The aim of this study was to determine in Karlovac (southern part of central Croatia)
the most important risk factors for coronary heart diseases in men and women according
to age 59 and 60 on the basis of their prevalence in 558 non-coronary patients and
442 symptomatic coronary patients. In younger male coronary patients (59 years of
age) in relation to the control study, the statistically significant more frequent risk factors
were hypercholesterolemia (p<0.001), smoking (p<0.01) and diabetes (p<0.01). In
older male patients (60 years of age) there was no statistically significant difference in
a single risk factor. In younger female coronary patients, the statistically significant
more frequent risk factors were hypercholesterolemia (p<0.001) and diabetes (p<0.001)
and in older female patients diabetes (p<0.05). This population sample showed higher
prevalence of cardiovascular risk factors in younger coronary patients. The most frequent
risk factors were diabetes, hypercholesterolemia and smoking. The difference is
slighter in older coronary patients where it is diabetes, which is the most important for
women

Davor Horvat

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Coll. Antropol. 27 (2003) 2: 541–546UDC 616.1-056(497.5)Original scientific paperCardiovascular Risk Factors ina Small Urban Community inCentral CroatiaDavor HorvatDepartment of Internal Diseases, General Hospital »Karlovac«, Karlovac, CroatiaA B S T R A C TThe aim of this study was to determine in Karlovac (southern part of central Croatia)the most important risk factors for coronary heart diseases in men and women accord-ing to age 59 and 60 on the basis of their prevalence in 558 non-coronary patients and442 symptomatic coronary patients. In younger male coronary patients (59 years ofage) in relation to the control study, the statistically significant more frequent risk fac-tors were hypercholesterolemia (p<0.001), smoking (p<0.01) and diabetes (p<0.01). Inolder male patients (60 years of age) there was no statistically significant difference ina single risk factor. In younger female coronary patients, the statistically significantmore frequent risk factors were hypercholesterolemia (p<0.001) and diabetes (p<0.001)and in older female patients diabetes (p<0.05). This population sample showed higherprevalence of cardiovascular risk factors in younger coronary patients. The most fre-quent risk factors were diabetes, hypercholesterolemia and smoking. The difference isslighter in older coronary patients where it is diabetes, which is the most important forwomen.Key words: coronary disease, risk factors, age distribution, sex distribution,CroatiaIntroductionToday’s attitudes show consistentlyhigher prevalence of standard risk factors(hypertension, hypercholesterolemia, obe-sity, smoking, positive family anamnesisand diabetes) in patients suffering fromcoronary heart diseases (CHD) (anginapectoris and myocardial infarction) thanin the control study1. The estimates showthat the significance of an individual riskfactor is considerably less if it occurs in-541Received for publication November 25, 2002dependently than if a patient suffers frommore of them simultaneously2. Preven-tive measures around the world should beaimed at those always the same risk fac-tors and the intervention should be glo-bal. However, one poses the question ifsome of the risk factors are more frequentand more important for development ofcoronary heart diseases depending on so-me regional, cultural and economical con-ditions3. The World Health Organizationestimates that in 1996 heart and vascu-lar diseases caused the death of 15 mil-lion people with 30% of the world’s mor-tality. In Croatia the situation is evenworse: the rate of cardiovascular mortal-ity increased from 387.7 per 100,000 peo-ple in 1971 to 533.3 in 1996. Moreover,the portion of total mortality in the sameperiod increased from 37.9% to 50.4%4. Inthe last 30 years one can notice the fall ofcardiovascular mortality in developedcountries