[The effect of risk factors on development of myocardial infarction among professional drivers in Kaunas]. / Vliianie nekotorykh faktorov riska na vozniknovenie infarkta miokarda u voditelei-professionalov Kaunasa.

We investigated effect of risk factors on elevated first myocardial infarction risk among professional drivers. We carried out case-control study among men aged 25-64 years in Kaunas in 1997-2000. We identified myocardial infarction cases (n=448) from the myocardial infarction hospital register (International Classification of Diseases, 10-th revision, code 121). Controls (n=1777) were selected on the basis of age, gender and city district of residence. We obtained information on sociodemographic, psychosocial and behavioral factors. We used the International Standard Classification of Occupations (ISCO) to code for occupations and conducted logistic regression analysis to evaluate association of risk factors with myocardial infarction in professional drivers. Compared with other occupations being a professional driver was associated with increased risk of first myocardial infarction with odds ratio (OR) adjusted for smoking, hypertension, presence of stress, obesity and educational status 1.42 and 95% confidence intervals (CI) 1.06-1.90. However additional adjustment for exposure to occupational vibration for 20 years or more eliminated effect of this occupation (OR 0.96, 95%CI 0.67-1.37). Among drivers exposure to occupational vibration for > or =20 years was most closely related to myocardial infarction (OR 3.01, 95% CI 1.54-5.89), while hypertension was associated with OR 2.80 (95% CI 1.58-4.96).

Epidemiology of stroke in Kaunas, Lithuania. First results from the Kaunas Stroke Register.

BACKGROUND AND PURPOSE: In Lithuania, only routine mortality statistics have thus far provided data on the epidemiology of stroke. This study aims to assess the mortality, incidence, and case-fatality rate of stroke in the city of Kaunas, Lithuania, during 1986 to 1988. METHODS: A community-based stroke register was set up in 1986 to collect data on all suspected events of acute stroke that occurred in the population aged 35 to 64 years permanently residing in Kaunas. Crude and age-standardized attack rates, incidence, mortality, and case-fatality rates were calculated for the period studied. RESULTS: Among men, the average age-standardized incidence of stroke (referring to first-ever events) was 230/100,000, the attack rate (all events) was 300/100,000, and the mortality from all strokes was 68/100,000. Among women, the corresponding rates were 131/100,000, 154/100,000, and 35/100,000, respectively. Of 973 acute stroke events registered, 80% were first-ever strokes. The age-adjusted 28-day overall case-fatality rate and the case-fatality rate of first-ever stroke were 23.3% and 19.8% in men and 21.8% and 21.3% in women, respectively. CONCLUSIONS: The findings from this first assessment of the incidence and mortality of stroke show that in the mid-1980s both were high in Kaunas compared with other countries. The case-fatality rate was similar to that reported for most other European countries. Further investigations are being carried out to assess the trends in mortality, incidence, and risk factors of stroke in the Kaunas population.

Comparison of trends in ischaemic heart disease between North Karelia, Finland, and Kaunas, Lithuania, from 1971 to 1987.

OBJECTIVE: To compare the long-term trends in mortality and attack rate of ischaemic heart disease in North Karelia, Finland, and in Kaunas, Lithuania, from 1971 to 1987. DESIGN: Data on routine mortality statistics were obtained from the Central Statistical Office of Finland and from the Central City Archives of Kaunas. In addition, data from the community based myocardial infarction registers were used. The registers used similar diagnostic criteria and had operated in both areas during the entire study period. SETTING: The province of North Karelia in Finland and the city of Kaunas in Lithuania. SUBJECTS: The target populations were the people of North Karelia and Kaunas aged 35-64 years. MAIN OUTCOME MEASURES: Mortality from ischaemic heart disease and the attack rate of acute myocardial infarction. RESULTS: In North Karelia mortality from ischaemic heart disease and the attack rate of acute myocardial infarction declined steeply both in men and women. This decline was accompanied by a decrease in total mortality. In Kaunas, both mortality and the attack rate increased in men but remained unchanged in women. In 1985 to 1987, age standardised total mortality per 100,000 inhabitants was similar in the two populations in men (1081 (95% confidence interval (CI) 1013 to 1149), in North Karelia; 1082 (95% CI 1032 to 1132), in Kaunas). The proportional mortality from ischaemic heart disease was considerably higher in North Karelia (40%) than in Kaunas (28%). In women, age standardised total mortality was lower in North Karelia (350 (95% CI 312-388)) than in Kaunas (440 (95% CI 413 to 467)). The proportional mortality from ischaemic heart disease in women was also higher in North Karelia (28%) than in Kaunas (13%). CONCLUSIONS: Despite the remarkable decline in the occurrence of ischaemic heart disease, it still remains the most important cause of premature mortality in North Karelia. In Kaunas ischaemic heart disease mortality and attack rate increased in men. Experiences from successful cardiovascular disease prevention programmes in western countries, such as the North Karelia Project, should be exploited to prevent an increasing epidemic of ischaemic heart disease in eastern Europe.

