina-Urban
ScotlandScotlandIrelandIreland
FinlandFinlandN. IrelandN. Ireland
GreeceGreeceEngland/WalesEngland/Wales
BelgiumBelgiumUSAUSA
DenmarkDenmarkN. ZealandN. Zealand
MexicoMexicoGermanyGermanyPortugalPortugalSwedenSweden
KoreaKoreaAustriaAustria
NetherlandsNetherlandsItalyItaly
NorwayNorwayCanadaCanada
SpainSpainAustraliaAustralia
FranceFranceSwitzerlandSwitzerland
IsraelIsraelJapanJapan
Death Rates for CVD and StrokeDeath Rates for CVD and StrokeMen, 35-74 yrsMen, 35-74 yrs
Circulation 2009Circulation 2009;;119:e21-e181119:e21-e181
Russian Fed.Russian Fed.BulgariaBulgariaRomaniaRomaniaHungaryHungary
ColombiaColombiaChina-RuralChina-Rural
China-UrbanChina-UrbanArgentinaArgentina
PolandPolandCzech RepublicCzech Republic
MexicoMexicoPuerto RicoPuerto Rico
ScotlandScotlandN.IrelandN.Ireland
USAUSAEngland/WalesEngland/Wales
New ZealandNew ZealandGreeceGreeceKoreaKorea
IrelandIrelandDenmarkDenmarkBelgiumBelgiumPortugalPortugalGermanyGermanySwedenSwedenFinlandFinland
NetherlandsNetherlandsCanadaCanada
ItalyItalyAustriaAustriaNorwayNorway
AustraliaAustraliaIsraelIsraelSpainSpain
SwitzerlandSwitzerlandJapanJapan
FranceFrance
Death Rates for CVD and StrokeDeath Rates for CVD and StrokeWomen, 35-74 yrsWomen, 35-74 yrs
Circulation 2009Circulation 2009;;119:e21-e181119:e21-e181
0
100
200
300
400
500
600
700
800
68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97
Austria Czech Republic Finland Italy Poland Romania UK
Dea
rth
/100
000
(ag
e ad
j.)
Dea
rth
/100
000
(ag
e ad
j.)
yearyear
CV MortalityCV Mortality - - MalesMales
0
50
100
150
200
250
68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97
Austria Czech Republic Finland Italy Poland Romania UK
yearyear
Dea
th/1
000
000
(age
ad
j.D
eath
/100
0 00
0 (a
ge a
dj.
CV MortalityCV Mortality - - FemalesFemales
Standardized mortalityStandardized mortalityCzech Republic, 2009Czech Republic, 2009
MalesMales FemalesFemales
CVDCVDMalignanciesMalignanciesOtherOther
45.3 %45.3 %
27.9 %27.9 %
26.8 %26.8 % 51.4 %51.4 %
26.1 %26.1 %
22.5 %22.5 %
MalesMales- - TotalTotal- CVD- CVD- CHD- CHD- - StrokeStroke
FemalesFemales- Total- Total- CVD- CVD- CHD- CHD- Stroke- Stroke
15811581 844844 436436 250250
944944 548548 223223 202202
963963436436218218
8989
577577296296134134
7272
- 38.8- 38.8- 48.3- 48.3- 47.9- 47.9- 64.4- 64.4
- 38.9- 38.9- 46.0- 46.0- 39.9- 39.9-- 64.464.4
< 0.001< 0.001< 0.001< 0.001< 0.001< 0.001< 0.001< 0.001
< 0.001< 0.001< 0.001< 0.001< 0.001< 0.001< 0.001< 0.001
1985 2009 % p 1985 2009 % p
Age-adjusted death rates/100,000Age-adjusted death rates/100,000Czech Republic, 1985-200Czech Republic, 1985-20099
Age-stand. total, CVD, IHD, and stroke mortality(age group 35-74 yrs)
Czech Republic 1970-2008
J Hypertens 2010;28:2196-203
Males Females
Total mortalityCVD mortalityIHD mortalityStroke mortality
Nu
mb
er o
f d
eath
s/10
0,00
0
Nu
mb
er o
f d
eath
s/10
0,00
0
Total mortality, age 35-74 yearsMales vs Females: p = 0,001
CVD mortality, age 35-74 yearsMales vs Females: p = 0,001
CAD mortality, age 35-74 yearsMales vs Females: p = 0,001
Stroke mortality, age 35-74 yearsMales vs Females: p = 0,0041
MalesFemales
year year
yearyear
Nu
mb
er o
f de
ath
s/10
0,00
0
Nu
mb
er o
f de
ath
s/10
0,00
0N
um
ber
of
deat
hs/
100,
000
Nu
mb
er o
f de
ath
s/10
0,00
0
J Hypertens 2010;28:2196-203
Factors affecting CHD mortalityFactors affecting CHD mortality
Risk factorsRisk factors
CHD incidenceCHD incidence
CHD mortalityCHD mortality
TreatmentTreatment
Case fatalityCase fatality
Pardubice
KroměřížChrudim
JindřichůvHradec
Benešov
Plzeň
Prahavýchod
Cheb
Litoměřice
WHO MONICA projekt
Nové okresy
Sample sizes and response ratesSample sizes and response rates
1985 1988 1992 1997/8 2000/1 2007/81985 1988 1992 1997/8 2000/1 2007/8
TotalTotal
MalesMalesResp.Resp.