and the rise of mortality in de-veloping countries in transition. A globalstrategy of prevention requires good know-ledge of the roles of certain cardiovascu-lar risk factors in different parts of theworld and in certain ethnic groups be-cause there are some indications that theirinfluence is regionally different5. The aimof this study is to determine for Karlovac(southern part of central Croatia) womenaccording to age 59 and 60 on the basisof their prevalence in 558 non-coronarypatients and 442 symptomatic coronarypatients.Subjects and MethodsA retrospective research will includethe study of pairs (case-control study)and the patterns will be independent andstratified according to distinguishing cri-teria. The study will include the patientswho were hospitalized in the Departmentof Cardiology of the General hospitalKarlovac, Karlovac, Croatia from 1998 to2001 and who have all necessary dataabout all risk factors for cardiovasculardisease. The case study will include allconsecutive symptomatic (chest pain) cor-onary patients (stable and non stable an-gina pectoris as well as acute myocardialinfarction with and without ST elevation)who were hospitalized for the first time.The control study will include all otherpatients without coronary heart diseases.The patients will be classified accordingto age 59 and 60). Cardiovascular riskfactors, which will be researched, will bepositive family anamnesis (coronary heartdiseases in parents, brothers, sisters andchildren), obesity (BMI>25 m/kg2), exist-ing type 2 diabetes, hypertension (exist-ing >140/90 mmHg or drug treated), hy-percholesterolemia (total cholesterolmeasured within 24 hours upon patients'arrival in hospital) and smoking morecigarettes a day (acute smokers and thosewho stopped smoking within 5 years willbe included). As far as statistical methodsare concerned, Chi- square analysis ofsmall independent samples with Fisher’stest as well as the test of proportions (z)for independent samples will be used.ResultsConcerning the control study, therewere 771 non-coronary patients who weretaken into consideration. However, 558patients satisfied the criteria of the studyand 213 patients were taken into consid-eration. However, 442 patients satisfiedthe criteria of the study and 184 patientswere excluded from the study.The study showed that in coronary pa-tients the statistically significant morefrequent risk factors were hypercholes-terolemia (z=5.07; p<0.001), smoking (z=2.21; p<0.01) and diabetes (z=2.1; p<0.01).Concerning other risk factors, there wasno statistically significant difference be-tween coronary and non-coronary patients(Table 1).542D. Horvat: Cardiovascular Risk Factors in CHD, Coll. Antropol. 27 (2003) 2: 541–546In coronary patients the statisticallysignificant more frequent risk factors we-re hypercholesterolemia (z=4.67; p<0.001and diabetes (z=2.62; p<0.001). In otherpatients there was no statistically signifi-cant difference between these two groups(Table 2).There was no statistically significantdifference concerning the risk factors be-tween older male patients (Table 3).In older female patients there was nostatistically significant difference concer-ning the risk factors except for diabetes(z=1.76; p<0.05) (Table 4).543D. Horvat: Cardiovascular Risk Factors in CHD, Coll. Antropol. 27 (2003) 2: 541–546TABLE 1MALE PATIENTS 59 YEARS OF AGERisk factorsNon-coronary CoronaryN % N % z pHypertension 81 63.78 51 58.62 0.75 nsHypercholesterolemia 71 55.91 77 88.51 5.07 0.001Obesity 94 74.02 61 70.11 0.63 nsSmoking 52 40.94 49 56.32 2.21 0.01Family history 46 36.22 40 45.98 1.43 nsDiabetes 11 8.66 16 18.39 2.1 0.01Total 127 100.00 87 100.00TABLE 2FEMALE PATIENTS 59 YEARS OF AGERisk factors Non-coronary CoronaryN % N % z pHypertension 92 75.41 27 79.41 0.48 nsHypercholesterolemia 25 20.49 21 61.76 4.67 0.001Obesity 96 78.69 29 85.29 0.85 nsSmoking 31 25.41 9 26.47 0.12 nsFamily history 51 41.80 16 47.06 0.55 nsDiabetes 16 13.11 11 32.35 2.62 0.001Total 122 100.00 34 100.00TABLE 3MALE PATIENTS 