Cardiovascular risk prediction in Central and Eastern Europe and former Soviet Union

SCORE scale assesses the risk of fatal atherosclerotic cardiovascular disease (CVD), based on traditional risk factor levels. The high-risk SCORE version is recommended for Central & Eastern Europe/former Soviet Union (CEE/FSU). The aim of the thesis was to evaluate SCORE performance in CEE/FSU, using evidence from two large CEE/FSU studies. These studies – MONICA and HAPIEE – include cohorts from CEE/FSU countries which have relatively high but heterogeneous CVD mortality. MONICA subjects were followed for >=10 years from the mid-1980s. Ongoing HAPIEE follow-up (baseline 2002-2004) allowed preliminary assessment of SCORE performance in contemporary CEE/FSU settings. The present study included Czech, Polish-Warsaw, Polish-Tarnobrzeg, Lithuanian, and Russian MONICA samples (n=15,027), plus Czech, Polish, and Russian HAPIEE samples (n=20,517). Predicted 10-year CVD mortality was calculated with high-risk SCORE; observed mortality data came from local registers. While SCORE calibration was good in most MONICA samples (predicted to observed (P/O) mortality ratios approached 1.0), mortality risk was under-estimated in Russian men and women. In Cox regression analysis, SCORE >=5% significantly predicted 10-year CVD mortality: hazard ratios (HR) ranged from 1.7 to 6.3. The shorter HAPIEE follow-up meant that P/O ratios exceeded 1.0. These ratios were 2-3 times higher in Czech and Polish vs. Russian participants. Estimates of 10-year HAPIEE mortality confirmed this gap between Czech and Polish vs. Russian samples. SCORE significantly predicted CVD mortality in each HAPIEE sample (HR 2.6-10.5). Values of Harrell’s C-statistic, a summary discrimination measure, reached 0.6-0.7 in MONICA and HAPIEE. Adding socioeconomic parameters or alcohol consumption characteristics to the SCORE model failed to improve its predictive performance. High-risk SCORE discrimination was satisfactory in most MONICA and HAPIEE samples, despite risk under-estimation in Russian MONICA. HAPIEE data suggest that in contemporary Czech and Polish populations, high-risk SCORE might over-estimate CVD risk. SCORE extension by additional predictors did not improve its performance

SCORE performance in Central and Eastern Europe and former Soviet Union: MONICA and HAPIEE results

Aims: The Systematic COronary Risk Evaluation (SCORE) scale assesses 10 year risk of fatal atherosclerotic cardiovascular disease (CVD), based on conventional risk factors. The high-risk SCORE version is recommended for Central and Eastern Europe and former Soviet Union (CEE/FSU), but its performance has never been systematically assessed in the region. We evaluated SCORE performance in two sets of population-based CEE/FSU cohorts. Methods and results: The cohorts based on the World Health Organization MONitoring of trends and determinants in CArdiovascular disease (MONICA) surveys in the Czech Republic, Poland (Warsaw and Tarnobrzeg), Lithuania (Kaunas), and Russia (Novosibirsk) were followed from the mid-1980s. The Health, Alcohol, and Psychosocial factors in Eastern Europe (HAPIEE) study follows Czech, Polish (Krakow), and Russian (Novosibirsk) cohorts from 2002–05. In Cox regression analyses, the high-risk SCORE ≥5% at baseline significantly predicted CVD mortality in both MONICA [n = 15 027; hazard ratios (HR), 1.7–6.3] and HAPIEE (n = 20 517; HR, 2.6–10.5) samples. While SCORE calibration was good in most MONICA samples (predicted and observed mortality were close), the risk was underestimated in Russia. In HAPIEE, the high-risk SCORE overpredicted the estimated 10 year mortality for Czech and Polish samples and adequately predicted it for Russia. SCORE discrimination was satisfactory in both MONICA and HAPIEE. Conclusion: The high-risk SCORE underestimated the fatal CVD risk in Russian MONICA but performed well in most MONICA samples and Russian HAPIEE. This SCORE version might overestimate the risk in contemporary Czech and Polish populations

Cross-country evidence on the social determinants of the post-socialist mortality crisis in Europe: a review and performance-based hierarchy of variables.

