Tracking of BMI, fatness and cardiorespiratory fitness from adolescence to middle adulthood: the Zagreb Growth and Development Longitudinal Study.

BACKGROUND: Effective intervention strategies aiming to improve cardiorespiratory fitness and to decrease body fatness are needed. However, long-term stability of these traits is not well understood. AIM: To assess long-term tracking of cardiorespiratory fitness and body fatness from late adolescence to middle adulthood. SUBJECTS AND METHODS: The sample consisted of 50 participants (31 boys) from the Zagreb Growth and Development Longitudinal Study who were followed up in adulthood (median age = 43). Fatness was evaluated through BMI and skin-folds, while cardiorespiratory fitness was assessed using a cardiopulmonary exercise test. Inter-age partial correlation coefficients were calculated to evaluate tracking. RESULTS: Body mass index and skin-folds showed moderate tracking from age 15 years to middle adulthood (partial r = 0.55, p < 0.001 and partial r = 0.52, p < 0.001, respectively), while tracking of subcutaneous fat distribution was somewhat lower (partial r = 0.38, p < 0.01). At the same time, the observed tracking of peak oxygen uptake was low-to-moderate (partial r = 0.30, p = 0.03), while ventilatory aerobic and anaerobic thresholds did not show significant tracking. CONCLUSIONS: The results of this study indicate that preventive efforts aiming to increase cardiorespiratory fitness should include all adolescents, irrespective of their cardiorespiratory fitness status. Conversely, strategies aiming at obesity prevention should focus on high-risk groups of adolescents.

Patients in cardiac rehabilitation programme--where we were in 1999 and where 10 years later.

The aim of this study was to find out and compare characteristics of cardiac patients who, after hospital treatment, participated in cardiac rehabilitation programmes at the Polyclinic for Cardiovascular Prevention and Rehabilitation in Zagreb during 1999 and 2009. The results show an increase in mean patients' age (men: 55.5 to 61.53; p = 0.000 and women: 58.95 to 62.66; p = 0.01), an increase of the proportion of those +/- 65 years by 23% in both genders (men: 17% to 40%; women: 27% to 50%), an increase in the proportion of women (21.16% to 28.22%), a marked increase in the proportion of post - PCI patients with stenting (men: 15.58% to 61.92%; women: 9.68% to 62.20%), reduction of patients with BMI < 25.00 kg/m2 (men: 47.19% to 13.93%; women: 54.84% to 24.41%) and a constantly high proportion of patients with hypercholesterolemia (above 85%). It is obvious that systematic action is required to improve awareness of risk factors and desirable health behaviour.

[Secondary prevention and cardiac rehabilitation]. / Sekundarna prevencija i rehabilitacija kardiovaskularnih bolesnika.

Coronary heart disease is a chronic disease with multifactorial etiology. The risk depends on several, already well-known, risk factors such as hypertension, diabetes mellitus, dyslipidemia, smoking, obesity, physical inactivity, stress, etc. Multiple risk factors will increase the risk. The variety of risk factors requires a multidisciplinary approach--a team of different experts guided by a cardiologist who ensures an appropriate rehabilitation program. This should include secondary prevention as an important part of coronary heart disease patient treatment. It is based on the generally accepted medical, professional and scientific principles and long standing international experience. Papers written by experts and published on behalf of the World Health Organization, European Society of Cardiology, European Society of Hypertension, European Association for Cardiovascular Prevention and Rehabilitation, and other societies, define the basic characteristics of cardiac rehabilitation programes: aims, forms, content, indications and ways of implementing it in order to make it comprehensive, and to help regain the patients' temporarily lost ability to return to normal life and work. The cardiac patient will be fully educated to manage his exercise program and secondary prevention for life. Taking into account the situation that we have in our country, in relation to social structure, demography, legislation and types of health insurance, we would recommend that post-acute coronary syndrome patients undergo a cardiac rehabilitation program, which includes secondary prevention. After the education and rehabilitation program, aimed at individual needs, patients will continue under the guidance of his/her GP, consulting the specialist only when needed. In this way, the positive effects of cardiac rehabilitation will be long lasting.

[Epidemiology of acute coronary syndrome in the City of Zagreb]. / Epidemiologija akutnog koronarnog sindroma u Gradu Zagrebu.

