[Snoring and excessive daytime somnolence and risk of cardiovascular diseases]. / Chrapanie i nadmierna sennosc dzienna a ryzyko chorób sercowo-naczyniowych.

Snoring and excessive daytime somnolence (EDS) are very common in middle-age adults. The goal of the investigation was to assess links between those symptoms and risk for cardiovascular diseases (CVD). The population studied included 1186 inhabitants of Warsaw (mean age 52 years), participants of the international multicentre study of cardiovascular disease MONICA II, who completed the sleep disordered breathing (SDB) questionnaire. Snoring was reported by 78% of males (48% habitual and 30% occasional) and 59% of females (27% habitual and 32% occasional). Every fourth (26.8%) subject declared observed apnoeas, in 9.2% apnoeas were observed every night. EDS was declared by 28.7% of studied sample. The results of the questionnaire were compared to the results of MONICA study. Snorers had significantly higher systolic and diastolic blood pressure (133.2 +/- 23/84.6 +/- 13 mm Hg) compared to non-snorers (126.4 +/- 22/80.4 +/- +/- 12 mm Hg) (p < 0.0001). The high total serum cholesterol (> or = 200 mg%) and triglycerides (> or = 200 mg%) concentration, and also obesity (BMI > or = 30 kg/m2) were more prevalent in snorers. Subjects reporting apnoeas more often had coronary artery disease (p < 0.001) or history of stroke (p = 0.002) compared to non-apnoeics. There was no relationship between EDS and risk of cardiovascular disorders, and also between diabetes and SDB. In conclusion, snoring was strongly associated with hyperlipidaemia, obesity or hypertension, well known risk factors for development of cardiovascular disorders. Reported apnoeas were related to risk of coronary artery disease.

Familial defective apolipoprotein B-100 in a group of hypercholesterolaemic patients in Poland. Identification of a new mutation Thr3492Ile in the apolipoprotein B gene.

The prevalence of the familial defective apolipoprotein B-100 (FDB) Arg3500Gln mutation in 525 unrelated hypercholesterolaemic Polish subjects was evaluated. DNA samples were screened for FDB mutation using SSCP method. Presence of mutation was confirmed using a mismatch MspI PCR strategy. Plasma lipid levels and clinical characteristics of 13 patients identified as carriers of the mutation and of their 23 affected relatives were analysed and compared with non-affected ones. In the affected individuals a variable expression of lipid concentrations and of atherosclerosis symptoms were observed. The prevalence of FDB Arg3500Gln mutation in hypercholesterolaemic Polish subjects (3.7%) seems to be similar to the frequency reported in other Caucasian hypercholesterolaemic populations. The estimated prevalence of the mutation in general Polish population is relatively high being 1/250. The same haplotype at the apoB locus in the carriers of this mutation in Poland as in other populations from Western Europe suggests its common origin. In one hypercholesterolaemic subject a non-hitherto described mutation was identified. It consisted in C-->T transition in apoB codon 3492 leading to threonine to isoleucine substitution in 3492 position of apoB gene (Thr3492Ile).

Heart failure in patients seeking medical help at outpatients clinics. Part I. General characteristics.