Relation between ventricular arrhythmia and sudden cardiac death in patients with acute myocardial infarction: the predictors of ventricular fibrillation.

Continuous electrocardiographic monitoring was recorded in 102 patients during the first 48 hours after the onset of myocardial infarction. One hundred forty-eight episodes of ventricular tachycardia having an ectopic rate of 180/min or more and without a background of treatment with antiarrhythmic drugs were analyzed; these included 125 cases of ventricular tachycardia that terminated spontaneously and 23 cases that deteriorated to ventricular fibrillation. Episodes of ventricular tachycardia with a polymorphic configuration were more frequent in the group with than in the group without ventricular fibrillation (30.4 and 8%, respectively). The incidence of ventricular tachycardia continuing for more than 100 QRS complexes was 20 times greater in the group with ventricular fibrillation, and ventricular tachycardia initiated by and R on T ventricular premature beat was recorded three times more often in this group. The 10 minute pretachycardia interval in both groups showed no significant difference in the incidence, complexity, intensity or dynamic pattern of ventricular premature contractions. The data provide reason to doubt the significance of ventricular premature beats as harbingers of sudden death from ventricular fibrillation. Rather, ventricular tachycardia with an ectopic rate of 180/min or more, a polymorphic configuration and persistence for more than 100 QRS complexes (or initiated by an R on T ventricular premature beat) is a more reliable predictor of the occurrence of ventricular fibrillation.

Ventricular tachycardia in myocardial infarction: relation to heart rate and premature ventricular contractions.

Analysis of monitored electrocardiograms, recorded in 77 patients during the first 48 hours following the onset of myocardial infarction, revealed 492 episodes of ventricular tachycardia with rates of 90-220 min-1. Characteristics of the ventricular tachycardia episodes were correlated with heart rate and with the rate and complexity of ventricular arrhythmias in the 10-min period preceding ventricular tachycardia. Ventricular tachycardia with rates of 140-180 min-1 and with a QS configuration was the most frequent event. The first ectopic complex of VT was R-on-T in only 17.2%. Sinus tachycardia was associated with significantly fewer episodes of VT with rates of 110-140 min-1 than when the sinus rate was normal. However episodes of ventricular tachycardia with rates of 181 to 220 beats min-1 were more frequent during sinus tachycardia. Analysis of the frequency of premature ventricular contractions in the 10-min period immediately preceding ventricular tachycardia revealed no premature ventricular contractions in 24.4% of cases. Multiple premature ventricular contractions with a frequency of greater than or equal to 5 min-1 were observed in 8.4% of cases, multifocal in 30.3%, couplets in 24% and early PVCs in 12.2%. In the minute before ventricular tachycardia, only 40.2% of cases displayed premature ventricular contractions. In that minute, complex premature ventricular contractions were distributed as follows: multifocal in 10%, couplets in 8.7% and early PVCs in 2.6% of cases. Out of the total of 492 runs of ventricular tachycardia, 5 cases (1%) resulted in ventricular fibrillation.(ABSTRACT TRUNCATED AT 250 WORDS)