FemalesFemalesResp.Resp.
25702570
1253125381.581.5
1317131785.085.0
27682768
1357135785.585.5
1411141188.488.4
23432343
1134113473.273.2
1209120976.776.7
19901990
96996963.263.2
1021102166.466.4
20552055
1003100362.062.0
1052105263.863.8
*** p < 0.001 *** p < 0.001 for trendfor trend
22462246
1102110262.762.7******
1144114463.163.1******
Systolic BPSystolic BP
Males FemalesMales Females
p < 0.001 p < 0.001
mmHgmmHg mmHgmmHg
Atherosclerosis 2010;211:676-81Atherosclerosis 2010;211:676-81
Diastolic BPDiastolic BP
Males FemalesMales Females
p < 0.001 p < 0.001
mmHgmmHg mmHgmmHg
Atherosclerosis 2010;211:676-81Atherosclerosis 2010;211:676-81
Prevalence of hypertensionPrevalence of hypertension
Males FemalesMales Females
p for linear trend: ns p < 0.001
%% %%
Atherosclerosis 2010;211:676-81Atherosclerosis 2010;211:676-81
BMIBMI
Males FemalesMales Females
p < 0.001kg/mkg/m22 kg/mkg/m22
p pro trend: NS
Atherosclerosis 2010;211:676-81Atherosclerosis 2010;211:676-81
Awareness of hypertensionAwareness of hypertension
Males FemalesMales Females
p for linear trend: 0.001
%% %%
p for linear trend: 0.001
Atherosclerosis 2010;211:676-81Atherosclerosis 2010;211:676-81
Antihypertensive medicationAntihypertensive medication
Males FemalesMales Females
p for linear trend: 0.001%% %%
p for linear trend: 0.001
Atherosclerosis 2010;211:676-81Atherosclerosis 2010;211:676-81
Hypertension controlHypertension controlBP < 140/90 mmHg of all hypertensivesBP < 140/90 mmHg of all hypertensives
Males FemalesMales Females
p for linear trend: 0.001
%% %%
p for linear trend: 0.001
Atherosclerosis 2010;211:676-81Atherosclerosis 2010;211:676-81
Total cholesterolTotal cholesterol
Males FemalesMales Females
p < 0.001 p < 0.001
mmol/lmmol/l mmol/lmmol/l
Atherosclerosis 2010;211:676-81Atherosclerosis 2010;211:676-81
Lipid-lowering drugsLipid-lowering drugs
81%81%
13%13% 3%3%3%3%
fibratesfibratesstatinsstatinsotherothercombinationscombinations
68.5%68.5%
27.5%27.5% 4%4%
1997/981997/98n = 130 n = 130 (3.95%)(3.95%)
2000/012000/01n = 171 n = 171 (5.1%)(5.1%)
78.0%78.0%
15.5%15.5%4.7%4.7%
2007/082007/08n = 386 n = 386 (10.7%)(10.7%)
1.6%1.6%
Atherosclerosis 2010;211:676-81Atherosclerosis 2010;211:676-81
SmokingSmoking
Males FemalesMales Females
p < 0.001 p for trend: n.s.
