Predictive importance of the visceral adiposity index and atherogenic index of plasma of all-cause and cardiovascular disease mortality in middle-aged and elderly Lithuanian population.

Background: Two indices: visceral adiposity index (VAI) and atherogenic index of plasma (AIP) during several recent years were implemented into epidemiological studies for predicting of cardiovascular diseases (CVD) and mortality risk. Our study aimed to evaluate the association of VAI and AIP with the risk of all-cause and CVD mortality among the Lithuanian urban population aged 45-72 years. Methods: In the baseline survey (2006-2008), 7,115 men and women 45-72 years of age were examined within the framework of the international study Health, Alcohol and Psychosocial Factors in Eastern Europe (HAPIEE). Six thousand six hundred and seventy-one participants (3,663 women and 3,008 men) were available for statistical analysis (after excluding 429 respondents with the missed information on study variables) and for them, VAI and AIP were calculated. The questionnaire evaluated lifestyle behaviors, including smoking and physical activity. All participants in the baseline survey were followed up for all-cause and CVD mortality events until December 31st, 2020. Multivariable Cox regression models were applied for statistical data analysis. Results: After accounting for several potential confounders, higher levels of VAI (compared 5th quintile to 1st quintile) were associated with significantly higher CVD mortality in men [Hazards ratio (HR) = 1.38] and all-cause mortality in women (HR = 1.54) after 10-year follow-up. CVD mortality significantly increased in men with 0 the highest AIP quintile compared with that for the lowest quintile (HR = 1.40). In women, all-cause mortality was significantly higher for the 4th quintile of AIP as compared with the 1st quintile (HR = 1.36). Conclusions: High-risk VAI levels were statistically significantly associated with all-cause mortality risk in men and women groups. The higher AIP level (5th quintile vs. 1st quintile-in men and 4th quintile vs. 1st quintile-in women) was significantly associated with increased mortality from CVD in the men group and increased all-cause mortality in the women group.

Trends in the Attack Rates, Incidence, and Mortality of Stroke during 1986-2012: Data of Kaunas (Lithuania) Stroke Registry.

BACKGROUND: There is a lack of reliable epidemiological data on longitudinal trends in stroke attack rates, incidence, and mortality in the countries of the Baltic region. AIMS: The aim of the present study was to explore the longitudinal trends of stroke in middle-aged urban population of Lithuania during the period of 1986 through 2012. METHODS: All stroke events in the studied population were ascertained and validated according to the standardized criteria outlined by the WHO MONICA Project. The study included all patients in Kaunas (Lithuania) city aged 25 to 64 years who experienced a stroke between 1986 and 2012. Estimates of time-trends of the annual percentage change in stroke attack rates, incidence of stroke, and mortality from this condition were made by applying the Joinpoint regression analysis. RESULTS: During the study period, 9,992 stroke events were registered. The overall proportion of recurrent events was 25.7%. Overall, 18.9% of the events (20.0% in men, and 17.4% in women) were fatal within 28 days. During the period of 1986 to 2012, a flat trend in the incidence of stroke was observed among both male and female middle-aged inhabitants of Kaunas city, while attack rates were increasing due to the increase in recurrent strokes. Both mortality and 28-day case fatality of stroke declined significantly over the study period in both sexes. CONCLUSIONS: An increase both in the incidence and recurrence of stroke among middle-aged men residing in Kaunas city and in the recurrence of stroke among women denotes the inefficiency of measures applied both for primary and secondary prevention of stroke in Lithuania. The revision of current prevention strategies and the introduction of new ones are of paramount importance in order to fight the epidemic of stroke.

Effects of age, period and cohort on stroke mortality among a middle-aged Lithuanian urban population from 1980 to 2004.

AIMS: The main purpose of this paper was to assess the effect of age, period, and cohort on stroke mortality rates among a Lithuanian urban population aged 25-64 years (1041 men and 724 women) between 1980 and 2004. METHODS: Routine stroke mortality data were obtained from official Kaunas region mortality register by codes 430-438 and I60-I69 in the 9th and in the 10th revisions of the International Classifications of Diseases (ICD), respectively. Mortality rates per 100,000 persons for men and women were age-adjusted using the age distribution of the European Standard Population. Age-specific mortality rates were analysed by sex, period, and birth cohort in eight 5-year age groups and five 5-year age groups. Goodness of fit of the Poisson regression models were evaluated using Pearson and Freeman-Tukey residuals. The age-period and age-period-cohort models provided a significantly better fit than a model with the factors "age'' and "cohort''. RESULTS: During the study period, mortality rates decreased from 46.8 to 33.0 per 100,000 for men, and from 20.2 to 18.1 per 100,000 for women (average annual decrease of -1.3%, p<0.1 for men, and -1.6%, p<0.03 for women). An age effect was present in both sexes. The definite upward period effect was observed from 1990 to 1994 both among men and women, and was followed by a sharp fall during 2000-4. Cohort and period effects have contained relevant information which partially explained trends in stroke mortality among a 25-64 year-old Lithuanian urban population. CONCLUSIONS: During the period of 1980-2004, the mortality trend declined among women only. The period effect contains relevant information for the explanation of increasing mortality rates during 2000-4 among men and women. The Poisson regression models could be applied for the examination and explanation of the different causes of the population mortality.