AIM: Amongst cardiovascular diseases (CVD), acute coronary syndrome (ACS) is an important cause of cardiovascular mortality. The aim of the study was to examine ACS in Zagreb, to determine how it is treated, and to assess the extent to which new guidelines have been implemented in daily practice. During the last decades, great improvements have been made in the prevention and management of ACS. We wished to ascertain how these improvements have been implemented in our hospitals in the year 2003. METHODS: We carried out a retrospective study including patients in the City of Zagreb that had been discharged from the hospital with the diagnosis of ACS. The community-based Registry of Acute Coronary Syndrome for the City of Zagreb for the year 2003 served as the source of data. Records on 1,733 ACS patients were analyzed. In 1,349 hospitalized patients, the following parameters were investigated: length of hospital stay; time from onset of symptoms to arrival in hospital; rate of angiography and reperfusion and medical therapy after discharge. RESULTS: Study results showed that 1,105 (64%) patients were discharged from hospital, 244 (14%) died in hospital, and 384 (22%) died outside hospital. There were 1,136 (84%) patients with AMI, 638 (56%) with ST segment elevation MI, 391 (34%) with non-ST segment elevation MI and 107 (10%) of patients with possible MI and MI with undetermined ECG. Patient records revealed that 688 (51%) stayed in hospital between 8 and 14 days. The time from symptom onset to hospital arrival was less than 6 hours in 566 patients, 349 (44%) men and 217 (39%) women; 6 to 12 hours in 157 patients, 79 (10%) men and 78 (14%) women; and over 12 hours in 410 patients, 238 (30%) men and 172 (31%) women. The time of symptom onset was unknown in 216 patients, 127 (16%) men and 89 (16%) women. Angiography and reperfusion therapy were performed in 557 (41%) patients, 373 (47%) men, and 184 (33%) women; PCI/PCI + stent in 33% of men with ST or non-ST segment elevation, and 25% of women with ST segment elevation and 19% of women with non-ST segment elevation. Fibrinolytic therapy was performed in 86 patients, 53 (7%) men and 30 (5%) women. Amongst ACS patients (N=966), 85% took aspirin, 70% beta-blockers, 69% angiotensin converting enzyme inhibitors and 63% statins. DISCUSSION AND CONCLUSION: Compared to other studies, non-ST segment elevation MI and unstable angina seemed to be less often diagnosed. Patients arrived in hospital rather late after symptom onset, and this was probably one of the reasons that reperfusion therapy could not be sufficiently applied. We also noted that physicians did not always follow the generally accepted guidelines to enable a better outcome by use of preventative measures and higher rate of effective therapy. There are important lessons to be learnt from this study for both patients and physicians.

The "Chaos Theory" and nonlinear dynamics in heart rate variability analysis: does it work in short-time series in patients with coronary heart disease?

BACKGROUND: Dynamic analysis techniques may quantify abnormalities in heart rate variability (HRV) based on nonlinear and fractal analysis (chaos theory). The article emphasizes clinical and prognostic significance of dynamic changes in short-time series applied on patients with coronary heart disease (CHD) during the exercise electrocardiograph (ECG) test. METHODS: The subjects were included in the series after complete cardiovascular diagnostic data. Series of R-R and ST-T intervals were obtained from exercise ECG data after sampling digitally. The range rescaled analysis method determined the fractal dimension of the intervals. To quantify fractal long-range correlation's properties of heart rate variability, the detrended fluctuation analysis technique was used. Approximate entropy (ApEn) was applied to quantify the regularity and complexity of time series, as well as unpredictability of fluctuations in time series. RESULTS: It was found that the short-term fractal scaling exponent (alpha(1)) is significantly lower in patients with CHD (0.93 +/- 0.07 vs 1.09 +/- 0.04; P < 0.001). The patients with CHD had higher fractal dimension in each exercise test program separately, as well as in exercise program at all. ApEn was significant lower in CHD group in both RR and ST-T ECG intervals (P < 0.001). CONCLUSIONS: The nonlinear dynamic methods could have clinical and prognostic applicability also in short-time ECG series. Dynamic analysis based on chaos theory during the exercise ECG test point out the multifractal time series in CHD patients who loss normal fractal characteristics and regularity in HRV. Nonlinear analysis technique may complement traditional ECG analysis.

Trends in acute myocardial infarction mortality and morbidity from 1979 to 2001 in the City of Zagreb, Croatia.

