Contribution of avoidable causes of death to premature mortality in Poland and selected European countries

Our study, availing the new, agreed by the OECD and Eurostat, lists of preventable and treatable causes of death, seeks to quantify the contribution of avoidable causes to premature mortality and its dynamics in Poland and Central European countries – Czechia, Hungary, Lithuania and Slovenia, in comparison with Sweden serving as a benchmark country in 1999–2017. We calculated age standardised death rates for the broad groups of avoidable causes and more specific ones, which comprised preventable and treatable cancer and diseases of the circulatory system (DCS), preventable injuries and alcohol-related diseases. Deaths from not avoidable causes were also analysed. The analysis of time trends in the death rates and calculation of the Average Annual Percent Change (AAPC) for the overall trend were performed with joint-point models. The contribution of changes in mortality from avoidable causes to increase life expectancy during 1999–2017 and contribution of the difference in mortality from these causes to the difference in life expectancy between five countries and Sweden were based on the decomposition of temporary life expectancy between birth and age 75 [e(0-75)]. For the calculation of life expectancy, we used the classic Chiang method and the decomposition of life expectancy by the death causes and age was conducted with the Arriaga method. The AAPC of death rates from avoidable causes in 1999–2017 was similar in all the countries but Lithuania, where the decline started later. The decline in the death rates from not avoidable causes is much slower than the rates from avoidable causes. Mortality from treatable causes was decreasing faster than from preventable causes in most populations. In 1999–2017, the average rate of mortality decline for preventable cancer was greater among men than among women, while for treatable cancer the sex-related differences were much smaller and in favour of women. As for preventable and treatable death from DCS, their decrease was faster among women than men in all the countries but Sweden. Improvements in mortality from causes that could be avoided through prevention or treatment made substantial positive contributions to the overall change in life expectancy in all the countries. The differences in temporary life expectancy e(0-75) between the analysed Central European countries and Sweden were much smaller in 2017 than in 1999, due to the reduction of the gap in mortality from avoidable causes. Our results show that among men, and to a lesser extent among women, mortality from preventable causes contributes more than mortality from causes that can be effectively treated to shorter life expectancy in the countries of Central Europe than in Sweden. This indicates that in reducing the health gap between the inhabitants of Central Europe and Western Europe, the healthcare system should consider disease prevention even to a greater extent than just treating them

Low-density lipoprotein cholesterol and survival in pulmonary arterial hypertension

Low-density lipoprotein cholesterol(LDL-C) is a well established metabolic marker of cardiovascular risk, however, its role in pulmonary arterial hypertension (PAH) has not been determined. Therefore we assessed whether LDL-C levels are altered in PAH patients, if they are associated with survival in this group and whether pulmonary hypertension (PH) reversal can influence LDL-C levels. Consecutive 46 PAH males and 94 females were age matched with a representative sample of 1168 males and 1245 females, respectively. Cox regression models were used to assess the association between LDL-C and mortality. The effect of PH reversal on LDL-C levels was assessed in 34 patients with chronic thromboembolic pulmonary hypertension (CTEPH) undergoing invasive treatment. LDL-C was lower in both PAH (2.6±0.8mmol/l) and CTEPH (2.7±0.7mmol/l) patients when compared to controls (3.2±1.1mmol/l, p<0.001). In PAH patients lower LDL-C significantly predicted death (HR:0.44/1mmol/l, 95%CI:0.26–0.74, p=0.002) after a median follow-up time of 33(21–36) months. In the CTEPH group, LDL-C increased (from 2.6[2.1–3.2] to 4.0[2.8–4.9]mmol/l, p=0.01) in patients with PH reversal but remained unchanged in other patients (2.4[2.2–2.7] vs 2.3[2.1–2.5]mmol/l, p=0.51). We concluded that LDL-C level is low in patients with PAH and is associated with an increased risk of death. Reversal of PH increases LDL-C levels

Depressive symptoms and cardiovascular diseases in the adult Polish population. Results of the NATPOL2011 study