%% %%
Atherosclerosis 2010;211:676-81Atherosclerosis 2010;211:676-81
ConclusionsConclusions
Total and CV mortality is decreasing in the Czech Republic.Total and CV mortality is decreasing in the Czech Republic.
The decrease is due to decreasing stroke and CHD mortality rates. The decrease is due to decreasing stroke and CHD mortality rates.
Explaining the CHD mortality fall in Explaining the CHD mortality fall in the the
Czech Czech RRepublic epublic 1985-2007: 1985-2007: RESULTSRESULTS
- 50000
- 30000
- 10000
10000
12,080 fewer deaths in 2007
Risk Factors worse Risk Factors worse ++ 6 6%%
Risk Factors better -Risk Factors better - 6611%%
Treatments Treatments -- 4411%%
Unexplained - 4%200
71985
- 50000
- 30000
- 10000
10000
12,080 fewer deaths in 2007
Risk Factors worse Risk Factors worse ++66%% Obesity (increase) +1% Diabetes (increase) +5%
Risk Factors better -6Risk Factors better -611%%Population BP fall -15%Smoking - 8%Cholesterol (diet) -38%
Treatments Treatments - -4141%%AMI treatments -7%Unstable angina -1%Secondary prevention post MI and post revasc. -11%Heart failure -13%Angina: CABG surgery -1.5%Angina ASA -1%Hypertension therapies -3% Statins (primary prevention) -4%
Unexplained -4%20071985
Explaining the CHD mortality fall in Explaining the CHD mortality fall in the the
Czech Czech RRepublic epublic 1985-2007: 1985-2007: RESULTS RESULTS
Percentage of the Decrease in Death from CHD Atributed Percentage of the Decrease in Death from CHD Atributed to Treatment and Risk-Factors Changesto Treatment and Risk-Factors Changes
NEJM 2007;356:2388-98NEJM 2007;356:2388-98
134.7 135.6 135.3
120122124126128130132134136138140
1985 1988 1990
128.8 131.3 131.1
120122124126128130132134136138140
1985 1988 1990
Systolic BPSystolic BPGerman CV Prevention StudyGerman CV Prevention Study
mm
Hg
mm
Hg
MalesMales FemalesFemales
Preventive Medicine 1994Preventive Medicine 1994;;23:197-20523:197-205
ns
** **
84.0 83.1 83.4
76
78
80
82
84
86
88
1985 1988 1990
FemalesFemales
Diastolic BPDiastolic BPGerman CV Prevention StudyGerman CV Prevention Study
79.8 79.8 80.3
76
78
80
82
84
86
88
1985 1988 1990
MalesMales
mm
Hg
mm
Hg
Preventive Medicine 1994Preventive Medicine 1994;;23:197-20523:197-205
**
BMIBMIGerman CV Prevention StudyGerman CV Prevention Study
MalesMales FemalesFemales
25.8 25.8 26.2
24
25
26
27
28
1985 1988 1990
26.5 26.5 26.8
24
25
26
27
28
1985 1988 1990
kg/m
kg/m
22
Preventive Medicine 1994Preventive Medicine 1994;;23:197-20523:197-205
****
SmokingSmokingGerman CV Prevention StudyGerman CV Prevention Study
41.6 43.7 39.0
0
10
20
30
40
50
1985 1988 1990
Males FemalesMales Females
26.7 27.4 28.0
0
10
20
30
40
50
1985 1988 1990
%% %%
Preventive Medicine 1994Preventive Medicine 1994;;23:197-20523:197-205
Total CholesterolTotal CholesterolGerman CV Prevention StudyGerman CV Prevention Study
MalesMales FemalesFemales
6.00 6.06 6.09
0
1
2
3
4
5
6
7
8
1985 1988 1990
6.08 6.12 6.16
0
1
2
3
4
5
6
7
8
1985 1988 1990
mmol/Lmmol/L mmol/Lmmol/L
Preventive Medicine 1994Preventive Medicine 1994;;23:197-20523:197-205
** ** **
HDL-cholesterolHDL-cholesterolGerman CV Prevention StudyGerman CV Prevention Study
1.67 1.63 1.74
0,2
0,4
0,6
0,8
1
1,2
1,4
1,6
1,8
2
1985 1988 1992
mmol/Lmmol/L
FemalesFemales
1.31 1.28 1.36
0,2
0,4
0,6
0,8
1
1,2
1,4
1,6
1,8
2
1985 1988 1990
MalesMalesmmol/Lmmol/L
Preventive Medicine 1994Preventive Medicine 1994;;23:197-20523:197-205
Kaunas Population, LithuaniaKaunas Population, LithuaniaAge range, 35-64 yrsAge range, 35-64 yrs
1983/84 1986/87 1992/93 2001/02 1983/84 1986/87 1992/93 2001/02
TotalTotalResp.Resp.
