Management of heart failure patients in Poland.

Over the next 10 years, heart failure is likely to become a medical and sociological problem as a result of improved treatment of ischaemic heart disease and hypertension. At present, in Poland, there are only 50% of the cardiological or cardiac surgery procedures (coronarography, PTCA, CABG, surgery of congenital or acquired heart disease) performed compared to Western Europe. After being registered on the waiting list, it can take anything between 3 and 12 months before the procedure is done. Patients with heart failure have diagnostic tests such as ECG, chest X-ray, and biochemical evaluation performed regardless of the level of care. When echocardiography, exercise testing or Holter monitoring is required, it is done at specialist or reference specialist facilities with a waiting time of approximately 1-3 months. Pharmaceutical treatment of CHF is also inadequate. ACE inhibitors are prescribed in approximately 68% of patients. The average prescribed dosage is far from that recommended in guidelines. Only 18-29% of patients with HF are on beta blockers. The improvement of cardiological care standards depends mainly on the financial resources of State Health System Agencies.

Psychosocial work characteristics and self rated health in four post-communist countries.

STUDY OBJECTIVES: To examine whether psychosocial factors at work are related to self rated health in post-communist countries. DESIGN AND SETTINGS: Random samples of men and women in five communities in four countries were sent a postal questionnaire (Poland, Czech Republic and Lithuania) or were invited to an interview (Hungary). Working subjects (n=3941) reported their self rated health in the past 12 months (5 point scale), their socioeconomic circumstances, perceived control over life, and the following aspects of the psychosocial work environment: job control, job demand, job variety, social support, and effort and reward at work (to calculate a ratio of effort/reward imbalance). As the results did not differ by country, pooled analyses were performed. Odds ratios of poor or very poor health ("poor health") were estimated for a 1 SD increase in the scores of work related factors. MAIN RESULTS: The overall prevalence of poor health was 6% in men and 7% in women. After controlling for age, sex and community, all work related factors were associated with poor health (p<0.05). After further adjustment for perceived control, only two work related factors remained associated with poor health; the odds ratios (95% confidence intervals) for 1 SD increase in the effort/reward ratio (log transformed) and job variety were 1.51 (1.29, 1.78) and 0.82 (0.73, 1.00), respectively. Further adjustment for all work related factors did not change these estimates. There were no interactions between individual work related factors, but the effects of job control and social support at work differed by marital status, and the odds ratio of job demand increased with increasing education. CONCLUSIONS: The continuous measure of effort/reward imbalance at work was a powerful determinant of self rated health in these post-communist populations. Although the cross sectional design does not allow firm conclusions as to causality, this study suggests that the effect of the psychosocial work environment is not confined to Western populations.

Apolipoprotein E genotype, lipid levels and coronary heart disease in a Polish population group.

Genotype of apolipoprotein E has been identified in a group of randomly selected Polish subjects participating in a cross-sectional study performed within the POL-MONICA Program, the part of international study WHO-MONICA Project. The investigated group consisted of 170 persons, 92 males and 78 females aged 41-69 years (mean age 62.0+/-5.11). The observed frequency of apolipoprotein E alleles was: epsilon2 - 7.6%, epsilon3 - 81.8% and epsilon4 - 10.6%, which was similar to frequencies in the neighbouring European countries. Statistically significant lower means of total cholesterol (TC) and of low density lipoprotein cholesterol (LDL-C) levels in epsilon2 carriers and higher means of TC, of LDL-C and of triglycerides in epsilon4 carriers were observed as compared with noncarriers of respective alleles. Some nonlipid cardiovascular risk factors (hypertension (HT) and obesity) and coronary heart disease (CHD) showed a tendency to lower prevalence in the epsilon2 allele carriers as compared to noncarriers. In the epsilon4 allele carriers a tendency to higher prevalence of HT, but not of CHD was observed as compared to noncarriers of this allele.

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.

Incidence and correlates of hypertension in the Atherosclerosis Risk in Communities (ARIC) study and the Monitoring Trends and Determinants of Cardiovascular Disease (POL-MONICA) project.