BACKGROUND: During the last decade, the beneficial changes in lifestyle and in medical care increased average life expectancy, particularly in patients with chronic diseases such as hypertension and coronary heart disease. Unfortunately this also increased the number of patients, particularly among the elderly, who are susceptible to complications of these conditions such as heart failure. Uncontrolled hypertension is known to be a primary cause of heart failure and is also known to be very prevalent and frequently uncontrolled in the Polish population. AIM: To estimate the prevalence and characteristics of heart failure among patients of 65 years and older seeking medical care in outpatient clinics in Poland. METHODS: The study is a cross-country epidemiological project in which 417 physicians from outpatient clinics were asked to register 50 consecutive patients aged 65 years and above seeking medical care for any cause. Information on case history, physical examination (diagnosis of heart failure, NYHA class, heart failure symptoms), laboratory tests (resting ECG, chest X-ray, echocardiogram) and data concerning pharmacology management during the 2 weeks prior to the index visit was obtained. RESULTS: Over 5 months, 19877 eligible patients (7324 men and 12553 women) presented to the 417 participating physicians (90% physicians registered 46-50 patients). Among the patients, 53% were diagnosed with heart failure (3901 men and 6678 women), prevalence did not differ by gender. Among patients with heart failure there were 38% of men in NYHA class III or IV and 34% of women. Coronary heart disease was a predominant cause of heart failure in 87% of men (26% of cases with isolated coronary heart disease, 53% with concomitant hypertension and 8% with other diseases), while percentages for women were 80% (15%, 61% and 4%, respectively). Isolated hypertension was a further cause of heart failure in 8% of men and 13% of women. Cardiac arrhythmia was found in approximately 20% of patients, enlargement of heart size in 32% of patients and peripheral leg edema in 54% of men and 64% of women. These symptoms increased with age. Chest X-ray revealed cardiomegaly in 68% of men and women and increased cardiothoracic ratio (>50%) in approximately 40% of patients. From resting ECGs, cardiac arrhythmia was recorded in 21% of patients with heart failure, with atrial fibrillation as a predominant disorder (19%). Left ventricular hypertrophy on resting ECG was noted in 42% of men and women and old myocardial infarction or cardiac ischemia was diagnosed in 71% of men and 66% of women. CONCLUSIONS: (1) Heart failure was diagnosed in over half of outpatients aged 65 and older; in more than a third of these it was NYHA class III and IV. (2) Outpatients with heart failure had a high frequency of co-existing diseases such as arrhythmia, coronary heart disease and hypertension.

Snoring and excessive daytime somnolence among Polish middle-aged adults.

There is considerable interest in the association of snoring and health consequences that have been linked to more severe sleep-disordered breathing, including obstructive sleep apnoea syndrome. The goal of this investigation was to assess the independent association of heavy, habitual snoring and daytime sleepiness. For this, a cross-sectional, population based study of snoring, sleepiness and other factors was conducted using the Warsaw sample of the Multinational Monitoring of Trends and Determinants of Cardiovascular Diseases (MONICA) study, a population-based multicentre study of cardiovascular disease. The well-defined MONICA sample of middle-aged males and females also allowed estimation of age- and sex-specific prevalences of habitual snoring in Polish adults. Data on self-reported snoring frequency and loudness, and daytime sleepiness using the Epworth Sleepiness Scale (ESS) and other questions, were collected with a postal questionnaire. Seventy-nine per cent of the MONICA sample completed the questionnaire, yielding a total of 1,186 participants. Of the total sample, 27% of the females and 48% of the males reported habitual snoring ("often" or "always"). There was an independent association of habitual snoring and excessive daytime sleepiness (EDS), sleepiness that interfered with work and with increasing ESS scores. Habitual snorers were 5.8 and 3.1 times more likely to report EDS in active and passive situations, respectively, compared to nonsnorers (all p<0.01). It is concluded that habitual snorers, most of whom are probably unlikely to have frank sleep apnoea syndrome, are at substantial risk for daytime sleepiness. These findings add support to the hypothesis that simple snoring is not benign and underscores the need for further research on health outcomes associated with this prevalent condition.

Hyperhomocysteinemia as a risk factor for cardiovascular diseases. The association of hyperhomocysteinemia with diabetes mellitus and renal transplant recipients.

Hyperhomocysteinemia has been recognised as an independent risk factor for cardiovascular, cerebrovascular and peripheral artery disease. There is strong evidence suggesting that hyperhomocysteinemia accelerates the process of atherogenesis. Possible explanations for this will be shortly reviewed. Recently a growing interest has been focused on the association of hyperhomocysteinemia with diabetes mellitus and with chronic renal disease, including renal transplant recipients. Some clinical aspects of this occurrence, such as interactions with insulin, metformin, and cyclosporine and also with some vitamins, will be described. The issue of hyperhomocysteinemia in heart transplant patients will also be mentioned. Last of all, the interaction of homocysteine concentration with some beverages will be considered.

[Excessive daytime somnolence in the adult population of Warsaw]. / Nadmierna sennosc dzienna wsród doroslych mieszkanców Warszawy.

