Risk factors for primary nonfatal myocardial infarction in Belgrade population

Uvod: Procenjuje se da ishemijske bolesti srca (IBS) uzrokuju oko 7 miliona smrtnih ishoda godišnje širom sveta. Poslednjih nekoliko decenija mortalitet od IBS opada u mnogim zemljama. Smatra se da su konvencionalni faktori rizika odgovorni za nastanak 75% kardiovaskularnih bolesti (KVB). Samački život je povezan sa povećanim rizikom za nastanak akutnog koronarnog sindroma (AKS) u opštoj populaciji, ali ne postoje konzistentni nalazi kada je u pitanju njegov uticaj na preživljavanje nakon akutnog infarkta miokarda (AIM). Ciljevi: Ispitivanje trendova mortaliteta svih IBS i infarkta miokarda (IM) u populaciji Beograda u dvadesetjednogodišnjem periodu od 1990 do 2010. godine, identifikacija potencijalnih faktora rizika za nastanak akutnog nefatalnog IM, identifikacija faktora koji mogu da preveniraju nastanak ovog oboljenja, analiza trogodišnjeg i petogodišnjeg preživljavanja pacijenata sa AIM u zavisnosti od sprovedenih mera rehabilitacije i dužine boravka u bolnici i procena uticaja samačkog života i drugih faktora na dugoročno preživljavanje pacijenata sa AIM. Materijal i metode: U deskriptivnoj studiji podaci o mortalitetu od svih IBS i IM dobijeni su iz nepublikovanog materijala Gradskog zavoda za statistiku u Beogradu. Podatke o populaciji dobili smo na osnovu projekcija populacije za svaku godinu pojedinačno iz Republičkog zavoda za statistiku. U analizi podataka smo izračunavali specifične stope mortaliteta po uzrastu i polu za IBS i IM, a zatim smo ih standardizovali direktnom metodom koristeći Evropsku populaciju. Joinpoint regresionu analizu smo upotrebili za procenu godišnje procentualne promene (GPP) u mortalitetu i za identifikaciju trenutka u vremenu kada su se odigrale značajne promene u trendu. Studija slučajeva i kontrola je izvedena u Beogradu u periodu od 2002 do 2006. godine. Grupu obolelih od primarnog nefatalnog infarkta miokarda činilo je 154 osoba, uzrasta od 35 do 82 godine, koje su u periodu 2002-2006. godine prvi put hospitalizovane u Urgentnom centru Kliničkog Centra Srbije u Beogradu, u koronarnoj jedinici. Kontrolnu grupu činilo je 308 pacijenata koji su u istom periodu lečeni u Institutu za Reumatologiju, Prvoj hirurškoj klinici i Specijalnoj ortopedskoj bolnici na Banjici. Oboleli i kontrole su individualno mečovani po polu, uzrastu (+/- 2 godine) i mestu stalnog boravka (urbane/ruralne opštine Beograda). 135 pacijenata odabranih u studiji slučajeva i kontrola je dalje praćeno do septembra 2011. godine...Background: Coronary heart disease (CHD) causes an estimated 7 million deaths worldwide each year. In the last few decades, mortality from CHD has been decreasing in many countries. It is estimated that conventional risk factors are responsible for 75% cardiovascular disease (CVD) occurence. Living alone has been associated with higher risk of acute coronary syndrome in general population, but there are no consistent findings about its effect on prognosis after acute myocardial infarction (AMI). Aims: To analyze trends in mortality from coronary heart diseases and myocardial infarction (MI) in Belgrade during the twenty-one-year period from 1990 to 2010, to identify which one among possible risk factors are independently related to first nonfatal MI in our population, to identify potential protective factors for this disease, to analyze three and five years free survival of patients after AMI regarding to rehabilitation programme and duration of hospitalisation and to assess the impact of living alone and other risk factors at baseline on long-term survival after AMI. Material and methods: In descriptive study mortality data for CHD and MI were obtained from the Municipal Institute of Statistics in Belgrade. We used projected Belgrade population figures, which were extracted from unpublished data from the Statistical Office of the Republic of Serbia, as the denominator for each year. In data analysis we calculated age- and sex-specific mortality rates for CHD and MI, and then standardize them using the direct method, according to the European Standard population. Joinpoint regression analysis was used to estimate annual percent changes (APCs) in mortality and to identify points in time where significant changes in trend occur. Case-control study was conducted in Belgrade during the period 2002-2006. Case group comprised of 154 subjects 35-82 years old who were hospitalized because of first nonfatal MI at the Coronary care unit-Clinical Centre of Serbia, Belgrade. Control group consisted of 308 persons chosen among patients treated during the same period at the Institute of Rheumatology, Institute for Gastroenterology, and Clinic for Orthopedics, Belgrade, Serbia. Cases and controls were individually matched by sex, age (+/- 2 years) and place of residence (urban/rural communities of Belgrade). 135 patients recruited in the case-control study were followed until September 2011..