OBJECTIVE: The purpose of this research is to assess short-term blood pressure change and hypertension incidence, and identify correlates of incident hypertension in the USA and Poland. DESIGN AND METHODS: Population-based samples aged 45-64 years at enrollment from the Atherosclerosis Risk in Communities (ARIC) and the Pol-MONICA studies: including 3777 whites from Minneapolis, Minnesota, USA suburbs (urban), 3635 whites from Washington County, Maryland, USA (semi-rural) and 3109 blacks from Jackson, Mississippi, USA surveyed in 1987-1989 and 1990-1992; and 389 persons from Warsaw, Poland (urban) and 322 from Tarnobrzeg Province, Poland (semi-rural) surveyed in 1987-1988 and 1992-1993. RESULTS: Age-standardized systolic and diastolic blood pressures at both screens were 9-20 and 5-9 mmHg higher in the Polish samples than in US blacks, who had higher levels than US whites. Age-adjusted annual hypertension incidence in both Polish male cohorts (6-8%) was higher than that in US white men (4%) and approaching that of US black men (7%); rates were also higher in Polish female cohorts (8-9%) than in US black women (8%), but nearly twice those in US white women (4%). Factors independently related to hypertension incidence included age, family history, smoking, baseline blood pressures and body mass index, and increase in body mass index and alcohol consumption between screenings. After adjustment for these factors, annualized hypertension incidence was similar in US white and Polish men (2.3 and 2.7%) compared with US black men (3.4%), and in US white and Polish women (1.5 and 1.3%) compared with US black women (3.9%). CONCLUSIONS: Despite substantial differences in blood pressure levels and age-standardized hypertension incidence rates, the differences in incidence between Polish and US white men appear to be explained largely by differences in risk factors for hypertension.

Association of lipids and lipoprotein level with total mortality and mortality caused by cardiovascular and cancer diseases (Poland and United States collaborative study on cardiovascular epidemiology).

This study evaluates the relation between total serum cholesterol, triglycerides, and high-density lipoprotein (HDL) cholesterol, and subsequent total, cardiovascular, and cancer mortality. These data are from 4,946 US and 5,198 Polish men and women aged 35 to 64 years at baseline with mortality follow-up over 13 years. Total cholesterol showed a U-shaped or J-shaped relation to age-adjusted total and cancer mortality across all samples, with significance only in Polish women. The multivariable adjusted relative risk for total and cancer mortality was higher in the lowest cholesterol category only in Poland and significant only for cancer. Cardiovascular mortality was positively related to cholesterol, but only in Polish men and US women was mortality significantly higher in the highest versus the lowest cholesterol category. The multivariable adjusted relative risk of cardiovascular death was greater in the highest versus the lowest cholesterol category, but this trend was significant only in the US. HDL cholesterol was inversely related to total (significant only in US men) and cardiovascular mortality (significant only in US and Polish men). A similar, but not significant, association of HDL cholesterol was found with cancer mortality. The multivariable adjusted relative risk of total mortality was inversely related to HDL cholesterol significant in both the US and Poland. The relative risk of cardiovascular mortality was significantly lower at higher HDL cholesterol levels in all samples. The relative risk of cancer mortality was highest and significant at the lowest HDL cholesterol level in the US and Poland. Elevated triglycerides were associated with increased risk of total and cardiovascular mortality, but this trend was significant only in the US. Cancer mortality was not significantly related to triglycerides. The present study indicates that in geographically and culturally diverse populations, the relation of lipids with cardiovascular mortality is similar. The relation with total and cancer mortality varies by country, gender, and lipids. This suggests that relations of total and cancer mortality with lipids or lipoproteins are weaker than associations with cardiovascular mortality.

Comparison of medical care and survival of hospitalized patients with acute myocardial infarction in Poland and the United States.

