Socioeconomic status and cardiovascular risk SCORE

  Background: Cardiovascular diseases (CVD) are one of the most frequent causes of morbidity and death both in men and women. The influence of the following factors on the occurrence and progression of atherosclerosis is well known: hyperten­sion, hypercholesterolaemia, tobacco smoking, obesity, diabetes, age, and sex. As well as the typical risk factors of CVD, there is also a significant association between the incidence of those diseases and socioeconomic status (SES). Aim: The aim of this study was to establish the correlation between SES status and CVD risk assessed according to the SCORE algorithm. Methods: The study encompassed 516 participants (207 men and 309 women) aged 40–74 years, who had never been diagnosed with any CVD. The SES was calculated by multiplying the patient’s education and net monthly income. The cor­relation between the SES and SCORE was established using linear and logistic regression analysis. Results: After considering the influence of age, an inverse correlation between the SCORE risk value and the SES index was established, both in the entire group (p = 0.006) and in the men’s group (p = 0.007). In the analysis of individual age subgroups, this correlation was demonstrated in the following groups: 55–59-year-olds (p = 0.011), 60–64-year-olds (p = 0.014), and 65–69-year olds (p = 0.034). A similar relationship was established in men aged 65–69 years (p = 0.038) and women aged 40–44 years (p = 0.003). The logistic regression analysis demonstrated that, after considering the influence of age, the odds of the SCORE risk value being ≥ 10% were becoming smaller along with the increase in the SES index value in the entire group (p = 0.048) and in the men’s group (p = 0.011). The odds ratio (OR) for the SCORE risk value being ≥ 10% depending on the SES index value was OR = 0.978 (95% confidence interval [CI] 0.956–0.999) in the entire group and OR = 0.964 (95% CI 0.938–0.992) in men. Furthermore, we also established that the risk of SCORE ≥ 5% decreased with the increase in the SES index value in the women’s group (OR = 0.970; 95% CI 0.941–0.999; p = 0.042). Conclusions: 1. We demonstrated a statistically significant correlation between the SES and the CVD risk assessed according to the SCORE algorithm. 2. The value of the CVD risk according to SCORE was inversely correlated with SES status.Wstęp: Schorzenia układu sercowo-naczyniowego są jedną z najczęstszych przyczyn zachorowań i umieralności zarówno wśród mężczyzn, jak i kobiet. Dotychczas określono wiele czynników ryzyka związanych z rozwojem schorzeń układu sercowo-naczyniowego. Dobrze znany jest wpływ czynników, takich jak: nadciśnienie tętnicze, hipercholesterolemia, palenie tytoniu, otyłość, cukrzyca, wiek oraz płeć na wystąpienie i progresję miażdżycy. Oprócz klasycznych czynników ryzyka schorzeń układu sercowo-naczyniowego istotny związek z występowaniem schorzeń z tej grupy ma pozycja socjoekonomiczna (SES). Cel: Celem pracy było określenie zależności między SES a ryzykiem sercowo-naczyniowym ocenionym wg algorytmu SCORE. Metody: Badanie jest częścią projektu WOBASZ II, które przeprowadzono w Polsce w latach 2013–2014 w ramach profilaktyki pierwotnej schorzeń układu sercowo-naczyniowego. Analizie poddano dane zebrane w losowej grupie mieszkańców województw: śląskiego, dolnośląskiego i opolskiego. W każdym z województw wylosowano do badania 6 gmin: 2 małe (do 8 tys. mieszkańców), 2 średnie (od 8 do 40 tys.) i 2 duże (od 40 tys.). Następnie w każdej gminie wylosowano 70 mężczyzn i 70 kobiet w wieku 20 i więcej lat. U wszystkich badanych określono pozycję socjoekonomiczną, którą zdefiniowano wg metody zastosowanej w badaniu ATTICA, jako iloczyn wykształcenia i dochodu miesięcznego (netto). Poszczególnym kategoriom zmiennych nadawano odpowiednie wartości liczbowe — wykształcenie: niepełne podstawowe = 1, podstawowe = 2, zasadnicze zawodowe po szkole podstawowej = 3, gimnazjum = 4, zasadnicze zawodowe po gimnazjum = 5, liceum/technikum (średnie) = 6, policealne = 7, licencjat (niepełne wyższe) = 8, wyższe = 9, dochód: ≤ 500 zł = 1, 501–1000 zł = 2, 1001–1500 zł = 3, 1501–2000 zł = 4, 2001–2500 zł = 5, 2501–3000 zł = 6 i > 3001 zł = 7. Iloczyn wykształcenia i dochodu stanowił wynik SES. Grupy SES zostały wyznaczone następująco: niski SES — wskaźnik 18. Wybrana losowo grupa liczyła 884 osoby. Z powyższej grupy wyodrębniono 516 osób (207 mężczyzn i 309 kobiet) w wieku 40–74 lat, u których nie stwierdzono schorzeń układu sercowo-naczyniowego. Określono u nich ryzyko sercowo-naczyniowe na podstawie algorytmu SCORE dla populacji Polski. SES oceniono jako iloczyn wykształcenia i dochodu miesięcznego (netto). Następnie określono związek między SES a SCORE przy użyciu analizy regresji liniowej i logistycznej. Wyniki: Wyniki analizy regresji liniowej wykazały, że po uwzględnieniu wpływu wieku zależność pomiędzy wartością ryzyka SCORE a wskaźnikiem SES została zaobserwowana zarówno w całej badanej grupie (p = 0,006), jak i w grupie mężczyzn (p = 0.007). Analizując poszczególne podgrupy wiekowe całej badanej grupy, zależność ta potwierdziła się w grupach wiekowych: 55–59 lat (p = 0,011), 60–64 lata (p = 0,014) i 65–69 lat (p = 0.034). Podobną zależność stwierdzono w grupie mężczyzn w wieku 65–69 lat (p = 0,038) i kobiet w wieku 40–44 lata (p = 0,003). Wyniki analizy regresji logistycznej wykazały, że po uwzględnieniu wpływu wieku zwiększone ryzyko wystąpienia wartości ryzyka SCORE ≥ 10% w zależności od wartości wskaźnika SES zaobserwowano w całej badanej grupie (p = 0,048) i w grupie mężczyzn (p = 0,011). Szansa wystąpienia wartości ryzyka SCORE ≥ 10% w zależności od wartości wskaźnika SES wyniosła OR = 0,978 (95% CI 0,956–0,999) w całej grupie oraz OR = 0,964 (95% CI 0,938–0,992) wśród mężczyzn. Ponadto stwierdzono zwiększone ryzyko wystąpienia SCORE ≥ 5% w zależności od wartości wskaźnika SES w grupie kobiet bez uwzględnienia wpływu wieku (p = 0,042; OR = 0,970; 95% CI 0,941–0,999). Wnioski: 1. Wykazano istotną statystycznie zależność między pozycją socjoekonomiczną a ryzykiem sercowo-naczyniowym ocenionym wg algorytmu SCORE. 2. Wartość ryzyka sercowo-naczyniowego wg SCORE była odwrotnie związana z pozycją społeczno-ekonomiczną