An unprecedented mortality crisis befell the former socialist countries between 1989 and 1995, representing one of the greatest demographic shocks of the period after the Second World War. While it is likely that country-level variation in the post-socialist mortality crisis in Eastern Europe can be explained by a constellation of political and socio-economic factors, no comprehensive review of the existing scholarly attempts at explaining these factors exists. We review 39 cross-national multi-variable peer reviewed studies of social determinants of mortality in post-socialist Europe in order to assess the social factors behind the post-socialist mortality crisis, determine the gaps in the existing literature and to make suggestions for future research. We propose a novel methodology to determine the relative importance of variables based on the ratio of significant to insignificant findings for each variable. The literature identifies inequality, welfare payments, religious composition, democracy, economic performance and unemployment as the leading factors that have a significant influence on mortality outcomes. Existing cross-country studies fail to establish a definitive connection between mortality and diets, drinking patterns, liberalisation, trust, health expenditure and war. We also point out that the level of analysis is not a neutral methodological choice but might influence the results themselves

Non-fatal injuries in three Central and Eastern European urban population samples: the HAPIEE study

Background: Despite high mortality from injuries and accidents, data on rates and distribution of non-fatal injuries in Central and Eastern European populations are scarce. Methods: Cross-sectional study of random population samples of 45–69-year-old men and women (n = 28 600) from Novosibirsk (Russia), Krakow (Poland) and six Czech towns, participating in the Health, Alcohol and Psychosocial factors In Eastern Europe (HAPIEE) study. Participants provided information on non-fatal injuries in the past 12 months, socio-economic characteristics, alcohol consumption and other covariates. Results: The period prevalence of non-fatal injuries in the last year among Czech, Russian and Polish men was 12.5, 9.4 and 5.3%, respectively; among women, the respective proportions were 9.9, 9.8 and 6.4%. Injury prevalence declined with age in men and increased with age in women. Higher injury prevalence was associated with being unmarried, material deprivation, higher drinking frequency and problem drinking. In the pooled data, the adjusted odds ratio (OR) for the highest versus lowest material deprivation category was 1.57 [95% confidence interval (CI) 1.38–1.79]; for problem drinking, the OR was 1.44 (95% CI 1.23–1.69). Alcohol did not mediate the link between socio-economic status and injury. Conclusion: Non-fatal injuries were associated with material deprivation, other socio-economic characteristics and with alcohol. These results not only underscore the universality of the inequality phenomenon, but also suggest that the mediating role of alcohol in social differentials in non-fatal injury remains an unresolved issue

Alcohol and risk of admission to hospital for unintentional cutting or piercing injuries at home: a population-based case-crossover study

<p>Abstract</p> <p>Background</p> <p>Cutting and piercing injuries are among the leading causes of unintentional injury morbidity in developed countries. In New Zealand, cutting and piercing are second only to falls as the most frequent cause of unintentional home injuries resulting in admissions to hospital among people aged 20 to 64 years. Alcohol intake is known to be associated with many other types of injury. We used a case-crossover study to investigate the role of acute alcohol use (i.e., drinking during the previous 6 h) in unintentional cutting or piercing injuries at home.</p> <p>Methods</p> <p>A population-based case-crossover study was conducted. We identified all people aged 20 to 64 years, resident in one of three regions of the country (Greater Auckland, Waikato and Otago), who were admitted to public hospital within 48 h of an unintentional non-occupational cutting or piercing injury sustained at home (theirs or another's) from August 2008 to December 2009. The main exposure of interest was use of alcohol in the 6-hour period before the injury occurred and the corresponding time intervals 24 h before, and 1 week before, the injury. Other information was collected on known and potential confounders. Information was obtained during face-to-face interviews with cases, and through review of their medical charts.</p> <p>Results</p> <p>Of the 356 participants, 71% were male, and a third sustained injuries from contact with glass. After adjustment for other paired exposures, the odds ratio for injury after consuming 1 to 3 standard drinks of alcohol during the 6-hour period before the injury (compared to the day before), compared to none, was 1.77 (95% confidence interval 0.84 to 3.74), and for four or more drinks was 8.68 (95% confidence interval 3.11 to 24.3). Smokers had higher alcohol-related risks than non-smokers.</p> <p>Conclusions</p> <p>Alcohol consumption increases the odds of unintentional cutting or piercing injury occurring at home and this risk increases with higher levels of drinking.</p