AIM: To define trends in age-adjusted acute myocardial infarction mortality and morbidity in women and men in the city of Zagreb, Croatia, in the period 1979-2001. METHODS: Acute myocardial infarctions occurring in both men and women at ages between 25 and 74 years were analyzed by using 1979-2001 data from the Acute Myocardial Infarction Population-based Register for the City of Zagreb, Croatia. The patients with myocardial infarction were identified retrospectively from the hospital discharge reports and death certificates in Zagreb hospitals and the Croatian Statistical Bureau. RESULTS: Over the period of 23 years, a total of 25,359 cases of acute myocardial infarction were registered in the city of Zagreb (18,345 men and 7,014 women). The age-adjusted attack rate for men was the lowest in 1981 (170 per 100,000 population) and the highest in 1993 (274 per 100,000 population), with a decreasing trend toward 2001. The rate for women was between 49 per 100,000 population in 1979 and 86 per 100,000 population in 1993, with a decreasing trend afterwards. Between 1993 and 2001, the rate for men decreased by 68.6% and for women by 62.8% (P=0.370). The age-adjusted mortality rate showed more pronounced changes and was much higher for men then for women. The rates per 100,000 population among men varied between 80 and 140, and among women between 20 and 40. Between 1993 and 2001, the age-adjusted myocardial infarction mortality rates decreased by 56.3% and 52.5% in men and women, respectively (P=0.670). The age-adjusted prehospital mortality rate for men was much higher than the hospital mortality rate and had an obvious decreasing trend since 1993. Both rates were much lower for women. Twenty-eight-day case-fatality rate for men ranged from 38.5% to 49.1%, and from 39.0% to 64.0% for women. It did not change much in men during the observed period. Women younger than 45 years had a significantly greater risk of a fatal heart attack, whereas the risk was greater for men in the older age groups (55-74 years). CONCLUSION: The age-adjusted attack rates, mortality rates, prehospital death rates, and case-fatality rates showed a definite decline since the early 1990s for both men and women, but the decline was greater for men.

Acute coronary syndrome and the 1992-1995 war in Bosnia and Herzegovina: a 10-year retrospective study.

OBJECTIVE: To examine the effects of war in Bosnia and Herzegovina on the occurrence of acute coronary syndrome among civilians. METHODS: The incidences of acute myocardial infarctions (first and recurrent) and unstable angina pectoris were examined among the residents of Mostar and the nine neighboring districts. The study population was the population that lived in the area before the war (182,000 in the 1991 census). Others who immigrated into the area were not taken into consideration. Five consecutive years (1987-1991) before the war and 5 consecutive years (1992-1996) during the war were analyzed. RESULTS: In the 5-year period during the war, 267 men and 161 women suffered from acute myocardial infarctions, compared with 246 men and 119 women in the 5-year period before the war. The wartime increase in acute myocardial infarctions for the combined male-female population was statistically significant (p = 0.025). For women, the wartime increase was statistically significant only for the age group of 60 to 69 years (p = 0.007). The smaller increase among men was not statistically significant (p = 0.354). The increase to a wartime number of 52 cases of recurrent myocardial infarctions from a prewar level of 24 was statistically significant (p = 0.001). The percentage of fatal myocardial infarctions among women, however, was lower during the war (18.6%) than before the war (32.8%) (p = 0.048). During the war, 109 men with unstable angina pectoris were hospitalized, compared with 84 before the war; the cases among women were 76 and 41, respectively. The increase was statistically significant among women (p = 0.001) but not among men (p = 0.072). There was a statistically significant increase (p < 0.001) in the total number of unstable angina pectoris cases during the war (185 cases, compared with 125 prewar cases). CONCLUSION: The common population during the war in Bosnia and Herzegovina had increased numbers of acute myocardial infarctions and unstable angina pectoris cases.

[Epidemiologic importance of acute coronary syndrome in the population of the city of Zagreb]. / Epidemiolosko znacenje akutnog koronarnog sindroma u populaciji Grada Zagreba.

AIM: The aim of the study was to determine the number of hospitalized patients with acute coronary syndrome (ACS) in the Zagreb population. METHODS: Zagreb residents hospitalized in five Zagreb hospitals (Sveti Duh General Hospital, Merkur, Sestre Milosrdnice, Dubrava University Hospitals, and Zagreb University Hospital Center) during 2000 and 2001 with the diagnosis of ACS, were examined. Patients who suffered from acute myocardial infarction with ST elevation (STEMI), patients with acute myocardial infarction without ST elevation (NSTEMI) and patients with unstable angina (UA) were analyzed according to gender and outcome. RESULTS: During 2000, and 2001, 1453 and 1538 Zagreb residents were hospitalized for ACS, respectively, 62% of them men. STEMI was present in 54% of patients hospitalized during 2000 and 56% of those hospitalized during 2001. NSTEMI was present in 19% of patients in 2000 and 23% of patients in 2001, while the respective percentage of UA was 17% and 21%. Among STEMI patients, case fatality was higher in women (> 20%) than in men (< 20%) (p = 0.05), whereas no sex difference was observed in NSTEMI (< 20%) and in UA (about 3%) patients. CONCLUSION: Women had a higher case fatality. Case fatality was also higher in patients with STEMI than in those with NSTEMI and UA, who had a much lower case fatality. Due to the lack of data, further follow-up is needed because reliable data can help us in the prevention and treatment of ACS.