[Quality of life in stroke survivors]. / Persirgusiuju galvos smegenu insultu gyvenimo kokybe

UNLABELLED: The aim of the study was to compare the quality of life among stroke survivors and healthy controls and to evaluate the influence of age, sex, and social and demographic factors on the quality of life. Contingent and methods. The case group consisted of 508 inhabitants of Kaunas city who were 25-84 years of age and had experienced their first stroke. The control group consisted of age- and sex-stratified randomly selected 508 stroke-free inhabitants of Kaunas city. The quality of life was evaluated using the SF-12 questionnaire. The study compared the quality of life between stroke survivors and controls in eight domains of quality of life and compared the evaluation of quality of life considering social and demographic features. RESULTS: In the domain of physical and mental health, stroke survivors presented poorer evaluation of their quality of life compared to controls except for the evaluations of mental health in the age groups of 25-34 and 35-44 years. As compared to healthy controls, stroke survivors presented poorer evaluation of their quality of life in all domains except for pain. Only in the control group, females presented poorer evaluation of physical health, whereas no differences in the evaluation of mental health between sexes were found. The evaluation of physical health in both groups worsened with age. Both stroke survivors and controls presented better evaluation of their physical health if they were living not alone, were better educated, and were employed compared to those who were living alone, had poorer education level, and were unemployed. In addition, controls who were currently or previously engaged in mental work evaluated their physical health better. CONCLUSIONS: Stroke survivors presented poorer evaluations of their quality of life in both physical and mental health domains compared to controls. Only in the control group, females evaluated their physical health worse than males did. In both groups studied, poorer evaluation of physical health was associated with older age and lower social and demographic status. Relationship between mental health and subjects' social and demographic status was not statistically significant in either of the studied groups.

Diverging trends in the incidence and mortality of stroke during the period 1986-2002: a study from the stroke register in Kaunas, Lithuania.

AIMS: The aim of the present study was to explore the longitudinal stroke trends in the middle-aged Lithuanian population. METHODS: All stroke events in the studied population were ascertained and validated according to the standardized criteria outlined by the WHO MONICA Project. The study included all patients aged 25 to 64 years who experienced a stroke between 1986 and 2002. RESULTS: A flat trend was observed in both the incidence and the attack rates of stroke among men during the 17-year study period, while among women, the incidence of stroke increased by 1.7%/year, and the attack rates by 2.3%/year. The 28-day case fatality and mortality rates of stroke decreased significantly in both sexes. The decline in case fatality explained 100% of the decline in mortality. Among the types of stroke, cerebral infarction contributed most to the decline in the mortality in men. In women, the mortality from cerebral infarction and intracerebral haemorrhage declined similarly to that from all types of strokes. CONCLUSIONS: Findings from our study indicating no positive changes in the incidence of stroke but instead an increase among middle-aged women in Kaunas are disturbing. These results suggest a need for the intensification of appropriate strategies for stroke prevention by the public health officials in Lithuania.

Trends in suicide in a Lithuanian urban population over the period 1984-2003.

BACKGROUND: Throughout the last decade of the twentieth century, Lithuania had the highest suicide rates in Europe among both men and women aged 25-64 years. The rates increased from 1986 until 1995, but later there was a slight decrease. This paper describes the trends in suicide deaths in urban population in Lithuania by gender, dates and suicide method over the period 1984-2003. METHODS: Data from the regional mortality register were used to analyze suicide deaths among all men and women aged 25-64 years in Kaunas city, Lithuania over the period 1984-2003. Age-standardized death rates per 100,000 persons (using European standard population) were calculated by gender, suicide method and dates. A joinpoint regression method was used to estimate annual percentage changes (EPACs) and to detect points where the trends changed significantly. RESULTS: The frequency of death by suicide among males was 48% higher in 1994-2003 than in 1984-1993. The corresponding increase among females was 28%. The most common methods of suicide among men were hanging, strangulation and suffocation (87.4% among all suicide deaths). The proportions of hanging, strangulation and suffocation in males increased by 6.9% - from 83.9% to 89.7% - compared to a 24.2% increase in deaths from handgun, rifle and shotgun firearm discharges and a 216.7% increase in deaths from poisoning with solvents, gases, pesticides and vapors. Among females, the most common methods of suicide were hanging, strangulation and suffocation (68.3% of all suicide deaths). The proportion of hanging deaths among females increased during the time period examined, whereas the proportion of poisonings with solid or liquid substances decreased. CONCLUSION: Suicide rates increased significantly among urban men aged 25-64 years in Lithuania throughout the period 1984-2003, whereas among women an increasing but statistically insignificant trend was observed. There were changes in the suicide methods used by both men and women. Changes in the choice of method may have contributed to the changes in suicide rates.

[Long-term risk of myocardial infarction after a first-ever stroke]. / Miokardo infarkto rizika ligoniams, sirgusiems pirmuoju galvos smegenu insultu.