New advances in treating patients with arterial hypertension and diabetes mellitus

The authors present literature review on the important clinical issue – arterial hypertension (AH) management in patients with Type 2 diabetes mellitus (DM-2). In DM-2 individuals, AH prevalence triples, and dangerous combination of AH and DM-2 substantially increases target organ damage (TOD) risk. Analyzing various studies on causes of additional TOD risk increase, the authors conclude that blood pressure control is most important in DM-2 treatment. Clinical importance of antihypertensive agents’ metabolic effects in regard to long-term cardiovascular prognosis is discussed

TOBACCO DEPENDENCE TREATMENT WITH NICOTINE REPLACEMENT THERAPY AS ONE OF THE METHODS FOR CARDIOVASCULAR DISEASE RISK REDUCTION

Aim. To investigate efficacy and safety of nicotine chewing gum and inhaler in individuals trying to quit smoking. To assess expected reduction of cardiovascular disease (CVD) and total mortality relative risks (RR).Material and methods. In this open, parallel study, 169 relatively healthy male smokers aged 18-60 years were randomly assigned to free choice vs admission of Nicorette gum (2/4 mg) or inhaler (10 mg). At baseline, all participants smoked ≥15 cig/d, for ≥3 years. The intervention phase lasted 3 months; follow-up evaluations were made at 3, 6 and 12 months after nicotine replacement therapy (NRT) initiation.Results. Twelve-month results were obtained for 152 subjects (response rate 89.9%). Point prevalence abstinence and reduction (smoking ≤50% of basic daily cigarette amount) rates were 19.7% and 35.5%, respectively. Neither abstinence, nor reduction rates depended on Nicorette form (gum vs inhaler), or on choice vs admission factor. The main predictors of long-term efficacy were nicotine dependence severity and contacts with other smokers.NRT was not associated with negative dynamics in objective health parameters (blood pressure, heart rate, ECG parameters, body weight, and body mass index) or self-evaluation of health. Both Nicorette forms seemed to be safe and well-tolerated.At 12 months, the expected mean RR reduction for CVD mortality reached 19%, for total mortality – 21%.Conclusion. In Russian clinical settings, NRT efficacy and safety are similar to that demonstrated in numerous international trials. NRT can be recommended as one of the methods of assistance to quit smoking and, therefore, for CVD risk reduction.</p

Arterial hypertension: ambulatory patients’ point of view. First results of GARANT Study

Aim. To study patients’ awareness on arterial hypertension (AH), its treatment and prevention, as well as to investigate AH therapy compliance, the GARANT Study (PharmacoepidemioloGy of ARteriAl HyperteNsion in Real-World Ambulatory PracTice) was performed, supported by KRKA company. Material and methods. Doctors and patients from 99 clinics in 63 Russian cities participated in the study. In total, 9214 patients (3189 men, 6025 women; mean age 54,7 years) responded to this doctor-performed survey. Results. AH awareness was high enough, with as many as 86,8% of the patients knowing their blood pressure (BP) level. At the same time, only every third participant knew his or her cholesterol (CH) level. More than 70% of men and 80% of women knew that AH is a risk factor (RF). From the patients’ point of view, AH was the leading RF. Awareness on the other RF was below 33%, with only two exceptions: alcohol (42,2% for men, 35,8% for women) and smoking (38,4% and 30,9%, respectively). Conclusion. While doctors are fully responsible for high BP diagnostics and explanation of pharmaceutical and non-pharmaceutical therapy benefits and risks to their patients, treatment compliance and lifestyle modification should be supported by patients themselves, their families, and society as a whole