We studied prevalence of excessive daytime somnolence (EDS) in a representative cohort of people living in Warsaw, aged 38-67y. Forty eight items questionnaire concerning sleep habits and symptoms including Epworth Sleepiness Scale assessing EDS was mailed twice to 1503 subjects. The response rate was 79%. The average sleep time on working days was 7.1 +/- 1.1h and 8.1 +/- 1.3h on week-ends. Moderate DS was found in 21% and severe DS in 7.5% of the studied group. 0.4% of studied subjects admitted falling asleep while driving a car. These figures are comparable to that reported in recent literature. There was no relation between EDS and short hours of sleep. Severe DS was twice as frequent among men than among women (p < 0.001). There was no clear-cut relations between age and EDS.

Stroke mortality rates in Poland did not decline between 1984 and 1992.

BACKGROUND AND PURPOSE: Stroke mortality has decreased in most industrialized countries in recent decades. In Poland, as in other eastern European countries, mortality rates for stroke remain high. METHODS: The Warsaw Stroke Registry (WSR) registered patients in the Mokotów district of Warsaw from 1991 through 1992. The Warsaw Pol-MONICA study registered stroke patients in the North and South Praga regions of Warsaw from 1984 through 1992. Stroke incidence rates, case-fatality rates, and stroke mortality rates were computed based on both studies and compared with published mortality rates based on death certificates. Eight-year trends of stroke incidence, case-fatality rate, and mortality were derived from the Warsaw Pol-MONICA study. RESULTS: The WSR and Warsaw Pol-MONICA studies showed similar incidence rates, mortality rates, and 28-day case-fatality rates for stroke. Mortality rates from the WSR and the Warsaw Pol-MONICA study were similar to rates from death certificate data. Mortality rates in the group aged 35 to 64 years were higher in men (47.5 to 50/100000 per year) than in women (30/100000 per year). CONCLUSIONS: Two different population-based studies suggest that stroke mortality is high in Poland because of high 28-day case-fatality rates. Stroke mortality failed to decline in Poland in the period 1984 through 1992 because neither case fatality nor stroke incidence declined in this period.

[Direction of pharmacotherapeutic changes used in cardiovascular diseases assessed by examination of two population samples from Warsaw]. / Kierunki zmian farmakoterapii stosowanej w chorobach ukladu krazenia, ocenione na podstawie badania dwóch próbek populacji Warszawy.

The aim of the study was to analyse the changes in pharmacotherapy of ischaemic heart disease (HD) and arterial hypertension (AH) between 1984 and 1988 using the results of screenings of two independent samples of Warsaw inhabitants. In this period the prevalence of IHD in Warsaw population aged 35-64 increased by 4.3% (from 30.3% to 31.6%) as well as the percentage of treated subjects by 19.5% (from 39.0% to 46.6%). Prevalence of arterial hypertension (AH) decreased in this period by 4.7% (from 35.8% to 34.1%) whereas the percentage of undertaking pharmacotherapy in these patients increased by 47.9% (from 33.8% to 50.0%) as well as the effectiveness of undertaken treatment (goal of treatment: < or = 160/95 mmHg) increased by 115.8% (from 22.8% to 49.2%). In subjects with IHD selected from general population the consumption of nitrates, beta blockers and calcium channel blockers increased and these drugs were the most frequently taken in IHD. In treatment of AH diuretics, the most frequently used in 1984, were replaced, to some extent, in 1988 by beta blockers and calcium channel blockers. Consumption of drugs by general population, expressed in DDD/1000 i/day, changed too--the consumption of beta blockers increased in 1988 twice, of calcium channel blockers 3-fold and of nitrates 1.5 fold, whereas that of dipyridamole decreased by 60%, while comparing of these consumption in 1984.

[Evaluation of the efficiency of gemfibrozil in treating hyperlipidemia type IIb and IV]. / Ocena skutecznosci gemfibrozilu w leczeniu hiperlipidemii typu IIb i IV.