PURPOSE: To examine the incidence of myocardial infarction during the first three years after a first-ever stroke. MATERIAL AND METHODS: Both Kaunas community-based stroke register and ischemic heart disease register served at the primary source of data. The methods used for data collection were those applied by the World Healt Organisation (WHO) for the WHO MONICA project. During 1986 to 1994, 2531 patients aged 25 to 64 years with a first-ever stroke were registered and followed-up for three years for the information on the first-ever acute myocardial infarction or death from ischemic heart disease. Actuarial life tables were used to analyze risk of myocardial infarction. RESULTS: During the study period, 58 patients with the first-ever acute myocardial infarction that occurred among the first-ever stroke survivors were identified. Fifty-three first-ever ischemic stroke survivors (39 (73.6%) men and 14 (26.4%) women, (p=0.07)) experienced their first-ever myocardial infarction. The cumulative risk of suffering an acute myocardial infarction was 3.5% (95% confidence interval 2.6 to 4.4%) by 3 years: in male ischemic stroke survivors this risk accounted for 4.3% (95% confidence interval 3.0 to 5.6%) and in female - 2.3% (95% confidence interval 1.1 to 3.5%). The risk was the highest one early after ictus in the ischemic stroke survivors: 0.5% (95% confidence interval 0.2 to 0.8%) by 3 months (men - 0.7% (95% confidence interval 0.2 to 1.2%), women - 0.3% (95% confidence interval 0.0 to 0.7%)). CONCLUSION: The risk of myocardial infarction is the highest early after the first stroke, although due to relatively small number of cases confidence intervals were too wide to reach a statistical significance.

Morbidity and mortality from the major cardiovascular diseases in Kaunas population from 1983 to 2002.

UNLABELLED: THE AIM of the present study was to evaluate the trends in morbidity and mortality from ischemic heart disease and stroke in Kaunas population aged 25-64 years from 1983 to 2002. MATERIAL AND METHODS: The source of data is the official mortality statistics and Kaunas population-based ischemic heart disease and stroke registers. The methods used for the data collection were those applied by the WHO MONICA project. The object - all permanent residents of Kaunas aged 25-64 years who died from ischemic heart disease and stroke in 1983-2002 and experienced ischemic heart disease or stroke in 1983-2000. The age-standardized rates were calculated by the direct method and using the Segi's World and European population as a standard. Trends were analyzed using the method of linear regression on logarithms of the age-standardized annual rates. RESULTS: During 1983 to 2000, the morbidity from acute myocardial infarction among Kaunas men aged 25-64 years decreased by 0.8%/yr. (p=0.08), and during 1986-2000, the morbidity from stroke among men of the same age was without significant changes (-0.4%/yr., p=0.5). Among women, both the morbidity from acute myocardial infarction (1.6%/yr., p=0.006) and the morbidity from stroke (2.9%/yr., p=0.000002) rates among women increased statistically significantly. During 1983 to 2002, the mortality rates from acute myocardial infarction and stroke decreased statistically significantly among both men and women: among men - by 2.2%/yr., p=0.003, and by 2.9%/yr., p=0.004, respectively; among women - by 2.6%/yr., p=0.005, and by 3.2%/yr., p=0.002, respectively. CONCLUSIONS: The morbidity of acute myocardial infarction and stroke remained without significant changes among Kaunas men aged 25-64 years, while it increased statistically significantly among women of the same age during the last two decades. Among both men and women the mortality rates from both ischemic heart disease and stroke decreased significantly from 1983 to 2002.

[Long-term risk of stroke after acute myocardial infarction]. / Galvos smegenu insulto rizika persirgus uminiu miokardo infarktu.

PURPOSE: To examine the incidence of stroke during the first three years after a first-ever myocardial infarction. MATERIAL AND METHODS: Both Kaunas community-based ischemic heart disease register and stroke register were used as the primary source of data. The methods used for data collection were those applied by the WHO for the international MONICA project. During 1986 to 1996, 4201 persons aged 25 to 61 years with a first-ever myocardial infarction were included into Kaunas community-based ischemic heart disease register and followed-up for three years against first-ever stroke or death from any cause. Actuarial life tables were used to analyze risk of stroke. RESULTS: During the study period, 82 (2.0%) patients with the first-ever stroke that occurred among survivors of myocardial infarction were identified: 68 (82.9%) men and 14 (17.1%) women. The cumulative risk of stroke was 3.19% (95% CI 2.50 to 3.88%) by 3 years: among male myocardial infarction survivors this risk was accounted for 3.37% (95% CI 2.54 to 4.17%) and that among female--for 2.51% (95% CI 1.22 to 3.80%). The risk was identified as the highest one early after ictus among the myocardial infarction survivors: 0.43% (95% CI 0.21-0.65%) by 3 months (men--0.51% (95% CI 0.24 to 0.78%), women--0.12% (95% CI 0 to 0.38%)) and 0.23% (95% CI 0.05 to 0.41%) by 6 months (men--0.25% (95% CI 0.03 to 0.47%), women--0.18% (95% CI 0 to 0.53%)). CONCLUSION: The risk of stroke is identified as the highest one early after the myocardial infarction.