Background: Poland is a country of high cardiovascular risk. Because depression was found to be a predictor of coronary artery disease and the prevalence of depressive symptoms (DSs) has risen worldwide, their monitoring in the population is desirable. Aims: We sought to evaluate the prevalence of DSs in relation to the socio-demographic status and selected types of cardio­vascular diseases in the adult Polish population. Methods: A country-representative random sample of 2413 subjects, aged 18 to 79 years, was examined in 2011. Rates of self-reported cardiovascular conditions including hypertension (HT), coronary artery disease (CAD), previous myocardial infarction (MI), heart failure, atrial fibrillation (AF), and stroke were assessed by a questionnaire, and the prevalence of DSs was assessed by Beck Depression Inventory (BDI), separately in men and women. DSs were defined as BDI score ≥ 10 points. Results: Depressive symptoms were found in 23.4% of men and 33.4% of women (p &lt; 0.0001). The prevalence of DSs increased with age, from 16.5% in the youngest group of men to 48.3% in the oldest group of women. We found that DSs were significantly more prevalent in subjects suffering from HT, CAD, stroke, AF, and diabetes, and also in women after MI. The rates of DSs in women with a history of MI or stroke were extremely high (76.3% and 83.3%, respectively). Age and primary education level were associated with DSs, as was history of stroke in women. DSs were more often found in older persons and in those with primary level of education. Conclusions: Depressive symptoms were more prevalent in women compared to men, and they were significantly and inde­pendently associated with age and primary education level in both sexes, and with a history of stroke in women

Insufficient knowledge of adults in Poland on criteria of arterial hypertension and its complications — results of the NATPOL 2011 Survey

Wstęp. Nadciśnienie tętnicze (NT) należy do najbardziej rozpowszechnionych czynników ryzyka chorób serca i naczyń. Wśród podstawowych warunków skutecznej prewencji, wykrywania oraz leczenia NT wymienia się odpowiednią wiedzę w populacji generalnej na temat nadciśnienia tętniczego. Celem pracy była ocena świadomości Polaków w zakresie kryteriów i powikłań NT.Materiał i metody. Analizę przeprowadzono na podstawie wyników uzyskanych w programie badawczym NATPOL 2011, w którym badaniami objęto reprezentatywną próbę 2413 losowo wybranych mieszkańców Polski w wieku 18–79 lat [1245 kobiet (K) i 1168 mężczyzn (M)]. Oceniono odpowiedzi udzielone na dwa otwarte pytania na temat kryteriów NT i jego powikłań z uwzględnieniem wieku, płci, wykształcenia i miejsca zamieszkania. Analizę statystyczną przeprowadzono z wykorzystaniem regresji logistycznej wieloczynnikowej. Dla uproszczenia analizy wyników za prawidłowe górne granice ciśnienia tętniczego przyjęto 139–140 mm Hg i 89–90 mm Hg, odpowiednio dla ciśnienia skurczowego (SBP) i rozkurczowego (DBP).Wyniki. Badania wskazują, że w populacji dorosłych Polaków znajomość prawidłowych granic ciśnienia tętniczego jest niewielka. Istnieje duża dysproporcja między deklarowaną a rzeczywistą wiedzą Polaków dotyczącą prawidłowych górnych granic ciśnienia (dla K: 79,4% v. 8,3%; dla M: 74,8 % v. 6,6%). Jedynie 188 badanych (7,8% w tym K = 103 i M = 85) odpowiedziało poprawnie na