60 YEARS OF AGERisk factors Non-coronary CoronaryN % N % z pHypertension 81 61.83 118 57.84 0.72 nsHypercholesterolemia 64 48.85 96 47.06 0.32 nsObesity 76 58.02 128 62.75 0.87 nsSmoking 27 20.61 41 20.10 0.11 nsFamily history 47 35.88 66 32.35 0.67 nsDiabetes 23 17.56 37 18.14 0.13 nsTotal 131 100.00 204 100.00DiscussionThis study showed greater difference,that is to say, higher frequency of risk fac-tors for coronary heart diseases in youn-ger patients. The most important riskfactors were diabetes, hypercholesterol-emia and smoking. In younger male coro-nary patients (59 years of age) in rela-tion to the control study, the statisticallysignificant more frequent risk factors we-re hypercholesterolemia (p<0.001), smok-ing (p<0.01) and diabetes (p<0.01) (Table1). In older male patients (60 years ofage) there was no statistically significantdifference in a single risk factor (Table 2).In younger female coronary patients, thestatistically significant more frequent riskfactors were hypercholesterolemia (p<0.001) and diabetes (p<0.001) (Table 3)and in older female patients diabetes (p<0.05) (Table 4). The results on smoking inyounger male coronary patients are in ac-cordance with the published results ofother studies which point out that smok-ing is a habit which is especially frequentin younger male coronary patients. Re-searches into heart and vascular diseasesin Croatia in patients suffering from acutemyocardial infarction less than 45 yearsof age have revealed the prevalence ofsmoking 80.5% in relation to 41.4% inolder patients6. The data on today’s post-war Croatian population reveal thatthere are about 31.4% male smokers and26.6% female smokers in Croatia3,7. Thereare 1.1 billion smokers in the worldtoday4. It is well known that mental stresscan have an effect upon smoking as aform of risky behaviour7. Great preva-lence of smoking in young male popula-tion in the researched area (for non-coro-nary patients 40.9% and coronary pa-tients 56.3%) can be justified by men’smore active role in the war and by greaterexposure to postwar health and socialproblems in relation to other Croatian re-gions, which were less affected by thewar. According to numerous studies, thelevel of cholesterol in blood along withage is the main predicable value for de-velopment of coronary heart diseases8,9.This study also showed significant influ-ence of hypercholesterolemia upon devel-opment of coronary heart diseases inyounger male and female patients. Theseresults reveal still inadequate diagnosisand treatment of hypercholesterolemia inthe researched area. A special problem,which is often associated with obesity, isdiabetes, especially its more frequent formindependent of insulin5,10. Anamnesticdata on diabetes tripled the risk of acutemyocardial infarction in INTER-HEARTstudy: OR 3.02 with 99% Cl 2.66–3.431.The results of this study also revealed asignificant frequency of diabetes in youn-ger male coronary patients and in bothage groups of female coronary patients.This is also in accordance with today’s re-544D. Horvat: Cardiovascular Risk Factors in CHD, Coll. Antropol. 27 (2003) 2: 541–546TABLE 4FEMALE PATIENTS 60 YEARS OF AGERisk factors Non-coronary CoronaryN % N % z pHypertension 145 81.46 91 77.78 0.77 nsHypercholesterolemia 110 61.80 68 58.12 0.63 nsObesity 138 77.53 88 75.21 0.46 nsSmoking 20 11.24 11 9.40 0.5 nsFamily history 78 43.82 61 52.14 1.4 nsDiabetes 51 28.65 45 38.46 1.76 0.05Total 178 100.00 117 100.00sult, which shows that diabetes is a moreimportant risk factor in women than inmen5. Hypertension was also greatly fre-quent in the control study, which can beexplained by the fact that the patientswere selected in the Department of Car-diology where a great number of patientsare treated due to hypertension. The dataof INTER-HEART study reveal that BMI> 30 kg/m2 increases the risk of acutemyocardial infarction for 23%1. The re-sults in this study did not verify statisti-cally significant frequency of obesity inany group of coronary patients. This