Metabolic syndrome and its components in Polish women of childbearing age : a nationwide study

Abstract Background Abnormal body mass and related metabolic disorders may affect female reproductive health. The purpose of the study was to determine the prevalence of underweight, overweight, obesity, lipid and glucose metabolism disorders, hypertension, and metabolic syndrome, among Polish women of childbearing age. Methods One thousand five hundred eighty-eight non-pregnant Polish women of childbearing age (20–49 years) who participated in the Multi-Centre National Population Health Examination Survey (WOBASZ II study) in 2013–2014, were assigned to 3 age groups: 20–29 years (n = 403), 30–39 years (n = 600) and 40–49 years (n = 585). Measurements of weight, height, waist circumference, blood pressure, blood lipids, and blood glucose were taken. For statistical analysis, the Kruskal-Wallis, Chi-Square, and Cohran-Armitage tests were used. Results Of the participants, 4.3% were determined to be underweight, 25.2% were overweight, 15% were obese, and 53.1% had abdominal obesity. With age, the prevalence of both excessive body mass and abdominal obesity tended to increase, and that of underweight to decrease. Frequency of hypercholesterolemia and hypertriglyceridemia found in the whole group were 50% and 12.6% respectively, and also tended to rise with age. Low serum HDL-cholesterol (high density lipoprotein cholesterol) levels were found in 15.1% of the participants. Prevalence of impaired fasting glucose in the whole group was 8.2% and tended to increase with age. Diabetes was found in 1.2% of the participants and its prevalence also tended to rise with age, at the borderline of significance. Frequency of arterial hypertension and metabolic syndrome in the whole group was 15.7% and 14.1% respectively and both tended to increase with age. Conclusions Overweight and obesity, especially of abdominal type, and the related metabolic abnormalities are common in Polish women of childbearing age. Their prevalence tends to increase with age. Underweight is relatively common in the youngest age group