Few studies have evaluated between-country differences in medical care and survival after acute myocardial infarction, and none have compared the US with countries from Eastern Europe. Comparable data from the US (Atherosclerosis Risk in Communities Study [US-ARIC]) and Poland (Multinational Monitoring of Trends and Determinants in Cardiovascular Disease project [Pol-MONICA]) were developed. From 1987 through 1993, a total of 3,694 patients were hospitalized with acute myocardial infarction events in the 2 Pol-MONICA communities and 4,801 in the 4 US-ARIC communities. Patients in the US-ARIC were 1.7 times more likely to be treated in a coronary care unit and received cardiac procedures, calcium channel blockers, and thrombolytic agents significantly more often than patients in the Pol-MONICA. The use of antiplatelet agents, nitrates, angiotensin-converting enzyme inhibitors, and beta blockade agents was similar in both countries. Case fatality (28-day) rates after hospitalized acute myocardial infarction were nearly identical (men, 7% in Pol-MONICA vs 6% in US-ARIC; women, 9% in Pol-MONICA vs 8% in US-ARIC). However, when fatal coronary heart disease events not associated with a hospitalized myocardial infarction were included, the US-ARIC rates were less than half than those seen in Pol-MONICA. Substantial differences in treatment of hospitalized acute myocardial infarction between countries did not translate into a survival advantage for patients reaching clinical attention. Differences in case severity, arising from the high out-of-hospital coronary death rate in Poland may play an important role in this finding.

[Total serum cholesterol and cholesterol lipoprotein fractions in random sample of Warsaw population]. / Cholesterol calkowity i cholesterol frakcji lipoproteinowych w surowicy krwi mieszkanców Warszawy.

The aim of the study was to evaluate the level of lipid risk factors in a random sample of Warsaw population aged 35-64 years, 764 men and 775 women, were screened within framework of the Pol-MONICA Warsaw Study. The lipids were determined by enzymatic methods in laboratory controlled by CDC Lipid Standardization Program in Atlanta. In the screened sample the observed levels of total cholesterol (5.76 +/- 1.01 and 5.68 +/- 1.03 mmol/l respectively in men and in women) and LDL cholesterol (3.67 +/- 0.90 and 3.56 +/- 0.94 mmol/l respectively) were rather high what can indicate on rather high coronary risk of Warsaw population. On the other hand the high mean level of HDL cholesterol (1.36 +/- 0.36 and 1.53 +/- 0.35 mmol/l respectively) and its subfractions HDL2 (0.24 in men and 0.39 mmol/l in women) as well as HDL3 (1.12 and 1.14 mmol/l respectively) observed in this sample can decrease this global risk. The compared mean level of cholesterol in lipoprotein fractions in the group of investigated persons with and without clinical manifestations of coronary heart disease confirm the observed in the other studies the higher mean levels of total cholesterol and LDL cholesterol in persons with coronary heart disease.

Opposing national stroke mortality trends in Poland and for African Americans and whites in the United States, 1968 to 1994.

BACKGROUND AND PURPOSE: The United States (US) has experienced declines in stroke mortality in contrast to the increases reported for Poland. As part of the Poland and US Agreement on Cardiovascular and Cardiopulmonary Research, stroke mortality trends in Polish and US subpopulations were compared in the context of cross-population differences in competing causes of death and determinants of stroke. METHODS: Age-adjusted annual stroke, cardiovascular disease (CVD), non-CVD, and all-cause mortality rates were determined for men and women aged 35 to 64 and 65 to 74 years from 1968 to 1994 for African Americans and US whites and in Poland. Mean annual percent changes of mortality rates were estimated during 1968 to 1980 and 1981 to 1994 with the use of piecewise log-linear regression. RESULTS: US stroke mortality rates declined 3.7% to 4.8% annually during 1968 to 1980 and 2.0% to 3.1% during 1981 to 1994, with similar declines in each ethnic, gender, and age group. Polish rates increased 3.3% to 5.5% annually for all age-gender groups in Poland during 1968 to 1980. Polish men aged 35 to 64 experienced increasing rates during 1981 to 1994 (1.6% annually), while Polish women and older men experienced slight declines or little change. Only Polish men aged 35 to 64 years exhibited increases in stroke, CVD, and non-CVD mortality rates during both time intervals. CONCLUSIONS: Poland and the US experienced opposing stroke mortality rate trends between 1968 and 1994. These national and ethnic trends occurring in just one generation suggest major effects of lifestyle, socioenvironmental, and/or medical care determinants.

Poland and U.S. collaborative study on cardiovascular epidemiology hypertension in the community: prevalence, awareness, treatment, and control of hypertension in the Pol-MONICA Project and the U.S. Atherosclerosis Risk in Communities Study.