Erratum: Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Interpretation: By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning

Risk factors for primary nonfatal myocardial infarction in Belgrade population

Uvod: Procenjuje se da ishemijske bolesti srca (IBS) uzrokuju oko 7 miliona smrtnih ishoda godišnje širom sveta. Poslednjih nekoliko decenija mortalitet od IBS opada u mnogim zemljama. Smatra se da su konvencionalni faktori rizika odgovorni za nastanak 75% kardiovaskularnih bolesti (KVB). Samački život je povezan sa povećanim rizikom za nastanak akutnog koronarnog sindroma (AKS) u opštoj populaciji, ali ne postoje konzistentni nalazi kada je u pitanju njegov uticaj na preživljavanje nakon akutnog infarkta miokarda (AIM). Ciljevi: Ispitivanje trendova mortaliteta svih IBS i infarkta miokarda (IM) u populaciji Beograda u dvadesetjednogodišnjem periodu od 1990 do 2010. godine, identifikacija potencijalnih faktora rizika za nastanak akutnog nefatalnog IM, identifikacija faktora koji mogu da preveniraju nastanak ovog oboljenja, analiza trogodišnjeg i petogodišnjeg preživljavanja pacijenata sa AIM u zavisnosti od sprovedenih mera rehabilitacije i dužine boravka u bolnici i procena uticaja samačkog života i drugih faktora na dugoročno preživljavanje pacijenata sa AIM. Materijal i metode: U deskriptivnoj studiji podaci o mortalitetu od svih IBS i IM dobijeni su iz nepublikovanog materijala Gradskog zavoda za statistiku u Beogradu. Podatke o populaciji dobili smo na osnovu projekcija populacije za svaku godinu pojedinačno iz Republičkog zavoda za statistiku. U analizi podataka smo izračunavali specifične stope mortaliteta po uzrastu i polu za IBS i IM, a zatim smo ih standardizovali direktnom metodom koristeći Evropsku populaciju. Joinpoint regresionu analizu smo upotrebili za procenu godišnje procentualne promene (GPP) u mortalitetu i za identifikaciju trenutka u vremenu kada su se odigrale značajne promene u trendu. Studija slučajeva i kontrola je izvedena u Beogradu u periodu od 2002 do 2006. godine. Grupu obolelih od primarnog nefatalnog infarkta miokarda činilo je 154 osoba, uzrasta od 35 do 82 godine, koje su u periodu 2002-2006. godine prvi put hospitalizovane u Urgentnom centru Kliničkog Centra Srbije u Beogradu, u koronarnoj jedinici. Kontrolnu grupu činilo je 308 pacijenata koji su u istom periodu lečeni u Institutu za Reumatologiju, Prvoj hirurškoj klinici i Specijalnoj ortopedskoj bolnici na Banjici. Oboleli i kontrole su individualno mečovani po polu, uzrastu (+/- 2 godine) i mestu stalnog boravka (urbane/ruralne opštine Beograda). 135 pacijenata odabranih u studiji slučajeva i kontrola je dalje praćeno do septembra 2011. godine...Background: Coronary heart disease (CHD) causes an estimated 7 million deaths worldwide each year. In the last few decades, mortality from CHD has been decreasing in many countries. It is estimated that conventional risk factors are responsible for 75% cardiovascular disease (CVD) occurence. Living alone has been associated with higher risk of acute coronary syndrome in general population, but there are no consistent findings about its effect on prognosis after acute myocardial infarction (AMI). Aims: To analyze trends in mortality from coronary heart diseases and myocardial infarction (MI) in Belgrade during the twenty-one-year period from 1990 to 2010, to identify which one among possible risk factors are independently related to first nonfatal MI in our population, to identify potential protective factors for this disease, to analyze three and five years free survival of patients after AMI regarding to rehabilitation programme and duration of hospitalisation and to assess the impact of living alone and other risk factors at baseline on long-term survival after AMI. Material and methods: In descriptive study mortality data for CHD and MI were obtained from the Municipal Institute of Statistics in Belgrade. We used projected Belgrade population figures, which were extracted from unpublished data from the Statistical Office of the Republic of Serbia, as the denominator for each year. In data analysis we calculated age- and sex-specific mortality rates for CHD and MI, and then standardize them using the direct method, according to the European Standard population. Joinpoint regression analysis was used to estimate annual percent changes (APCs) in mortality and to identify points in time where significant changes in trend occur. Case-control study was conducted in Belgrade during the period 2002-2006. Case group comprised of 154 subjects 35-82 years old who were hospitalized because of first nonfatal MI at the Coronary care unit-Clinical Centre of Serbia, Belgrade. Control group consisted of 308 persons chosen among patients treated during the same period at the Institute of Rheumatology, Institute for Gastroenterology, and Clinic for Orthopedics, Belgrade, Serbia. Cases and controls were individually matched by sex, age (+/- 2 years) and place of residence (urban/rural communities of Belgrade). 135 patients recruited in the case-control study were followed until September 2011..