Analysis of the efficacy and tolerability of gemfibrozil (Gevilon-Parke Davis) was performed including 29 patients aged 19-69 years with primary hyperlipoproteinemia (HLP) type IIb-16 persons, IV-13 persons. All patients got dietary recommendations and received gemfibrozil 450-900 mg/day for 3 months. In both types of HLP a significant reduction of serum cholesterol (TCh)--15.5% triglycerides (TG)--32.1% VLDL-Ch--34.9% and VLDL-TG concentration--36.6% was observed as well as an increase of HDL3 fraction-16.3%. The greatest reduction of serum TCh concentration and VLDL-Ch were observed in type IIb, while that of TG and VLDL-TG in type IV HLP. The best therapeutic effect was obtained during the first month of treatment. The percent of TCh, TG, VLDL-Ch, VLDL-TG reduction correlated with their initial level. Tolerability of gemfibrozil was very good. Only in 2 patients transient abdominal pain was observed.

[Effect of bezafibrate on serum lipid, lipoprotein and apoprotein levels in patients with hyperlipoproteinemia type II and IV]. / Wplyw bezafibratu na lipidy, lipoproteiny i apoproteiny surowicy u chorych z II i IV typem hiperlipoproteinemii.

The effect of six months' treatment with bezafibrate (400-600 mg daily) on serum lipids, lipoproteins and apolipoproteins concentrations was investigated in 32 patients with primary hyperlipoproteinemia (HLP) type IIa, IIb and IV. In all types of HLP the reduction of serum cholesterol (CH), triglycerides (TG), very low density lipoprotein (VLDL) fraction and increase in high density lipoprotein (HDL) cholesterol, HDL3-CH and apolipoprotein AI concentrations was observed. In type IIa and IIb HLP low density lipoprotein (LDL) cholesterol and apolipoprotein B levels decreased while in type IV increased. The greatest fall of serum CH concentrations was observed in type IIb while of serum TG level--in type IV. In 15 (46.9%) patients the side effects were noted. They were: abdominal pain, skin rash, myalgia, moderate increase in CPK and aminotransferase activities. Most of there side effects disappeared spontaneously without treatment cessation.

[Lovastatin in the treatment of primary hypercholesterolemia]. / "Lovastatin" w leczeniu hipercholesterolemii pierwotnej.

The results of 12 weeks treatment of primary hyperlipidemias with Lovastatin are presented. This drug belonging to a new generation of hypercholesterolemic drugs inhibits the endogenous synthesis of cholesterol by means of inhibiting the HMG-CoA reductase. The sample consisted of 30 men aged 28-68 years: in 17 of them heterozygotic familial hypercholesterolemia (FH) was diagnosed and in 13--primary non familial hypercholesterolemia (NFH). After 12 weeks of treatment in both groups a significant reduction of total serum cholesterol concentration was observed--(-28%) and--(-32%) as well as LDL-cholesterol concentration (in both groups about -37%) and apo B concentration--(-32%) and -34%. Only in one patients with NFH a significant reduction of VLDL-cholesterol (-29%) and or triglycerides (-15%) concentrations was observed. In this group also a 9% increase of HLD-cholesterol, mainly HDL-2 concentration, was found. Side effects were observed in 6 patients--in 4 of them a minor increase of ALAT, AsPAT or CPK activities (less than 3 times above norm were observed) without any symptoms and with a spontaneous normalization with no need to stop treatment, and in 2 of them abdominal pains not causing drug treatment cessation.

[Long-term Pol-MONICA-Warsaw project: pattern of blood pressure among the population and the effects of selected factors on the blood pressure level]. / Badanie dlugoterminowe Pol-MONICA-Warszawa: rozklad cisnienia tetniczego w populacji oraz wplyw wybranych czynników na poziom cisnienia.

Out of 1800 men and 1800 women being the random sample of population of two Warsaw districts aged 35-64 years, 1309 men and 1337 women (response rate 72.7% and 74.3% were screened in 1984 within the framework of the Pol-MONICA Warsaw Project. Standardized mean values of systolic blood pressure did not differ between men and women but the mean values of diastolic blood pressure were higher in men. Mean values of systolic and diastolic blood pressure increased in both sexes with age, however diastolic blood pressure increased only up to age 45-54 years. Prevalence of hypertension according to WHO criteria was higher in men than in women and in both sexes increased with age. Among subjects with hypertension the mild diastolic hypertension was most frequent. The high percentage of subjects with hypertension at screening was not previously detected (47.4% men and 27.6% women). The fact of hypertension detection was not equal with undertaking therapy because 58.9% men and 46.6% women with detected hypertension were never treated. The effectiveness of therapy (achieving goal) was 24% in men and 27.4% in women. The performed multiple regression analysis indicated that Quetelet index and pulse rate were independently related with systolic blood pressure in both sexes and additionally education level, alcohol consumption and HDL-cholesterol concentration in men and age and family history of hypertension in women. As far as the diastolic blood pressure is concerned the Quetelet index, pulse rate and family history were significantly related in both sexes and additionally in men ethanol consumption and HDL-cholesterol concentration.

