Cognitive Function and Mortality: Results from Kaunas HAPIEE Study 2006-2017.

BACKGROUND: The purpose of the study is to evaluate the association between cognitive function and risk of all-cause and cardiovascular disease mortality during 10 years of the follow-up. METHODS: 7087 participants were assessed in the baseline survey of the Health Alcohol Psychosocial Factors in Eastern Europe (HAPIEE) study in 2006-2008. During 10 years of follow-up, all-cause and CVD mortality risk were evaluated. RESULTS: During 10 years of follow-up, 768 (23%) men and 403 (11%) women died (239 and 107 from CVD). After adjustment for sociodemographic, biological, lifestyle factors, and illnesses, a decrease per 1 standard deviation in different cognitive function scores increased risk for all-cause mortality (by 13%-24% in men, and 17%-33% in women) and CVD mortality (by 19%-32% in men, and 69%-91% in women). Kaplan-Meier survival curves for all-cause and CVD mortality, according to tertiles of cognitive function, revealed that the lowest cognitive function (1st tertile) predicts shorter survival compared to second and third tertiles (p < 0.001). CONCLUSIONS: The findings of this follow-up study suggest that older participants with lower cognitive functions have an increased risk for all-cause and CVD mortality compared to older participants with a higher level of cognitive function.

Long-term survival after stroke in Lithuania: Data from Kaunas population-based stroke registry.

BACKGROUND: There is a lack of reliable epidemiological data on long-term survival trends of first-ever stroke patients in Lithuanian population. AIMS: To evaluate trends in long-term survival after stroke and to determine the influence of some sociodemographic and lifestyle factors, time and subtype of stroke, and stroke care on survival. METHODS: All stroke events included in Kaunas stroke register database 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 2011. Death time was confirmed by the Office for National Death Statistics. Estimates of stroke long-term survival data and factors influencing survival changes were made by applying the Kaplan-Meier and Cox regression analysis. RESULTS: During the study period, 4,129 persons aged 25-64 years suffered from a first-ever stroke: 2,215 (53.6%) of them were men and 1,914 (46.4%)-women. Ischemic stroke was significantly more frequent in males than in females (80.6% and 78.6%, respectively, p<0.05) and subarachnoid hemorrhage was more common in women than in men (9.0% and 7.0% respectively, p <0.05). Of all first-ever stroke patients, 3,272 (79.2%) survived 1 year and 2,905 (70.4%) survived 5 years after stroke onset. The 1- and 5-years survival rate after a first-ever stroke in women was significantly higher as compared with that in men (Log-rank test p = 0.0001). The older (55-64 year) persons had poorer 1-year and 5-years survival rate as compared with persons in the younger (25-54 years) age group (Log-rank test p = 0.0001). Among persons with a first-ever stroke who had their stroke in 2007-2011, 1- and 5-year survival rate was higher compared with that in persons who had had a stroke in 1986-1990 and in 1997-2001 (Log-rank test p = 0.0001). The persons with a first-ever ischemic stroke had a better chance to survive first 1- and 5-years after stroke compared with persons who had intracerebral or subarachnoid haemorrhage. Only female gender was associated with higher 1- and 5-year survival rate after first-ever stroke. The older age, previous myocardial infarction and diabetes mellitus were associated with lower 1- and 5-year survival rate after first-ever stroke. CONCLUSIONS: This population-based study of patients with first-ever stroke demonstrated that the long-term survival was better in women than men, and improved significantly in both men and women during the past decade. Long-term survival was better of those with first-ever ischemic stroke and of younger age- 25 to 54 years.

Long-Term Survival after Acute Myocardial Infarction in Lithuania during Transitional Period (1996-2015): Data from Population-Based Kaunas Ischemic Heart Disease Register.