PURPOSE: The objectives of this manuscript are to assess differences in blood pressure levels and in hypertension prevalence, awareness, treatment, and control for selected rural and urban areas in the U.S. and Poland, where ischemic heart disease mortality trends are different. METHODS: Included are white persons aged 45-64 selected in Minneapolis, MN suburbs [urban] and Washington County, MD [semi-rural] from the U.S. Atherosclerosis Risk in Communities Study (ARIC) surveyed in 1987-89, and in Warsaw [urban] and Tarnobrzeg Province [semi-rural] from Poland's Pol-MONICA Project surveyed in 1987-88. Sample sizes were: U.S.--3,696 men, 3,801 women; Poland--875 men, 960 women. RESULTS: Mean blood pressures were > 15% higher for Polish samples than for the U.S. (p < 0.01). In multivariable analysis, hypertension was significantly positively related to age and body mass index (BMI) in both U.S. and Polish samples (except age in Polish men), and to heart rate in Polish samples and U.S. rural women. Smoking was significantly negatively related to hypertension in urban Polish and rural U.S. men. Hypertension awareness, treatment, and control were better in U.S. than in Polish samples. In the U.S. > 80% of subjects with hypertension (systolic blood pressure (SBP) > or = 160 mmHg or diastolic blood pressure (DBP) > or = 95 mmHg or on treatment) were controlled whereas in Polish samples < or = 17% of hypertensive men and 16% of hypertensive women were controlled. When SBP > or = 140 mmHg or DBP > or = 90 mmHg or on treatment defined hypertension, control was about 55% in U.S. samples and about 2% in Polish samples. CONCLUSIONS: Hypertension prevalence is higher and blood pressure levels are less well controlled in Polish than in U.S. samples. These striking differences can be expected to contribute to opposing trends in coronary heart disease (CHD) mortality in the two countries. Hypertension control programs in the U.S. are almost certainly responsible for much of the observed differences. There is a clear need for similar programs in Poland.

Constitutional, biochemical and lifestyle correlates of fibrinogen and factor VII activity in Polish urban and rural populations.

BACKGROUND: Fibrinogen and factor VII activity are known to be related to atherosclerosis and coronary heart disease, but population differences in clotting factors and modifiable characteristics that influence their levels have not been widely explored. METHODS: This paper examines correlates of plasma fibrinogen concentration and factor VII activity in 2443 men and women aged 35-64 in random samples selected from the residents in two districts in urban Warsaw (618 men and 651 women) and from rural Tarnobrzeg Province (556 men and 618 women) screened in 1987-1988, and assesses which characteristics might explain urban-rural differences. Fibrinogen and factor VII activity were determined using coagulation methods. RESULTS: Fibrinogen was 12.9 mg/dl higher in men and 14.1 mg/dl higher in women in Tarnobrzeg compared to Warsaw. Factor VII activity was higher in Warsaw (9.2% in men and 15.3% in women). After adjustment for selected characteristics, fibrinogen was higher in smokers compared to non-smokers by 28 mg/dl in men and 22 mg/dl in women. In women, a 15 mg/dl increase in HDL-cholesterol was associated with a 10 mg/dl decrease in fibrinogen (P < 0.01). After adjustment for other variables, a higher factor VII activity in Warsaw remained significant (a difference of 9.4% in men and 14.8% in women). Lower fibrinogen in Warsaw remained significant only in women (15.4 mg/dl difference). CONCLUSIONS: The study confirmed that sex, age, BMI, smoking and blood lipids are related to clotting factors. However, with the exception of gender differences and smoking, associations between clotting factors and other variables were small and of questionable practical importance.

[Efficacy and safety of treating hyperlipidemia type II with fluvastatin in patients with arterial hypertension]. / Skutecznosc i bezpieczenstwo leczenia hiperlipidemii typu II za pomoca fluwastatyny u chorych z nadcisnieniem tetniczym.

62 patients with hyperlipidemia II and hypertension were 8 weeks on low fat and low cholesterol diet (acc. to EAS recommendations). If LDL-Ch > or = 4.1 mmol/l the diet was continued and 12 weeks treatment by fluvastatin (Lescol, Sandoz Pharma Ltd) started with control every 4 weeks Preliminary dosage 20 mg once daily in the evening increased to 40 mg if LDL-Ch > 3.5 mmol/l. After 12 weeks the mean level of T.Chol decreased by 21%, LDL-Ch by 29%, LDL-Ch/HDL-Ch by 31% and T.Chol/HDL-Ch by 24%. HDL-Ch increased by 8% and TG decreased by 5% but not significantly. The first goal of treatment (LDL-Ch < 4.14 mmol/l) achieved 73% and second (LDL-Ch < or = 3.5 mmol/l)-43.3% patients. In 2 patients treatment was discontinued (in one due to severe alimentary symptoms and in second-due to infection of respiratory tract with increase of SGOT and SGPT) and in next 2 the dosage was decreased to 20 mg/day (due to transitory alimentary symptoms).

