Changes in cardiovascular medicines utilization and morbidity and mortality from cardiovascular disease in Lithuania

Cardiovascular disease (CVD) remains a leading cause of mortality globally. The age-SDR for CVD in Lithuania is one of the highest in the European Union. The European Cardiology Society published guidelines for CVD prevention in clinical practice, which described the following main tools for prevention: smoking cessation, adequate physical activity, healthy nutrition and correction of overweight/obesity, adequate arterial blood pressure (BP), blood lipid metabolism and glycaemic control, and stress management. Arterial hypertension (AH) is the main CVD risk factor, requiring timely treatment. The use of cardiovascular medicines (CVM) is widespread and increasing, with the goal of lowering CVD complications and improving patient outcomes. The increasing use of antihypertensive medicines in Lithuania, exceeds that of other countries, but the effects of this increased drug use on the CVD death rate and morbidity have not yet been observed. Administrative databases were created in many of the European countries to collect data regarding the distribution and use of Long-term research on CVM use has not yet been conducted in Lithuania, despite the existence of data regarding reimbursed drugs dating back to the year 2000 (the National Health Insurance Fund [NHIF] database). This research would allow the evaluation of CVM utilization pattern and rationality, its impact on CVD mortality, and provide information on interventional tools to improve CVM use

Širdies ir kraujagyslių sistemą veikiančių vaistų vartojimo ir sergamumo bei mirštamumo nuo šios sistemos ligų kitimai Lietuvoje

Cardiovascular disease (CVD) remains a leading cause of mortality globally. The age-standardized death rate for CVD in Lithuania is one of the highest in the European Union. The decrease in mortality from CVD in Europe is attributed to the correction of risk factors, primarily through active preventive practices and proper treatment. The European Cardiology Society published guidelines for CVD prevention in clinical practice, which described the following main tools for prevention: smoking cessation, adequate physical activity, healthy nutrition and correction of overweight/obesity, adequate arterial blood pressure (BP), blood lipid metabolism and glycaemic control, and stress management. Arterial hypertension (AH) is the main CVD risk factor, requiring timely treatment. The use of cardiovascular medicines (CVM) is widespread and increasing, with the goal of lowering CVD complications and improving patient outcomes. The increasing use of CVM and treatment for CVD complications contributes to the increasing costs of treatment. The increasing use of antihypertensive medicines in Lithuania exceeds that of other countries, but the effects of this increased drug use on the CVD death rate and morbidity have not yet been observed. Long-term research on CVM use has not yet been conducted in Lithuania, despite the existence of data regarding reimbursed drugs dating back to the year 2000 (the National Health Insurance Fund [NHIF] database). This research would allow the evaluation of CVM utilization pattern and rationality, its impact on CVD mortality, and provide information on interventional tools to improve CVM use

Utilization of cardiovascular medicines and cardiovascular mortality in Lithuania, Sweden and Norway in 2003–2012

Objective: The aim of this ecological study was to evaluate whether any changes in cardio-vascular (CV) medicine utilization, population, socioeconomic and health system factors were associated with CV mortality in Lithuania, Sweden and Norway in 2003–2012.Materials and methods: CV drug utilization was calculated using the Anatomical Therapeutic Chemical/Defined Daily Dose (DDD) methodology and expressed as a number of DDD per 1000 inhabitants per day (DDD/TID). The CV age-standardized death rate (CV-SDR) and risk factors data were obtained from the WHO, EUROSTAT, and FAOSTAT databases. The multiple linear regression model was used for modeling outcome measures - the relationship between the CV-SDR and CV medicine utilization including socioeconomic (GDP, unemployment and divorce rate), population (alcohol consumption, smoking and amount of kcal per day, consumption of fruit and vegetables, health status self-evaluation) and health system factors (number of hospital beds, practicing physicians and health care expenditure).Results: The higher CV medicine utilization in Sweden (307–455 DDD/TID, P < 0.001) and Norway (306–394 DDD/TID, P < 0.001) was associated with a definite decline in CV-SDR (in Norway from 215 to 146 and in Sweden from 233 to 174). In Lithuania, the increasing but lower consumption of CV medicines (135–360 DDD/TID, P < 0.001) and twice higher CV-SDR (from 541 to 447) was registered. A significant inverse correlation was observed between CVSDR and DDD/TID. We found a strong association between the DDD/TID and the CV-SDR (R2 = 0.67, P < 0.001). There was a strong correlation between CV-SDR and nine factors (P < 0.05), except the number of practicing physicians, amount of kcal per day. There was a strong correlation between DDD/TID and nine factors (P < 0.05), except the unemployment rate and amount of kcal per day. Association between an increase in the use of medicines and a decrease in CV-SDR was stronger in the case of higher alcohol consumption, higher number of available beds in hospitals and the lower unemployment rate.Conclusions: We confirmed the strong negative correlation between CV medicine utilization and CV mortality in all countries. The strong correlation was found between CV-SDR and nine factors, also between the use of CV medicines and nine factors. The impact of factors on the medicines induced decrease in CV-SDR showed the stronger influence in case of lower unemployment, higher alcohol consumption and higher number of beds for hospitalization

Two Dog-Related Infections Leading to Death: Overwhelming Capnocytophaga canimorsus Sepsis in a Patient With Cystic Echinococcosis