Background and Objective: There is a lack of reliable epidemiological data on the long-term survival after acute myocardial infarction (AMI) in the Lithuanian population. The aim of the study was to evaluate the long-term (36 months) survival after AMI among persons aged 25-64 years, who had experienced AMI in four time-periods 1996, 2003-2004, 2008, and 2012. Material and Methods: The source of the data was Kaunas population-based Ischemic heart disease (IHD) register. Long-term survival after AMI (36 months) was evaluated using the Kaplan-Meier method. The survival curves significantly differed when p < 0.05. Hazard ratio for all-cause mortality and their 95% CIs, adjusted for baseline characteristics, were estimated with the Cox proportional hazards regression model. Results: The analysis of data on 36 months long-term survival among Kaunas population by sex and age groups showed that the survival rates among men and women were 83.4% and 87.6%, respectively (p < 0.05) and among 25-54 years-old and 55-64 years-old persons, 89.2% and 81.7%, respectively (p < 0.05). The rates of long-term survival of post-AMI Kaunas population were better in past periods than in first period. According to the data of the Kaplan-Meier survival analysis, long-term survival of 25 to 64-year-old post-AMI Kaunas population was without significantly difference in 1996, 2003-2004, 2008 and 2012 (Log-rank = 6.736, p = 0.081). The adjusted risk of all-cause mortality during 36 months among men and 25 to 54-year-old patients was on the average by 35% and 60% lower in 2012 than in 1996, respectively. Conclusion: It was found that 36 months survival post MI among women and younger (25-54 years) persons was significant better compared to men and older (55-64 years) persons. Long-term survival among 55 to 64-year-old post-AMI Kaunas population had a tendency to decrease during last period, while among 25-54 years old persons long-term survival was without significant changes. The results highlight the fact that AMI survivors, especially in youngest age, remain a high-risk group and reinforce the importance of primary and secondary prevention for the improvement of long-term prognosis of AMI patients.

Trends in electrocardiographic abnormalities and risk of cardiovascular mortality in Lithuania, 1986-2015.

BACKGROUND: This study aimed to assess the trends in the prevalence of electrocardiographic (ECG) abnormalities from 1986 to 2015 and impact of ECG abnormalities on risk of death from cardiovascular diseases (CVD) in the Lithuanian population aged 40-64 years. METHODS: Data from four surveys carried out in Kaunas city and five randomly selected municipalities of Lithuania were analysed. A resting ECG was recorded and CVD risk factors were measured in each survey. ECG abnormalities were evaluated using Minnesota Code (MC). Trends in age-standardized prevalence of ECG abnormalities were estimated for both sexes. Multivariate Cox proportional hazards models were used to estimate hazard ratios (HR) for coronary heart disease (CHD) and CVD mortality. Net reclassification index (NRI), integrated discrimination improvement and other indices were used for evaluation of improvement in the prediction of CVD and CHD mortality risk after addition of ECG abnormalities variable to Cox models. RESULTS: From1986 to 2008, the decrease in the prevalence of Q-QS MC was observed in both genders. The prevalence of high R waves increased in men, while the prevalence of ST segment and T wave abnormalities as well as arrhythmias decreased in women. Ischemic changes and possible MI were associated with a 2.5-fold and 4.4-fold higher risk of death from CVD in men and 1.51-fold and 2.56-fold higher mortality risk from CVD in women as compared to individuals with marginal or no ECG abnormalities. The addition of ECG abnormalities to traditional CVD risk factors improved Cox regression models performance. According to NRI, 18.6% of men were correctly reclassified in CVD mortality prediction model and 25.2% of men - in CHD mortality prediction model. CONCLUSIONS: the decreasing trends in the prevalence of ischemia on ECG in women and increasing trends in the prevalence of left VH in men were observed. ECG abnormalities were associated with higher risk of CVD mortality. The addition of ECG abnormalities to the prediction models modestly improved the prediction of CVD mortality beyond traditional CVD risk factors. The use of ECG as routine screening to identify high risk individuals for more intensive preventive interventions warrants further research.

Psychological well-being and mortality: longitudinal findings from Lithuanian middle-aged and older adults study.

BACKGROUND: The study aimed to examine whether after confounding by possible socio-demographic and other risk factors, psychological well-being is independently associated with reduced all-cause and cardiovascular mortality. METHODS: Initial data were collected within the framework of the international project HAPIEE in 2006-2008. A random sample of 7115 individuals aged 45-72 years was screened. Deaths were evaluated by death register of Kaunas city (Lithuania) in a follow-up study till 2016. Psychological well-being was evaluated by a CASP-12 questionnaire. Socio-demographic, lifestyle, biologic factors and depressive symptoms were evaluated. RESULTS: Age-adjusted survival curves revealed that psychological well-being predicts longevity in men and women (p < 0.001). After adjustment for many possible confounders psychological well-being was independently associated with all-cause mortality in men (HR 0.77; 95% CI 0.62-0.94) and women (HR 0.73; 95% CI 0.56-0.96). However, psychological well-being association with cardiovascular mortality attained statistical significance only in the women's group (HR 0.53; 95% CI 0.33-0.87), but not in men (HR 0.98; 95% CI 0.72-1.33). CONCLUSIONS: Psychological well-being is an important predictor of longevity, controlling well-recognized risk factors such as age, education, cardiovascular diseases, social status, marital status, lifestyle and biological factors and depressive symptoms. Positive psychological well-being should be taken into account when screening older people to prevent negative health outcomes.