2413241370.270.2
1762176269.669.6
1231123158.658.6
Medicina 2003Medicina 2003;;39:1193-119939:1193-1199
1403140362.462.4
139.7 135.3 135.9 133.2
120
125
130
135
140
145
150
1983/84 1986/87 1992/93 2001/02
Systolic BP Systolic BP Kaunas, LithuaniaKaunas, Lithuania
mm
Hg
mm
Hg
138.9 136.2 138.3 136.4
120
125
130
135
140
145
150
1983/84 1986/87 1992/93 2001/2002
MalesMales FemalesFemales
p < 0.001
**** ****
Medicina 2003Medicina 2003;;39:1193-119939:1193-1199
87.9 87.0 88.9 87.1
76
78
80
82
84
86
88
90
1983/84 1986/87 1992/93 2001/02
FemalesFemales
86.5 84.2 86.6 82.7
76
78
80
82
84
86
88
90
1983/84 1986/87 1992/93 2001/02
MalesMales
mm
Hg
mm
Hg
************
Medicina 2003Medicina 2003;;39:1193-119939:1193-1199
Diastolic BP Diastolic BP Kaunas, LithuaniaKaunas, Lithuania
MalesMales FemalesFemales
30.0 29.8 28.2 28.9
26
27
28
29
30
31
32
1983/84 1986/87 1992/93 2001/02
27.5 27.5 27.1 27.4
26
27
28
29
1983/84 1986/87 1992/93 2001/02
kg/m
kg/m
22
** ************
BMIBMIKaunas, LithuaniaKaunas, Lithuania
Medicina 2003Medicina 2003;;39:1193-119939:1193-1199
MalesMales FemalesFemales
5.95 5.99 5.94 6.11
0
1
2
3
4
5
6
7
8
1983/84 1986/87 1992/93 2001/02
6.09 6.32 6.27 6.31
0
1
2
3
4
5
6
7
8
1983/84 1986/87 1992/93 2001/02
mmol/Lmmol/L mmol/Lmmol/L
p < 0.001p < 0.001
** ****** ** ******
Total CholesterolTotal CholesterolKaunas, LithuaniaKaunas, Lithuania
Medicina 2003Medicina 2003;;39:1193-119939:1193-1199
WHO MONICA ProjectWHO MONICA ProjectMultinational Multinational MONIMONItoring of Trends and Determinants in toring of Trends and Determinants in CACArdiovascular Diseaserdiovascular Disease
38 populations in 21 countries38 populations in 21 countries
• monitoring of nonfatal MI and CHD deaths in males and females monitoring of nonfatal MI and CHD deaths in males and females aged 35-64 yearsaged 35-64 years
• cross-sectional population surveys of major RFcross-sectional population surveys of major RF
WHO MONICAWHO MONICAAge-standardized SBP Age-standardized SBP
Men, 35-64 yearsMen, 35-64 years
133
136129
133135135
132133
130132
134126
131141
132137
136137
130129
100 110 120 130 140 150
BEL-GHEBEL-GHECAN-HALCAN-HALCZE-CZECZE-CZEGER-AURGER-AURGER-AUUGER-AUUGER-BREGER-BREGER-EGEGER-EGE
ITA-BRIITA-BRINEZ-AUCNEZ-AUCPOL-TARPOL-TAR
POL-WARPOL-WARRUS-MOCRUS-MOCRUS-MOIRUS-MOIRUS-NOCRUS-NOCRUS-NOIRUS-NOI
UNK-BELUNK-BELUNK-GLAUNK-GLAUSA-STAUSA-STA
YUG-NOSYUG-NOS
MEANMEAN
Lancet 2000Lancet 2000; ; 355:675-87355:675-87