[Myocardial infarction incidence and mortality among urban and rural populations during the 3-year period]. / Zachorowalnosc i smiertelnosc spowodowana zawalem serca populacji wielkomiejskiej i rolniczej w okresie 3-letniej obserwacji.

In years 1984-1986 3639 men and 1885 women were registered with suspected myocardial infarction from right-side Warsaw, simultaneously 2371 men and 917 women with the same suspected disease were registered from the Tarnobrzeg province population. The myocardial infarction diagnosis was confirmed in 54% of men and 43% of women from the Warsaw population as well as in 77% of men and 66% of women from Tarnobrzeg province population. In Warsaw the standardized incidence due to myocardial infarction increased during years of study from 466 to 588/100,000 among men and from 178 to 206/100,000 among women. The analogous increase among the Tarnobrzeg province population was 302 to 559/100,000 among men and 64 to 195 among women. Fatality during 28 days from the onset of the disease did not show any relationship with year of study and corresponded yearly among men to 45% and among women to 37% in Warsaw and to 42% among men and 33% among women in the Tarnobrzeg province . High fatality was noted during first 24 hours of hospitalization (Warsaw: 36% among men and 26% among women, Tarnobrzeg: 39% among men and 32% among women). The highest fatality was noted in the youngest of analysed groups.

[Stroke incidence and mortality among urban and rural populations during the 3-year period]. / Zachorowalnosc i smiertelnosc na udar mózgu w populacji wielkomiejskiej i rolniczej w okresie trzyletniej obserwacji.

In years 1984-1986 582 men and 338 women have been registered with clinical diagnosis of cerebral stroke. The respective numbers in the Tarnobrzeg province were 340 and 263. Preliminary diagnosis of cerebral stroke was confirmed according to criteria of registration in 82% of men or women from Warsaw and in 81% of men and 84% of women in the Tarnobrzeg province . Standardized incidence due to cerebral stroke was significantly higher in every of analysed years in the Warsaw population both among men and women in compare with that in the Tarnobrzeg province . In both population studied the incidence was significantly higher among men than among women. Standardized fatality during 28 days from the start of sickness was higher in the Tarnobrzeg province population than in the Warsaw population so far as both men and women are concerned. In both populations among men and women the most frequently diagnosis was acute disease of cerebral vessels.

[Effect of inter-population differences in the levels of selected factors on the differences in arterial blood pressure]. / Wplyw miedzypopulacyjnych róznic w poziomie wybranych czynników na róznice w cisnieniu tetniczym krwi.

According to the Pol-MONICA program the random selected population samples were studied in inhabitants of Warsaw or the Tarnobrzeg province . After excluding from analysis the subjects treated with the hypotensive++ or hypolipemic drugs the differences between populations studies with regard to range of mean pressure value, except systolic pressure (RRs) in women, appeared significant ones. In populations studied the arterial blood pressure (CTK) was influenced by: age, sex, education, family history with regard to the circulatory system, the alcohol intake, smoking, heart action frequency the Quetelet coefficient value, triglyceride concentration and daily sodium intake. After analysis of inter-population differences in values of above factors the mean RRs values in populations studied did not differed significantly whereas differences in mean values of diastolic pressure (RRr) were highly statistically significant.

[Hypertension--diagnosis, treatment and the effectiveness of the treatment of Polish population participating in the POL-MONICA program]. / Nadcisnienie tetnicze--wykrywalnosc, leczenie oraz efektywnosc leczenia w populacji polskiej objetej programem POL-MONICA.