Body mass index and other risk factors for kidney cancer in men: a cohort study in Lithuania.

OBJECTIVES: Previous studies have observed notable unexplained geographic differences in incidence of kidney cancer in Europe. Lithuania is among the countries with the highest incidence and mortality. Our objective was to investigate the effect of different lifestyle, anthropometric and biological factors on the risk of kidney cancer in Lithuanian men. METHODS: This population-based cohort study included 6,849 men initially free from cancer. During the follow-up (1978-2008), 79 incident cases of kidney cancer were identified. Cox proportional hazards regression models were used to estimate hazard ratios (HR) and corresponding 95% confidence intervals (95% CI). RESULTS: Risk of kidney cancer was significantly associated with increasing body mass index (BMI), the adjusted HR for ≥ 35 vs. < 25 kg/m2 was 3.00, 95% CI 1.10-8.19 and the HR per 1 unit increment of BMI was 1.07, 95% CI 1.01-1.14. In overweight men (BMI ≥ 25 kg/m2), the HRs for kidney cancer per 10 mmHg increment of systolic or diastolic blood pressure were 1.10, 95% CI 0.96-1.25 and 1.26, 95% CI 1.01-1.56, respectively. We found no significant association between smoking, alcohol consumption or total serum cholesterol level and kidney cancer risk. CONCLUSIONS: This study supports a link between increased BMI and the development of kidney cancer among men in Lithuania. Hypertension appears to be associated with risk of kidney cancer in overweight men, although the assessment was limited by the lack of statistical power.

Changes in psychological well-being among older Lithuanian city dwellers: Results from a cohort study / Cambios en el bienestar psicológico de los habitantes de las ciudades más antiguas de Lituania: resultados de un estudio de cohorte

Background/Objective: The purpose of this study is to evaluate changes of psychological well-being (PWB) in older Lithuanian city dwellers during ten years of follow-up, and to establish factors associated with it. Method: 7,115 men and women of age 45-72 years participated in the initial survey in 2006-2008. In 2016 the follow-up survey was performed among all 6,210 participants who survived. 4,266 individuals responded to postal questionnaires. PWB was evaluated by using CASP-12 questionnaire. Depressive symptoms were evaluated by CES-D-10 scale. Quality of life, self-rated health, and social activity were evaluated. Socio-demographic, socio-economic factors were included into standard questionnaire. Results: PWB deteriorated in all age groups during 10-years follow-up. Poor quality of life, poor self-rated health, having depressive symptoms, and not being member of social organization are associated with lower PWB after 10 years in men and women. Employed-retired, retired, and not socially active women have higher possibility to have lower PWB over 10 years. Conclusions: PWB in older Lithuanian city dwellers deteriorates as many other socio-economic and psychosocial indicators during ten-year follow-up. Mostly psychosocial factors, but not the socio-demographic, and socio-economic ones predict PWB over 10 years. It is crucial to understand and promote predictors of PWB in older age

Antecedentes/Objetivo: Evaluar los cambios en el bienestar psicológico (BP) de los habitantes de las ciudades lituanas más antiguas en un seguimiento de diez años e identificar factores asociados. Método: Inicialmente participaron 7.115 hombres y mujeres de 45-72 años de edad durante los años 2006-2008. En 2016, la encuesta de seguimiento se realizó entre 6.210 participantes. De ellos, 4.266 personas respondieron a los cuestionarios. El BP fue evaluado mediante el cuestionario CASP-12. Los síntomas depresivos mediante la escala CES-D-10. Se evaluó la calidad de vida, la salud y la actividad social. Resultados: El BP se deterioró en todos los grupos de edad a los 10 años de seguimiento. Mala calidad de vida, mala autoevaluación de la salud, síntomas depresivos y la no pertenencia a una organización social se asocian con BP más bajo. Mujeres jubiladas y socialmente inactivas tienen mayor probabilidad de peor BP. Conclusiones: El BP de los habitantes de las ciudades lituanas más antiguas se deteriora, al igual que otros muchos indicadores socioeconómicos y psicosociales a los diez años de seguimiento. La mayoría de los factores psicosociales, aunque no los sociodemográficos y socioeconómicos, predicen el BP. Es crucial promover predictores de bienestar psicológico en la vejez

Changes in psychological well-being among older Lithuanian city dwellers: Results from a cohort study.