zadane pytanie, a tylko 3 osoby (0,1%, w tym K = 2 i M = 1) podały w pełni prawidłowe górne wartości ciśnienia (tj. 139 mm Hg dla SBP i 89 mm Hg dla DBP). Wiedza w tym zakresie istotnie zwiększa się wraz z wiekiem (p &lt; 0,002) i poziomem wykształcenia (p &lt; 0,001). Do najczęściej wymienianych przez respondentów powikłań NT należały choroby serca (69,8%) oraz wylew krwi do mózgu lub niedokrwienie mózgu (66%). W małym stopniu znany jest w społeczeństwie związek między nieleczonym NT a chorobami nerek (11%) i uszkodzeniem narządu wzroku (7,7%). Świadomość w przypadku udaru mózgu i chorób nerek istotnie zwiększała się wraz z wiekiem i poziomem wykształcenia.Wnioski. Wiedza Polaków dotycząca kryteriów rozpoznania NT oraz powikłań, jakie może powodować nieleczone NT jest niewystarczająca. Dlatego konieczne jest prowadzenie intensywnych działań edukacyjnych w tym zakresie. Prezentowane w pracy wyniki powinny stanowić wskazówkę do planowania i realizacji tych działań, szczególnie u osób młodych oraz z wykształceniem podstawowym.Background. Arterial hypertension is one of the most widespread cardiovascular disease risk factors. Among the basic conditions of effective prevention, detection and treatment is appropriate knowledge in the general population about hypertension. The purpose of our study was to evaluate knowledge of adults in Poland on criteria and complications of hypertension.Material and methods. The analysis was based on the results obtained in the research program NATPOL 2011. The survey covered a representative sample of adults in Poland: 2413 randomly selected subjects aged 18–79 years [1245 females (F) and 1168 males (M)]. Rated answers to the two open questions on upper limits of normal blood pressure and complications of untreated hypertension were assessed and calculated with regard to age, gender, education and place of residence. Statistical analysis was performed using multivariate logistic regression. To simplify the analysis of results, for upper limits of normal blood pressure were taken: 139–140 mm Hg and 89–90 mm Hg, for systolic and diastolic blood pressure, respectively.Results. Knowledge on hypertension criteria was small. A large disparity between the declared and actual knowledge on correct upper limits of blood pressure (for F: 79.4% vs. 8.3%; for M: 74.8% vs. 6.6%) was found. Only 188 subjects (7.8%; F = 103 and M = 85) answered correctly to the question and in the whole sample only 3 subjects (0.1%; F = 2 and M = 1) reported fully correct values, i.e. 139/89 mm Hg. We observed significant increase of knowledge with age (p &lt; 0.002) and level of education (p &lt; 0.001). Heart disease (69.8%) and stroke (66%) were the most frequently reported complications of untreated hypertension. Only a small percentage of subjects mentioned kidney damage (11%) and blurred vision (7.7%). Awareness on stroke and renal disease significantly increased with age and level of education.Conclusions. Knowledge of adults in Poland on upper limits of normal blood pressure and on complications of un treated hypertension is insufficient. Therefore, it is necessary to conduct intensive education in this field. The results of our study provide guidance for planning and implementation of these activities, which should be led particularly in young people and subjects with primary education