Changes over time in blood lipids and their correlates in Polish rural and urban populations: the Poland-United States Collaborative Study in cardiopulmonary disease epidemiology.

PURPOSE: The purpose of this manuscript is to examine changes in blood lipid levels and related factors between 1983 and 1987 in two selected Polish populations, to evaluate these changes and their association with other coronary heart disease (CHD) risk factors, and to examine the nutrient intake changes for consistency with observed lipid changes. METHODS: Men and women, aged 35-64 were screened from Warsaw and rural Tarnobrzeg province, Poland-the Pol-MONICA screening sites. An independent random sample of 5132 screened in 1983-84 and a second independent random sample of 2596 screened in 1987-88 were compared. A 25% cohort of the 1983-84 sample was also rescreened in 1987-88 (n = 1236) and 24-hour dietary recall information on this cohort was used to evaluate nutrient intake changes and their relationship to the lipid changes. RESULTS: For the random samples, the total cholesterol increased by 5.1 mg/dL (rural) and by 7.9 mg/dL (urban) for women; there were no significant changes among men. Low-density lipoprotein cholesterol (LDL-C) increased for all site and gender subgroups by 5.4-8.7 mg/dL. Among rural men and women, high-density lipoprotein cholesterol (HDL-C) decreased by 3.4 and 3.3 mg/dL, respectively, whereas it increased by 3.3 mg/dL among urban women and did not change among urban men. Total triglycerides (TG) increased by 9.5 mg/dL for rural men, with no significant change for rural women. For urban men and women, TG decreased by 29.5 and 21.8 mg/dL respectively. In the cohort, changes in dietary intake (decreases in energy from fat, Keys index and increases in the polyunsaturated to saturated fats ratio) were related to a decrease in TC at both sites and to a decrease or smaller increase in LDL-C for rural men. CONCLUSIONS: The observed changes were generally unfavorable, with a decrease in the proportion of persons with desirable lipid levels. At both sites nutritional changes were favorable, including a drop in total energy intake. Less pronounced were changes in percentages of total energy from fats, where the only significant decrease was for rural women; however, improvements in dietary fat composition and declines in cholesterol consumption were found. These favorable changes in diet were not strong enough or were not in effect long enough to counter the unfavorable changes in blood lipids.

[Dyslipoproteinemia in primary hypertension]. / Dyslipoproteinemia w pierwotnym nadcisnieniu tetniczym.

The aim of the study was the estimation of the lipid profile and prevalence of dyslipoproteinemia in patients with essential hypertension. The study group consisted of 108 outpatients (61 men and 47 women) with mild to moderate hypertension (HT), aged 35-64, who did not receive antihypertensive drugs for at least four weeks. The matched controls (MC) were randomly chosen for each HT patient from population of Warsaw inhabitants, covered by Pol-MONICA II screen. The concentrations of total cholesterol (CH) and triglycerides (TG) in serum and cholesterol in lipoprotein fractions and subfractions (LDL, HDL, HDL3) were measured by enzymatic methods. The levels of apolipoproteins (Apo A-I, Apo B) were estimated by immunoassay. Laboratory was under control of WHO-Lipid Reference Laboratory and CDC-NHLBI Lipid Standardization Program. In HT the concentration of cholesterol in LDL was significantly higher (p < 0.001) than in MC, both in men (by 15%) and in women (by 22%), but the concentrations of cholesterol in HDL and HDL3 and Apo A-I (in men only) were significantly lower (p < 0.001) in HT than in MC in men (by 21% and by 26%) as well in women (by 16% and by 25%). Also in HT group the mean levels of TG, CH and Apo B were higher than in MC, but these differences were significant only in TG level in men. In HT group the prevalence of normolipemia was twice lower than in MC (22% and 42%). Essential hypertension fractions is associated with abnormal levels of some lipoprotein fraction and with higher prevalence of hyperlipoproteinemia. The coexistence of both abnormalities may be particularly detrimental as important factor in the development of atherosclerosis.