Background/Objective: The purpose of this study is to evaluate changes of psychological well-being (PWB) in older Lithuanian city dwellers during ten years of follow-up, and to establish factors associated with it. Method: 7,115 men and women of age 45-72 years participated in the initial survey in 2006-2008. In 2016 the follow-up survey was performed among all 6,210 participants who survived. 4,266 individuals responded to postal questionnaires. PWB was evaluated by using CASP-12 questionnaire. Depressive symptoms were evaluated by CES-D-10 scale. Quality of life, self-rated health, and social activity were evaluated.Socio-demographic, socio-economic factors were included into standard questionnaire. Results: PWB deteriorated in all age groups during 10-years follow-up. Poor quality of life, poor self-rated health, having depressive symptoms, and not being member of social organization are associated with lower PWB after 10 years in men and women. Employed-retired, retired, and not socially active women have higher possibility to have lower PWB over 10 years. Conclusions: PWB in older Lithuanian city dwellers deteriorates as many other socio-economic and psychosocial indicators during ten-year follow-up. Mostly psychosocial factors, but not the socio-demographic, and socio-economic ones predict PWB over 10 years. It is crucial to understand and promote predictors of PWB in older age.

Antecedentes/Objetivo: Evaluar los cambios en el bienestar psicológico (BP) de los habitantes de las ciudades lituanas más antiguas en un seguimiento de diez años e identificar factores asociados. Método: Inicialmente participaron 7.115 hombres y mujeres de 45-72 años de edad durante los años 2006-2008. En 2016, la encuesta de seguimiento se realizó entre 6.210 participantes. De ellos, 4.266 personas respondieron a los cuestionarios. El BP fue evaluado mediante el cuestionario CASP-12. Los síntomas depresivos mediante la escala CES-D-10. Se evaluó la calidad de vida, la salud y la actividad social. Resultados: El BP se deterioró en todos los grupos de edad a los 10 años de seguimiento. Mala calidad de vida, mala autoevaluación de la salud, síntomas depresivos y la no pertenencia a una organización social se asocian con BP más bajo. Mujeres jubiladas y socialmente inactivas tienen mayor probabilidad de peor BP. Conclusiones: El BP de los habitantes de las ciudades lituanas más antiguas se deteriora, al igual que otros muchos indicadores socioeconómicos y psicosociales a los diez años de seguimiento. La mayoría de los factores psicosociales, aunque no los sociodemográficos y socioeconómicos, predicen el BP. Es crucial promover predictores de bienestar psicológico en la vejez.

The Prognostic Value of Combined Smoking and Alcohol Consumption Habits for the Estimation of Cause-Specific Mortality in Middle-Age and Elderly Population: Results from a Long-Term Cohort Study in Lithuania.

AIM: To evaluate the prognostic value of combined smoking and alcohol consumption habits for the estimation of cause-specific mortality risk in middle-age and elderly population. METHODS: The study presents data from the four surveys. A random sample of 6,729 subjects aged 35-64 years was selected for statistical analysis. During the follow-up of 31 years (1983-2014), there were 2,158 deaths from any cause. Multivariate Cox's proportional hazards models were used to estimate hazard ratios (HR) for all-cause mortality and Competing Risk Regression analysis was used to estimate subdistribution hazard risk (SHR) for cause-specific mortality. RESULTS: Smoking clearly increased the risk of all-cause mortality and mortality from cancer and cardiovascular disease (CVD), but alcohol use had little effect in men aged 35-64 years. However, heavy alcohol consumption (>14 units/week) increased the risk of all-cause mortality and mortality from external causes in the never-smokers men group who drank alcohol of 1-14 units/week (HR 2 = 1.57 and SHR 2 = 2.40, resp.). CONCLUSIONS: The smoking habits and alcohol consumption are modifiable risk factors, and thus efforts to support abstinence from alcohol and smoking use should be a public health priority.

An optimal ultrasonographic diagnostic test for early gout: A prospective controlled study.