WHO MONICAWHO MONICAAge-standardized SBP Age-standardized SBP
Women, 35-64 yearsWomen, 35-64 years
129
137119
126129
137131
133133
128134
122127
137128
131129
134126
122
100 110 120 130 140 150
Lancet 2000Lancet 2000; ; 355:675-87355:675-87
BEL-GHEBEL-GHECAN-HALCAN-HALCZE-CZECZE-CZEGER-AURGER-AURGER-AUUGER-AUUGER-BREGER-BREGER-EGEGER-EGE
ITA-BRIITA-BRINEZ-AUCNEZ-AUCPOL-TARPOL-TAR
POL-WARPOL-WARRUS-MOCRUS-MOCRUS-MOIRUS-MOIRUS-NOCRUS-NOCRUS-NOIRUS-NOI
UNK-BELUNK-BELUNK-GLAUNK-GLAUSA-STAUSA-STA
YUG-NOSYUG-NOS
MEANMEAN
WHO MONICAWHO MONICASmokersSmokers
Men, 35-64 yearsMen, 35-64 years
36
4923
4129
5860
4247
5254
1734
2645
3524
3932
43
10 15 20 25 30 35 40 45 50 55 60
BEL-GHEBEL-GHECAN-HALCAN-HALCZE-CZECZE-CZEGER-AURGER-AURGER-AUUGER-AUUGER-BREGER-BREGER-EGEGER-EGE
ITA-BRIITA-BRINEZ-AUCNEZ-AUCPOL-TARPOL-TAR
POL-WARPOL-WARRUS-MOCRUS-MOCRUS-MOIRUS-MOIRUS-NOCRUS-NOCRUS-NOIRUS-NOI
UNK-BELUNK-BELUNK-GLAUNK-GLAUSA-STAUSA-STA
YUG-NOSYUG-NOS
MEANMEAN
Lancet 2000Lancet 2000; ; 355:675-87355:675-87
WHO MONICAWHO MONICASmokersSmokers
Women, 35-64 yearsWomen, 35-64 years
21
3019
4125
86
1414
3421
1423
1130
2516
2325
27
0 5 10 15 20 25 30 35 40 45
BEL-GHEBEL-GHECAN-HALCAN-HALCZE-CZECZE-CZEGER-AURGER-AURGER-AUUGER-AUUGER-BREGER-BREGER-EGEGER-EGE
ITA-BRIITA-BRINEZ-AUCNEZ-AUCPOL-TARPOL-TAR
POL-WARPOL-WARRUS-MOCRUS-MOCRUS-MOIRUS-MOIRUS-NOCRUS-NOCRUS-NOIRUS-NOI
UNK-BELUNK-BELUNK-GLAUNK-GLAUSA-STAUSA-STA
YUG-NOSYUG-NOS
MEANMEAN
Lancet 2000Lancet 2000; ; 355:675-87355:675-87
WHO MONICAWHO MONICATotal cholesterolTotal cholesterol
Men, 35-64 yearsMen, 35-64 years
5,8
6,45,4
6,15,9
5,45
5,45,3
5,75,65,7
5,95,8
6,26,2
6,16,2
5,66,2
0 1 2 3 4 5 6 7
BEL-GHEBEL-GHECAN-HALCAN-HALCZE-CZECZE-CZEGER-AURGER-AURGER-AUUGER-AUUGER-BREGER-BREGER-EGEGER-EGE
ITA-BRIITA-BRINEZ-AUCNEZ-AUCPOL-TARPOL-TAR
POL-WARPOL-WARRUS-MOCRUS-MOCRUS-MOIRUS-MOIRUS-NOCRUS-NOCRUS-NOIRUS-NOI
UNK-BELUNK-BELUNK-GLAUNK-GLAUSA-STAUSA-STA
YUG-NOSYUG-NOS
MEANMEAN
Lancet 2000Lancet 2000; ; 355:675-87355:675-87
WHO MONICAWHO MONICATotal cholesterolTotal cholesterolWomen, 35-64 yearsWomen, 35-64 years
5,8
6,25,3
6,15,9
5,45,3
5,55,65,6
5,55,6
5,95,8
6,25,95,9
6,15,8
6
0 1 2 3 4 5 6 7
BEL-GHEBEL-GHECAN-HALCAN-HALCZE-CZECZE-CZEGER-AURGER-AURGER-AUUGER-AUUGER-BREGER-BREGER-EGEGER-EGE
ITA-BRIITA-BRINEZ-AUCNEZ-AUCPOL-TARPOL-TAR
POL-WARPOL-WARRUS-MOCRUS-MOCRUS-MOIRUS-MOIRUS-NOCRUS-NOCRUS-NOIRUS-NOI
UNK-BELUNK-BELUNK-GLAUNK-GLAUSA-STAUSA-STA
YUG-NOSYUG-NOS
MEANMEAN