Blood pressure levels in the 41 populations of the WHO MONICA Project.

In the early to mid 1980s, the WHO MONICA Project conducted cardiovascular risk factor surveys in 41 study populations in 22 countries. Study populations aged 35-64 years comprised 32,422 men and 32,554 women. Blood pressures (BP) and body mass index (BMI) were measured according to a standard protocol. Participants were asked about antihypertensive medication. In men, the average age-standardized BPs ranged among the populations from 124 to 148 mm Hg for systolic (SBP) and from 75 to 93 mm Hg for diastolic (DBP). The corresponding values in women were 118-145 mm Hg for SBP and 74-90 mm Hg for DBP. In all populations, women had lower SBP than men in the age group 35-44. However, SBP in women rose more steeply with age so that in 34 of 41 populations women had higher SBP than men in the age group 55-64. The proportion of participants with untreated major elevation of BP ranged from 4.5% to 33.7% in men and from 1.9% to 22.3% in women. The proportions of participants receiving antihypertensive medication were 4.3-17.7% for men and 6.0-22.0% for women. These proportions were not correlated with the prevalence of untreated hypertensives. Age-adjusted BMI was associated with SBP and accounted for 14% of the SBP variance in men and 32% in women. We found a large difference in SBP among the MONICA study populations and conclude that the results represent a valid estimate of the public health problem posed by elevated BP. We also have shown that almost universally the problem of elevated BP is more prevalent in women than in men, especially in the older age groups.

Sex difference in high density lipoprotein cholesterol in six countries.

It is known that women have higher levels of high density lipoprotein (HDL) cholesterol than men. The authors examined the association between HDL cholesterol and biologic sex in 8,631 women and 10,690 men aged 45-54 years from six countries studied between 1972 and 1989. The variation in the sex difference for HDL cholesterol was significant; the smallest difference (0.06 mmol/liter) was seen in China and the largest (0.40 mmol/liter) in Canada. Adjustment for differences in body mass index, smoking, alcohol use, and heart rate reduced but did not eliminate the variability. The sex difference in HDL cholesterol levels, usually assumed to be due to biologic factors, differs across cultures and may be related to environmental factors.

Poland and United States Collaborative Study on Cardiovascular Epidemiology. A comparison of HDL cholesterol and its subfractions in populations covered by the United States Atherosclerosis Risk in Communities Study and the Pol-MONICA Project.

HDL cholesterol (HDL-C) levels are inversely related to coronary heart disease (CHD) risk, and HDL-C distributions vary among countries. Poland is one of the few developed countries in which CHD rates are increasing at the same time that US rates have been falling, but whether these differences are explained by differences in risk factors such as HDL-C has not been determined. To examine this possibility, levels of HDL-C and its subfractions were compared in US and Polish urban and rural men and women aged 45 to 64 years. Age-adjusted HDL-C means were 0.20 mmol/L higher in urban Polish men and 0.37 mmol/L higher in rural Polish men than in their US counterparts (P < .0001); means in urban Polish women were 0.06 mmol/L higher (P < .05) and in rural Polish women 0.09 mmol/L higher (P < .001) than in their US counterparts. Adjustment for age, education, alcohol intake, smoking, BMI, heart rate, and menopause status (in women) had little effect on differences. Means of HDL2 and HDL3 levels showed similar between-country differences, although differences were minimal for HDL2 in urban men and women, and HDL3 means did not differ between rural women. BMI was inversely related to HDL-C and both subfractions in all gender-country-site strata (P < .001), and alcohol was directly related to HDL-C (P < .001) in all strata except Polish women. Cigarette smoking was negatively related to HDL-C and both subfractions in all US samples except HDL2 in urban men, whereas in Polish samples, significant associations were found only in urban women for HDL-C and in rural and urban women for HDL3. Age, heart rate, and education showed inconsistent or no association with HDL-C and its subfractions in either country. This profile of HDL-C and its subfractions in Polish samples contrasts sharply with the opposite trend in CHD mortality rates, which suggests either that other risk factors may account for the trends or that the relationship between HDL-C and CHD may differ between the two countries.

[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.