Cardiovascular diseases prevention in Poland - results of WOBASZ and WOBASZ II

Background: Cardiovascular diseases are the main cause of morbidity and an important cause of disability and premature death in European countries. Current guidelines recommend prevention delivery by physicians during medical consultations. Aim: We sought to evaluate the prevention support offered by Polish physicians in 2013–2014 compared to 2003–2005, and its determinants. Methods: The data from two population surveys were analysed: WOBASZ (6392 men and 7153 women, aged 20–74 years, screened in 2003–2005) and WOBASZ II (2751 men and 3418 women, aged ≥ 20 years, screened in 2013–2014). For comparison analysis, the population of WOBASZ II was restricted to persons aged 20–74 years. Prevention delivery was assessed using a questionnaire. Results: Overall, 64% of men and 75% of women screened in 2003–2005 consulted their physicians at least once in the preceding year; 10 years later these rates were 70% and 82%, respectively. In both studies, 70% of respondents recalled having received one piece of prevention advice during a medical consultation. One-third of participants neither received any prevention advice nor had their blood pressure or cholesterol level measured. In WOBASZ II we observed a significant increase in the frequency of counselling regarding smoking cessation, nutrition, and increased physical activity, as well as in the frequency of cholesterol measurements, compared to WOBASZ. The prevention support was related to the health status. Conclusions: The prevention support in the years 2013–2014 was better than in 2003–2005, but was still insufficient. About one-third of participants did not receive any preventive advice. The prevention support was offered more often to patients with worse health status

Trends in hypertension prevalence, awareness, treatment, and control among Polish adults 75 years and older during 2007–2014

Background: The aim of this study was to assess changes in the prevalence, awareness, and treatment of hypertension and its effectiveness between 2007 (WOBASZ Senior study) and 2013–2014 (WOBASZ II) in a sample of the Polish population over the age of 75 years. Methods: Sampling had three stages, stratified according to voivodeships, type of community, and gen­der. Finally, the WOBASZ II study included 467 persons (290 women and 177 men). For a comparison of the data, 1096 persons (538 women and 554 men) examined in the WOBASZ Senior study were used. Results: Systolic and diastolic blood pressures significantly decreased from 153.0 ± 23.9 mmHg to 142.9 ± 22.3 mmHg and from 85.2 ± 11.9 mmHg to 78.4 ± 11.3 mmHg, respectively, from 2007 to 2014 (p < 0.0001). Prevalence of hypertension among people included in WOBASZ studies slightly decreased from 83.8% to 77.9% (rate ratio [RR]: 0.95; 95% confidence interval [CI]: 0.78–1.16) in men, and from 75.4% to 71.8% (RR: 0.93; 95% CI: 0.8–1.09) in women. Hypertension awareness was improved from 59.2% to 72.9% (RR: 1.23; 95% CI: 0.97–1.56) in men, and from 74,8% to 93% (RR: 1.26; 95% CI: 1.01–1.58) in women. The proportion of men and women, with implemented hypertension treatment, increased from 48.4% to 61.1% (RR: 1.26; 95% CI: 1.01–1.58), and from 63.2% to 82.0% (RR: 1.3; 95% CI: 1.1–1.53), respectively. The effectiveness of the treatment was improved over two-fold, there was an increase from 10.3% to 26.8% (RR: 2.65; 95% CI: 1.81–3.89) in men, and from 13.8% to 33.5% in women (RR: 2.44; 95% CI: 1.81–3.3). Conclusions: The prevalence of hypertension in Polish seniors remains high, but has decreased slightly in the perspective of the last 7 years. Although treatment and control has improved over the last decade, it remains below expectations. Efforts to improve the diagnosis and effective treatment of hypertension in Polish seniors should be intensified