Capnocytophaga canimorsus is a fastidious, capnophilic, fusiform, and filamentous gram-negative rod. It is part of the normal oral flora of dogs and cats and can cause an infection in humans, but is of generally low virulence in healthy individuals. A case of fatal sepsis due to Capnocytophaga canimorsus in a 46-year-old woman with clinically silent cystic echinococcosis discovered postmortem is present. She had been bitten by a dog 3 days before the symptoms appeared. The family had owned the dog for 4 years. A preliminary diagnosis of septic shock of unknown etiology with multisystem organ failure was established. Despite all the efforts, the patient died on the seventh day of hospitalization. Laboratory findings received postmortem showed Capnocytophaga canimorsus isolated from the blood culture after 7 incubation days. Autopsy showed a cyst in the liver with a fibrotic wall and necrotic eosinophilic interiors containing fragments of Echinococcus granulosus scolices. In conclusion, an interaction possibly established long ago between the host and Echinococcus granulosus conditioned immunosuppression mechanisms developed by the parasite in this case, which can explain such an aggressive course of the infection with Capnocytophaga. Two dog-related infections were fatal in the middle-aged dog owner considered healthy before this hospitalization. Vigilance concerning recent exposure to dogs or cats and potential immunosuppression risk factors must be maintained in a patient presenting with clinical features of fulminant sepsis

Evaluation of antihypertensive medications use and survival in patients with ovarian cancer: a population-based retrospective cohort study

Abstract Background Despite declining mortality in most countries and in Lithuania, ovarian cancer burden has remained high. Studies have indicated that antihypertensive medications use may help to improve ovarian cancer survival, however findings remain controversial. The aim of the study was to analyse the association between post-diagnosis antihypertensive medications intake and cancer-specific survival in ovarian cancer patients. Methods This retrospective cohort study included 588 ovarian cancer cases diagnosed between 2013 and 2015. Hazard ratios (HR) and corresponding 95% confidence intervals (95%CI) were estimated using multivariable Cox proportional hazards models to assess associations between antihypertensive medications and ovarian cancer-specific mortality. Results In total, 279 (47%) patients died during the follow-up; 242 (87%) of them died due to ovarian cancer. The risk of ovarian cancer death was reduced in angiotensin-converting enzyme inhibitors (ACE inhibitors) users vs. non-users (HR 0.55, 95% CI: 0.36–0.83). Subgroup analysis showed better ovarian cancer survival in higher dose ACE inhibitors users (HR 0.46, 95% CI: 0.28–0.77, p for trend 0.002); the effect was also stronger in age 51–65 years, stage I–III, surgery or chemotherapy treatment, pre-diagnosis ACE inhibitor users’ and pre-diagnosis hypertension subgroups. The risk of cancer-specific death was slightly lower among calcium-channel blocker and angiotensin-receptor blocker users and higher among beta-blocker users as compared to non-users, however chance and confounding could not be ruled out. We found no association between the use of centrally and peripherally acting antiadrenergic agents and diuretics and risk of ovarian cancer-specific mortality. Conclusions Our findings imply that post-diagnosis use of ACE inhibitors may be associated with reduced ovarian cancer-specific mortality; however, further research is needed for the comprehensive assessment

Role of fat-free mass index on amino acid loss during CRRT in critically Ill patients

Background and objectives: Amino acid (AA) loss is a prevalent unwanted effect of continuous renal replacement therapy (CRRT) in critical care patients, determined both by the machine set-up and individual characteristics. The aim of this study was to evaluate the bioelectrical impedance analysis-derived fat-free mass index (FFMI) effect on amino acid loss. Materials and methods: This was a prospective, observational, single sample study of critical care patients upon initiation of CRRT. AA loss during a 24 h period was estimated. Conventional determinants of AA loss (type and dose of CRRT, concentration of AA) and FFMI were entered into the multivariate regression analysis to determine the individual predictive value. Results: Fifty-two patients were included in the study. The average age was 66.06 ± 13.60 years; most patients had a high mortality risk with APAHCE II values of 22.92 ± 8.15 and SOFA values of 12.11 ± 3.60. Mean AA loss in 24 h was 14.73 ± 9.83 g. There was a significant correlation between the lost AA and FFMI (R = 0.445, B = 0.445 CI95%: 0.541–1.793 p = 0.02). Multivariate regression analysis revealed the independent predictors of lost AA to be the systemic concentration of AA (B = 6.99 95% CI:4.96–9.04 p = 0.001), dose of CRRT (B = 0.48 95% CI:0.27–0.70 p < 0.001) and FFMI (B = 0.91 95% CI:0.42–1.41 p < 0.001). The type of CRRT was eliminated in the final model due to co-linearity with the dose of CRRT. Conclusions: A substantial amount of AA is lost during CRRT. The amount lost is increased by the conventional factors as well as by higher FFMI. Insights from our study highlight the FFMI as a novel research object during CRRT, both when prescribing the dosage and evaluating the nutritional support needed

Primary prevention strategy for cardiovascular disease in Lithuania

Cardiovascular diseases are the main cause of premature death worldwide. More than half of deaths were caused by cardiovascular diseases in 2017 in Lithuania. Primary prevention programmes encourage both medical staff and general population to pay attention to potential health issues as well as attempt to eradicate risk factors causing cardiovascular diseases. “A Funding Programme for the Screening and Preventive Management of the High Cardiovascular Risk Individuals” published in Lithuania has been implemented as of 2006. Analysis of the results of the programme shows that the prevalent cases of arterial hypertension are gradually declining. However, the prevalence of dyslipidaemia is still not decreasing. The prevalence of other modifiable cardiovascular disease risk factors has erratic trends with a slight overall decline. Consequently, mortality rate of cardiovascular diseases has decreased by more than one third among middle-age population over the past 10 years. Having higher availability of the anti-hypertensive and anti-lipid medications already achieved, the future plans include the aim of further reducing elevated blood pressure and effectively treating dyslipidaemia. In order to implement a strategy that focuses on smoking prevention, promotion of healthy nutrition and physical activity, a significant contribution is required from the state authorities