Lancet 2000Lancet 2000; ; 355:675-87355:675-87
WHO MONICAWHO MONICABMIBMI
Men, 35-64 yearsMen, 35-64 years
26,6
27,326,9
26,826,3
26,125,9
25,625,2
27,125,9
26,726,4
26,926,8
27,127,8
27,627,5
27,1
25 25,5 26 26,5 27 27,5 28
BEL-GHEBEL-GHECAN-HALCAN-HALCZE-CZECZE-CZEGER-AURGER-AURGER-AUUGER-AUUGER-BREGER-BREGER-EGEGER-EGE
ITA-BRIITA-BRINEZ-AUCNEZ-AUCPOL-TARPOL-TAR
POL-WARPOL-WARRUS-MOCRUS-MOCRUS-MOIRUS-MOIRUS-NOCRUS-NOCRUS-NOIRUS-NOI
UNK-BELUNK-BELUNK-GLAUNK-GLAUSA-STAUSA-STA
YUG-NOSYUG-NOS
MEANMEAN
Lancet 2000Lancet 2000; ; 355:675-87355:675-87
WHO MONICAWHO MONICABMIBMI
Women, 35-64 yearsWomen, 35-64 years
26,5
27,826,6
26,925,6
29,328,5
26,326,5
27,528,5
25,625,5
26,426,3
26,526,8
27,827,6
26,1
25 25,5 26 26,5 27 27,5 28 28,5 29 29,5 30
BEL-GHEBEL-GHECAN-HALCAN-HALCZE-CZECZE-CZEGER-AURGER-AURGER-AUUGER-AUUGER-BREGER-BREGER-EGEGER-EGE
ITA-BRIITA-BRINEZ-AUCNEZ-AUCPOL-TARPOL-TAR
POL-WARPOL-WARRUS-MOCRUS-MOCRUS-MOIRUS-MOIRUS-NOCRUS-NOCRUS-NOIRUS-NOI
UNK-BELUNK-BELUNK-GLAUNK-GLAUSA-STAUSA-STA
YUG-NOSYUG-NOS
MEANMEAN
Lancet 2000Lancet 2000; ; 355:675-87355:675-87
ConclusionsConclusions
CVD mortality in all European post-Communist CVD mortality in all European post-Communist
countries is the highest in Europecountries is the highest in Europe..
IIn fact, CVD mortality rates continue to rise in most n fact, CVD mortality rates continue to rise in most
post-Communist countries in Europe except for the post-Communist countries in Europe except for the
Czech Republic, Poland, and Slovenia.Czech Republic, Poland, and Slovenia.
Conclusions, Conclusions, cont’dcont’d
In most of the countries, there is a In most of the countries, there is a lack oflack of recent CVD risk recent CVD risk
factor factor datadata on representative populations. Longitudinal on representative populations. Longitudinal
trends are available only for the Czech Republic, Germany trends are available only for the Czech Republic, Germany
and Lithuania. and Lithuania. Improvement in the CV risk profileImprovement in the CV risk profile was was
seen in the seen in the Czech RepublicCzech Republic (BP, lipids, smoking in males); (BP, lipids, smoking in males);
a smaller improvementa smaller improvement was found was found in Kaunasin Kaunas, mostly , mostly
in females (BP, BMI). Most of the in females (BP, BMI). Most of the major risk factors major risk factors
increased increased slightly slightly in Germanyin Germany over the study period. over the study period.