Prevalence of lipid abnormalities in Poland. The NATPOL 2011 survey

Wstęp: Polska ciągle należy do krajów o wysokim ryzyku sercowo-naczyniowym. Zaburzenia lipidowe należą do głównych czynników ryzyka chorób sercowo-naczyniowych. Dotyczy to przede wszystkim stężenia cholesterolu całkowitego (TC) i cholesterolu frakcji liporotein o niskiej gęstości (LDL-C). Dlatego potrzebna jest okresowa ocena występowania dyslipidemii w populacji, by sprawdzić efektywność podejmowanych działań prewencyjnych i terapii. Cel: Celem pracy było zbadanie średniego stężenia lipidów w surowicy krwi oraz ocena częstości występowania, wykrywania i kontroli zaburzeń lipidowych w dorosłej populacji Polski. Metody: Badanie przeprowadzono w reprezentatywnej próbie 1168 mężczyzn (M) i 1245 kobiet (K) w wieku 18–79 lat. W surowicy krwi ozna­czono stężenie TC, cholesterolu o wysokiej gęstości (HDL-C) i triglicerydów (TG). Korzystając z formuły Friedewalda, wyliczono stężenie LDL-C. Wyniki: Średnie stężenie TC u M wynosi 197,1 mg/dl (95% Cl 193,8–200,4), a u K 198,6 mg/dl (195,7–201,5), LDL-C odpowiednio: 123,6 mg/dl (120,9–126,2) i 123,7 mg/dl (121,4–126,1), HDL-C: 45,8 mg/dl (44,7–47,0) i 54,1 mg/dl (53,1–55,1), a TG: 140,9 mg/dl (133,0–148,8) i 104 mg/dl (99,8–108,2). Stężenie TC ≥ 190 mg/dl stwierdzono u 54,3% badanych. Odsetki są podobne dla M (54,3%) i K (54,4%). Biorąc pod uwagę również osoby leczące się z tego powodu, hipercholesterolemia (TC ≥ 190 mg/dl lub terapia statynami) występuje u 61,1% (58,2–63,9%) dorosłych Polaków, w tym u 60,8% M (56,4–65,1%) i 61,3% K (57,4–65,1%). Częstość występowania zwiększonego stężenia LDL-C (≥ 115 mg/dl) wśród wszystkich badanych wynosi 57,8% (M 58,3%; K 57,3%). Stężenie HDL-C &lt; 40 mg/dl zanotowano u 35,2% M, a &lt; 45 mg/dl — u 22,2% K. Hipertriglicerydemia (TG ≥ 150 mg/dl) występuje u 21,1% badanych (M 28,4%; K 14,0%). Nieprawidłowe stężenia TC i LDL-C najczęściej stwierdzano u pacjentów w wieku 40–59 lat. Wśród osób z hipercholesterolemią 58,7% (M 61,5%, K 56,0%) było nieświadomych jej obecności, 22,0% (M 21,0%, K 24,5%) wiedziało o tym, ale się nie leczyło, 8,1% (M 7,7%, K 8,5%) leczyło się, ale nieskutecznie i tylko 10,9% (M 10,7%, K 11,0%) leczyło się skutecznie (TC &lt; 190 mg/dl). Jak wynika z porównań wyników badań NATPOL PLUS (2002) i NATPOL 2011, średnie stężenie TC w populacji zmniejszyło się. Jednak korzystne zmiany stężenia TC i LDL-C dotyczą osób po 60. rż. Wnioski: Wśród dorosłych Polaków w wieku 18–79 lat aż 61% ma hipercholesterolemię. Niepokojące jest, że nieprawidłowe stężenia TC i LDL-C dotyczą szczególnie często osób w średnim wieku, a poprawa pod tym względem w latach 2002–2011 dotyczy pacjentów &gt; 60. rż. Może to wskazywać i wynikać ze wzrostu przyjmowania statyn przez osoby w tym wieku. Prewencja zaburzeń lipidowych, ich wykrywanie i kontrola w Polsce wymagają radykalnej poprawy.Background: Poland represents a country of high cardiovascular (CV) risk. The association between lipid abnormalities and increased CV risk is well established. Therefore, it is important to monitor the prevalence and control of dyslipidaemia. Aim: To evaluate serum lipids concentrations as well as the prevalence, awareness, and control of lipid abnormalities in a representative sample of adults in Poland. Methods: In 2011, in a national cross-sectional survey blood samples were collected from 1168 males and 1245 females, aged 18–79 years, for measurement of total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), and triglycerides (TG) in blood serum. Low density lipoprotein cholesterol (LDL-C) was calculated using Friedewald’s formula. Results: Mean serum TC concentration was 197.1 mg/dL (95% CI 193.8–200.4) in males (M) and 198.6 mg/dL (95% CI 195.7–201.5) in females (F). Levels of LDL-C were 123.6 mg/dL (120.9–126.2) and 123.7 mg/dL (121.4–126.1), HDL-C — 45.8 mg/dL (44.7–47.0) and 54.1 mg/dL (53.1–55.1), TG — 140.9 mg/dL (133.0–148.8) and 104.0 mg/dL (99.8–108.2) for males and females, respectively. TC ≥ 190 mg/dL was found in 54.3% subjects (M 54.3%; F 54.4%). After adding patients on lipid-lowering treatment, hypercholesterolaemia was present in 61.1% of adults (M 60.8%; F 61.3%). LDL-C ≥ 115 mg/dL was detected in 57.8% of all subjects (M 58.3%; F 57.3%), while HDL-C &lt; 40 mg/dL in 35.2% of males and &lt; 45 mg/dL in 22% of females TG ≥ 150 mg/dL was found in 21.1% of subjects (M 28.4%; F 14.0%). The highest prevalence of elevated TC and LDL-C levels was present in the age group of 40–59-year-olds. Of those with hypercholesterolaemia 58.7% (M 61.5%, F 56.0%) were not aware of the condition; 22.0% (M 21.0%, F 24.5%) were aware but were not being treated; 8.1% (M 7.7%, F 8.5%) were treated but with TC ≥ 190 mg/dL; and only 10.9% (M 10.7%, F 11.0%) were being treated with TC &lt; 190 mg/dL. Conclusions: The prevalence of dyslipidaemia in Poland continues to be high — over 60% of adults have hypercholesterolaemia, and control remains poor. The results of the NATPOL 2011 survey call for urgent preventive measures