According to the POL-MONICA program basing on screening studies of random population samples of two Warsaw districts and the Tarnobrzeg provinceip the detectability of arterial hypertension (AH), the AH treatment fact, the effectiveness+ of AH treatment and the populational control of AH has been evaluated. The AH control was better in Warsaw (men 55%, women 73%) than in the Tarnobrzeg province (men 44%, women 65%). In both populations the control was better among women than among men and increased with the age of subjects investigated. In both populations the treatment was introduced only in half of detected AH and increased also with the age of subjects studied. Only 20% men and 25% of women in Warsaw and 35% of men and 42% of women in the Tarnobrzeg province was effectively treated. The AH control in the Warsaw population was twice a lower than in the Tarnobrzeg province (Warsaw: men 5%, women 10%, Tarnobrzeg: men 7%, women 16%). Exceptionally bad control of HT has been stated in the youngest and the middle age men group in Warsaw (2.9%). The patterns studied with the use of MLF functions in both population studied have significant influence on the detectability and the AH treatment fact and remain without the influence of effectivity of treatment.

Comparison of official mortality statistics with data obtained from myocardial infarction and stroke registers.

Two sources of information about deaths caused by myocardial infarction and stroke were compared: official statistical data obtained from the Central Statistical office (CSO), and data from the registers of myocardial infarction and stroke conducted under the POL-MONICA Warsaw Project. The completeness of the MONICA registers with respect to the CSO data was 78%, and the completeness of the CSO data with respect to the MONICA registers was 88%. The main causes of the differences were: lack of information in the registers on deaths outside Warsaw; lack of unequivocal identification markers in patients' records from different sources; and other errors in data processing. The agreement of the diagnoses in death certificates (in the CSO material) with the diagnoses in the MONICA registers was 70.4% for myocardial infarction, and 64.4% for stroke. The main cause of the disagreement between the diagnoses was a different methodological approach to the collection of data in the two information sources.

[Regional differences in drug use in relation to the causes]. / Regionalne zróznicowanie w spozyciu leków w zaleznosci od przyczyny.

The purpose of the study was in comparison of drug use in the treatment of coronary disease or hypertension in the random selected representative population sample of Warsaw and Tarnobrzeg province . In the study women and men aged 35 to 64 years were included according to POL-MONICA studies. Among 2646 subjects studied in Warsaw 23% used drugs whereas among 2722 subjects from the Tarnobrzeg province the drug users represented 12.1%. The most frequently used drugs in the treatment of coronary disease were nitrates, curantyl and beta-blockers. The drug use in subjects with coronary disease (DDD/1000 inhabitants/day) was 4.5-fold higher in Warsaw than in the Tarnobrzeg province . The most frequently drug used in treatment of hypertension in Warsaw were beta-blockers and diuretics, whereas in the Tarnobrzeg province among men diuretic and composed drug preparations; women in the last region used frequently composed drug preparations and smooth muscle relaxants. The relationship between the use of particular drug groups and the region was significant in women. The hypotensic drug use in Warsaw was twice as high as in the Tarnobrzeg voivodship despite similar frequency of hypertension in both regions.

Epidemiology of cardiovascular diseases in Warsaw Pol-MONICA area.

In the Warsaw Pol-MONICA area, which is inhabited by 274,000 people of ages 25-64, trends in total mortality showed increases similar to those for the whole of Poland. In Warsaw, mortality from cardiovascular disease in men and from ischaemic heart disease (IHD), myocardial infarction (MI), and cerebrovascular disease in both sexes decreased from 1976 to 1986, whereas trends for these diseases were increasing for the whole of Poland. Within the last 11 years, the MI attack rate and case-fatality rate increased in Warsaw. In the Warsaw male population, an increase in the majority of CHD risk factors was also observed. Age-adjusted mortality rates, MI attack and incidence rates, and stroke attack rates in Warsaw were all higher in men than in women. The mean values of HDL cholesterol and LDL cholesterol, Quetelet's index, and prevalence of hypercholesterolaemia in Warsaw were higher in women than in men, whereas the mean values of triglycerides, diastolic blood pressure, and number of cigarettes smoked as well as prevalence of hypertriglyceridaemia, hypertension, and smoking were higher in men.