Conclusions, Conclusions, cont’dcont’d
Therefore, the best comparable data are still provided Therefore, the best comparable data are still provided
by the WHO-coordinated by the WHO-coordinated MONICA studyMONICA study confirming confirming
a a poor CV risk profilepoor CV risk profile in most of the Europeanin most of the European
post-Communist countriespost-Communist countries (particularly for smoking, (particularly for smoking,
BP, and BMI).BP, and BMI).
304 territorial clusters, three-stage stratified sampling procedure304 territorial clusters, three-stage stratified sampling procedure
CV RISK ASSESSMENT CV RISK ASSESSMENT IN POLAND IN 2002IN POLAND IN 2002
DESIGN AND METHODS:DESIGN AND METHODS:
The diagnosis of hypertension was based on three separate visits The diagnosis of hypertension was based on three separate visits (BP>=140/90 mmHg or medication) (BP>=140/90 mmHg or medication)
Response rate for BP and anthropometric measurements 78%,Response rate for BP and anthropometric measurements 78%,for laboratory tests 62% for laboratory tests 62%
BP, BMI, laboratory tests BP, BMI, laboratory tests RepRepresentative sample of 3051 adults in Polandresentative sample of 3051 adults in Poland AAge range18-94 yearsge range18-94 years
95% confidence interval ± 95% confidence interval ± 2%2%
T. Zdrojewski et al.,J Hum Hypertens 2004T. Zdrojewski et al.,J Hum Hypertens 2004;;18:557-6218:557-62
18%
31%
33%
19%
OptimalNormalHigh normalHypertension
Prevalence and control of arterial Prevalence and control of arterial hypertension in Poland (age range 30-70)hypertension in Poland (age range 30-70)
31%
11%
44%
14%
Treated sufficientlyTreated insufficiently Detected, not treatedNot detected
T. Zdrojewski et al., J Hum Hypertens 2004T. Zdrojewski et al., J Hum Hypertens 2004;;18:557-6218:557-62
Gypsies Non-GypsiesGypsies Non-Gypsies ppNumber 156 501 Number 156 501 Response, % 28 53Response, % 28 53
Hypertension 49 43 nsHypertension 49 43 nsUndiagnosedUndiagnosed hypertension 16 23 nshypertension 16 23 nsObesity 65 30 0.0001Obesity 65 30 0.0001Central obesity 38 20 0.04Central obesity 38 20 0.04Metabolic syndrome 20 4 0.0001Metabolic syndrome 20 4 0.0001CVD 35 26 0.04 CVD 35 26 0.04
Age- and sex-adjusted prevalenceAge- and sex-adjusted prevalence
““Manage it well!“ program:Manage it well!“ program:blood pressure control ratesblood pressure control rates
0
20
40
60
80
100
120
overall control systoliccontrol
diastoliccontrol
responders
baseline end of follow-upP
atie
nts
wit
h c
ontr
olle
d B
P (
%)
Pat
ien
ts w
ith
con
trol
led
BP
(%
)
overall control: <140/90 mmHg, systolic control: <140 mmHg, diastolic control: <90 mmHgoverall control: <140/90 mmHg, systolic control: <140 mmHg, diastolic control: <90 mmHgresponders: responders: <<140 or 140 or <<90 mmHg90 mmHg
L. Szirmai, J Hypertens 2005L. Szirmai, J Hypertens 2005;;23:203-21123:203-211
n = 4568n = 4568
Limitations of hypertension studies Limitations of hypertension studies in primary carein primary care
Not dealing with population random samples (involving Not dealing with population random samples (involving mostly individuals with a disease), predominantly elderly mostly individuals with a disease), predominantly elderly populationpopulationss
Most of the studies are based on a questionnaire completed Most of the studies are based on a questionnaire completed by GPs with no review of source databy GPs with no review of source data
No review of patient selection according to the protocolNo review of patient selection according to the protocol