ABSTRACT
BACKGROUND: Cardiovascular diseases are the leading cause of death in Germany. The knowledge of causal risk factors and their distribution is of utmost importance to design screening programs. PROBANDS AND METHODS: In this cross-sectional study design we used STROBE criteria to achieve the highest comparability possible. Anthropometric measures (height and weight), total cholesterol, glucose level, and blood pressure were measured. Probands' history was collected by using a standardized questionnaire. The data was age- and gender-adjusted for the working population 16 to 70 years of age, derived from the micro census, the 1 %-sample census of the German statistical office. For each study year weight factors were calculated. Logistic regression analysis was conducted regarding the cardiovascular risk factors: smoking, arterial hypertension, diabetes, hypercholesterolemia, and obesity. RESULTS: Between 2006 and 2015 a total of 28,293 employees took part in the ongoing company screenings. The mean age was 42.3 years for both sexes (median: 43 years). The mean body mass index (BMI) was 25.6 kg/m2 (men: 26.5 kg/m2, women: 24.7 kg/m2). A history of hypertension was present in 16 % of the employees (men: 17.8 %, women: 13.8 %). Of the respondents 2 % suffered from diabetes (men: 2.4 %, women: 1.6 %). Lipid-lowering drugs were taken by 2.8 % of all employees (3.6 % men and 1.9 % women). 23.3 % of the men and women indicated to be active smokers. In the regression analysis obesity was associated with a four times higher risk of hypertension and a three times higher risk of elevated glucose levels, thus manifesting as main contributor for vascular diseases. Meanwhile the risk for obesity was 140 % higher in probands who are former smokers. CONCLUSIONS: We regard obesity as the number one cardiovascular risk which should be assessed by various medical, legislative, and socio-economic actions to limit future mortality and health-care costs in Germany.
Subject(s)
Cardiovascular Diseases/epidemiology , Obesity/epidemiology , Occupational Health , Adolescent , Adult , Aged , Cardiovascular Diseases/diagnosis , Cross-Sectional Studies , Diabetes Mellitus/diagnosis , Diabetes Mellitus/epidemiology , Female , Germany/epidemiology , Health Surveys , Humans , Hypercholesterolemia/diagnosis , Hypercholesterolemia/epidemiology , Hypertension/diagnosis , Hypertension/epidemiology , Male , Middle Aged , Obesity/diagnosis , Prevalence , Prognosis , Risk Assessment , Risk Factors , Smoking/adverse effects , Smoking/epidemiology , Time Factors , Young AdultABSTRACT
OBJECTIVES: This study aims to evaluate the clinical outcome following total cavopulmonary connection (TCPC) and to identify factors affecting early and late outcome. METHODS: Between May 1994 and March 2015, 434 patients underwent TCPC with 50 lateral tunnels and 374 extracardiac conduits. The clinical outcome, exercise capacity and liver examination results were retrospectively reviewed. RESULTS: Thirty-day survival was 98.2%, and the estimated survival rate at 15 years was 92.3%. Freedom from tachyarrhythmia at 15 years was 91.0%. Other late morbidities included bradyarrhythmia in 17, protein-losing enteropathy (PLE) in 15, thromboembolism in 3 and plastic bronchitis in 3 patients. At last follow-up, normal systemic ventricular function (ejection fraction >50%) was observed in 88.2%. Atrioventricular valve (AVV) regurgitation was mild or less in 90% of patients with systemic left ventricle, in 63% of those with systemic right ventricle and 58% of the patients with unbalanced atrioventricular septal defect or common inlet ventricles. Cardiopulmonary exercise capacity showed impaired peak oxygen uptake (71% of normal) in a sub-group of 120 patients at a mean of 9 years postoperatively. Biochemistry of 338 patients at last follow-up revealed a gamma-glutamyl transferase value beyond normal in 90 patients (26%), with a positive correlation between the level and the time after the initial operation (P < 0.01). Pre-TCPC high transpulmonary gradient emerged as a predictor for delayed hospital recovery (P = 0.002), late mortality (P = 0.016) and reoperation (P = 0.015) in multivariable analysis. CONCLUSIONS: Contemporary TCPC can be performed with low risk and provides excellent survival in the long-term. Classic morbidities of the original Fontan procedure, such as Fontan pathway revision, tachyarrhythmia and thromboembolism seem mitigated. However, exercise limitations, PLE and liver dysfunction remain an issue. AVV insufficiency and ventricular dysfunction are still a concern.