Prevalence, awareness, treatment and control of hypertension in the adult Polish population : multi-center National Population Health Examination Surveys : WOBASZ studies

Introduction: Hypertension is one of the main risk factors of cardiovascular diseases. The first aim of the study was to evaluate the prevalence, awareness and treatment of hypertension as well as treatment effectiveness (blood pressure < 140/90 mm Hg) in a representative sample of the Polish population over the age of 19, examined in the WOBASZ II program. The second aim was to assess the changes in these parameters between 2003-2005 (WOBASZ study) and 2013-2014 in adults aged 20-74. Material and methods: Sampling was performed in three stages, stratified according to voivodeship (province), type of commune, and gender. Finally, the study included 6163 persons (3406 women and 2757 men) examined in the years 2013-2014 (aged ≥ 19 years). For comparison the data from 14 755 persons (7783 women and 6452 men aged 20-74 years) examined in the years 2003-2005 were used. Results: In the years 2013-2014, the age-standardized prevalence of hypertension, awareness, treatment and control was 42.7%, 59.3%, 46.1%, and 23% respectively. In the last decade an increase in the prevalence of hypertension (relative ratio (RR) 1.12; 95% confidence interval (CI): 1.07- 1.18), treatment (RR = 1.26; 95% CI: 1.17-1.36) and control (RR = 2.16; 95% CI: 1.91-2.45) was found. In contrast, the awareness decreased nonsignificantly (RR = 0.98; 95% CI: 0.92-1.05). Conclusions: The prevalence of hypertension in Poland is high, and increased by about 12% in 10 years. Although the number of treated patients and blood pressure control improved nearly twofold over the last decade, this is still below expectations. Efforts to improve the diagnosis and effective treatment of hypertension in Poland should still be intensifie

Vitamin D – dietary intake, supplementation and metabolic status of Polish adults

ObjectivesContrary to popular opinion on the preventive properties of vitamin D, results of previous studies have been inconclusive. The aim of this research was to evaluate the associations between the intake of vitamin D and metabolic abnormalities in a representative sample of Polish adults.Material and MethodsWithin the framework of the Multi-Center National Population Health Examination Survey (referred to as WOBASZ), a random sample of 2381 adult residents of Poland (53.8% of whom were women) was examined. All the study subjects were extensively reviewed, including 24-h dietary recall. The intake of vitamin D was assessed on the basis of dietary and supplements reviews. Metabolic abnormalities were evaluated using measurements of waist circumference (WC), blood pressure (BP), serum triglycerides (TG), high-density lipoprotein cholesterol (HDL-C) and fasting glycemia. Metabolic syndrome was defined according to the International Diabetes Federation.ResultsOf all the study participants, about 4.4 % of women and 2.6% of men declared a regular supplementation of vitamin D. Among women, a significant inverse correlation between vitamin D supplementation and the mean systolic BP was found (p < 0.01). A more substantial relationship was noted after dividing the study subjects according to their body mass. Among obese men, there was a significant inverse relationship between vitamin D intake and the mean systolic BP (p < 0.01) and diastolic BP (p < 0.05), as well as a positive correlation with HDL-C (p < 0.05). Among obese women, a negative correlation was found between vitamin D supplementation and the mean systolic BP (p < 0.01) and diastolic BP (p < 0.05), and a positive correlation with TG (p < 0.05). Among non-obese male subjects, a negative correlation between vitamin D intake and WC was observed.ConclusionsThe obtained findings suggest that the correlation between vitamin D intake and metabolic abnormalities may depend on the obesity status. A higher vitamin D intake may reduce BP and increase HDL-C in obese subjects. The positive relationship between vitamin D intake and TG concentration in women needs further investigation