canalso be explained by less specific data onobesity because over well-fed patients we-re also taken into consideration (BMI>25kg/m2) causing thus great prevalence ofthe obese even in the control study. Thepossible shortcoming of this study is en-closure of positive family anamnesiswithout limitations to the age of the rela-tives. Future researches should also takethese facts in to consideration. Accordingto the results of this study, in Karlovacyounger male population should be war-ned about diabetes, smoking and hyper-cholesterolemia, younger female popula-tion about hypercholesterolemia and diabe-tes and older female population should bewarned about diabetes as the risk factorswhich are the most important factors fordevelopment of coronary heart diseasesin these groups. For this purpose ade-quate preventive measures and diagnos-tic and therapy treatments should be im-plemented thus reducing influence ofthese risk factors. This study revealedgreater prevalence of cardiovascular riskfactors in younger coronary patients. Themost frequent risk factors were diabetes,hypercholesterolemia and smoking. Thedifference is slighter in older coronary pa-tients where it is diabetes, which is im-portant for women. Importance of indi-vidual risk factors is more expressed inyounger patients while in older patientsthere is identical incidence in both coro-nary and non-coronary patients.R E F E R E N C E S1. INTER-HEART PROJECT OFFICE STAFF,Am. Heart J., 141 (2001) 711. — 2. LUEPKER, R. V.,L. RASTAM, P. J. HANNAN, D. M. MURRAY, C.GRAY, W. L. BAKER, R. CROW, D. R. JACOBS, P. L.PIRIE, S. R. MASCIOLO, M. B. MITTELMARK, H.BLACKBURN, Am. J. Epidemiol., 144 (1996) 351. —3. RUMBOLDT, Z., M. RUMBOLDT, Lije~ni~ki vijes-nik, 124 Suppl. 3 (2002) 19. — 4. LJUBI^I], M., V.HRABAK @ERJAVI]: Promicanje zdravlja u hrvat-skom pu~anstvu. (HZZJZ, Zagreb, 1999). — 5. YU-SUF, S., S. REDDY, S. OUNPUU, S. ANAND, Circu-lation, 104 (2001) 2746. — 6. RUMBOLDT, Z., M.RUMBOLDT, Eur. Heart J., 19 (1998) 1410. — 7.KRANTZ, D. S., D. S. SHEPS, R. M. CARNEY, B. H.NATELSON, JAMA, 283 (2000) 1800. — 8. HIG-GINS, M., W. KANNEL, R. GARRISON, J. PINSKY,J. STROKES, Acta Med. Scand., 723 Suppl. (1988)23. — 9. STAMLER, J., M. L. DAVIGLUS, D. B. GAR-SIDE, A. R. DYER, P. GREENLAND, J. D. NEATON,JAMA, 284 (2000) 311. — 10. DONATO, K., WHLNewsletter, 81 (2002) 1.D. HorvatDepartment of Internal Diseases, General Hospital »Karlovac«, Andrije [tampara 3,47000 Karlovac, Croatia545D. Horvat: Cardiovascular Risk Factors in CHD, Coll. Antropol. 27 (2003) 2: 541–546^IMBENICI RIZIKA ZA RAZVOJ KARDIOVASKULARNIH BOLESTIU STANOVNI[TVU MALE URBANE ZAJEDNICE U SREDI[NJOJHRVATSKOJS A @ E T A KCilj istra`ivanja bio je odrediti na karlova~kom podru~ju (ju`ni dio sredi{nje Hrvat-ske) najva`nije kardiovaskularne ~imbenike rizika koronarne bolesti srca kod mu{ka-raca i `ena prema dobi 59 godina i 60 godina na temelju usporedbe njihove prevalen-cije kod 558 nekoronarnih bolesnika i 442 simptomatska koronarna bolesnika. U mla-|oj mu{koj populaciji koronarnih bolesnika (59 godina) statisti~ki zna~ajno u~estalijifaktori rizika u odnosu na kontrolnu skupinu su bili hiperkolesterolemija (p<0,001),pu{enje (p<0,01) i dijabetes (p<0,01), a u starijoj (60 godina) nije bilo statisti~ki zna-~ajne razlike ni u jednom ~imbeniku rizika. U mla|oj `enskoj populaciji koronarnihbolesnika statisti~ki je zna~ajno ~e{}i ~imbenik rizika bio hiperkolesterolemija (p<0,001) i dijabetes (p<0,001), a u starijoj populaciji dijabetes (p<0,05). Ovaj populacijskiuzorak je pokazao ve}u prevalenciju kardiovaskularnih ~imbenika rizika u mla|oj po-pulaciji koronarnih bolesnika, a najve}i su ~imbenici rizika dijabetes, hiperkolestero-lemija i pu{enje. Manja je razlika u prevalenciji kod starijih koronarnih bolesnika gdjeje za `ene najva`niji dijabetes.546D. Horvat: Cardiovascular Risk Factors in CHD, Coll. Antropol. 27 (2003) 2: 541–546

Cardiovascular Risk Factors in a Small Urban Community in Central Croatia

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