Objective To identify the optimal sites for classification of early gout by ultrasonography. Methods Sixty patients with monosodium urate crystal-proven gout (25 with early gout [≤2-year symptom duration], 35 with late gout [>2-year symptom duration], and 36 normouricemic healthy controls) from one centre were prospectively evaluated. Standardized blinded ultrasound examination of 36 joints and the triceps and patellar tendons was performed to identify tophi and the double contour (DC) sign. Results Ultrasonographic sensitivity was lower in early than late gout. Binary logistic regression analysis showed that two ultrasonographic signs (tophi in the first metatarsophalangeal joint [odds ratio, 16.46] and the DC sign in the ankle [odds ratio, 25.18]) significantly contributed to the final model for early gout diagnosis (sensitivity and specificity of 84% and 81%, respectively). The inter-reader reliability kappa value for the DC sign and tophi was 0.712. Conclusions Four-joint investigation (both first metatarsophalangeal joints for tophi and both ankles for the DC sign) is feasible and reliable and could be proposed as a screening test for early ultrasonographic gout classification in daily practice.

Link between healthy lifestyle and psychological well-being in Lithuanian adults aged 45-72: a cross-sectional study.

OBJECTIVE: This study uses a cross-sectional study design to analyse the connection between psychological well-being (PWB) and components of a healthy lifestyle in the Lithuanian population aged 45-72. The purpose of our study is to establish the links between PWB and lifestyle factors such as physical activity, smoking, alcohol consumption and dietary patterns in people above the age of 44. PARTICIPANTS: A stratified sample of 10 940 urban citizens aged 45-72 years were randomly selected from the National Population Register. The response rate was 65%. METHODS: PWB was evaluated by using a Control Autonomy Self-realization and Pleasure (CASP-12) questionnaire. The standard questionnaire included questions regarding the respondent's sociodemographic, socioeconomic and social status. The lifestyle questionnaire evaluated behavioural factors as smoking status, alcohol consumption, nutrition habits and physical activity. Objective measurements of cardiovascular disease (CVD) risk factors were taken. RESULTS: Adjusted for sociodemographic, socioeconomic, social and biological CVD risk factors, the probability of higher PWB increased for physically active men and women and male former smokers. Higher PWB was directly associated with consumption of fresh vegetables and fruits. Responders who consumed potatoes, meat, boiled vegetables and eggs less frequently than average were more likely to have higher PWB. A direct association was ascertained between PWB and consumption of chicken and fish, as well as an inverse association between PWB and consumption of sweets in women. CONCLUSIONS: Healthy lifestyle education efforts should focus on increasing physical activity, controlling smoking and improving diversity in healthy food consumption including the consumption of fresh vegetables and fruits, particularly among older adults with lower PWB.

Trends in major risk factors and mortality from main non-communicable diseases in Lithuania, 1985-2013.

BACKGROUND: This study aimed to assess the trends in the prevalence and levels of risk factors and mortality from main non-communicable diseases in the Lithuanian population aged 45-64 years during 1985 to 2013. METHODS: Data from four general population surveys conducted between 1985 and 2008 were used. All these surveys were carried out in Kaunas city and five randomly selected municipalities of Lithuania. Risk factors measured at each survey included regular smoking, overweight, obesity, arterial hypertension, and high levels of blood lipids. In total, data of 10,719 subjects (4,965 men and 5,754 women) aged 45-64 were analysed. Trends in standardized all-cause mortality and mortality from cardiovascular disease (CVD), coronary heart disease (CHD), and malignant neoplasms were estimated for both sexes by joinpoint regression analysis. RESULTS: In 1985-2013, some favourable trends were observed in the age-standardized mean levels and prevalence of risk factors and mortality from main non-communicable diseases in the Lithuanian middle-aged population. The mean values of blood lipids (with the exception of triglycerides) and the prevalence of dyslipidemias declined. In women, mean levels of systolic blood pressure and body mass index decreased, while in men, the levels of these factors increased. The prevalence of arterial hypertension and obesity increased in men. The proportion of obese women decreased. Smoking prevalence increased in both men and women. From 2007 to 2008, significant downward trends, which were steeper in women than in men, were observed in all-cause, CVD, and CHD mortality. CONCLUSIONS: Despite the favourable changes in some risk factors and mortality rates, the prevalence of risk factors and mortality from main non-communicable diseases in Lithuania are still high. This indicates the importance of the ongoing primary and secondary prevention and optimal treatment of these diseases.

The Prognostic Value of Family History for the Estimation of Cardiovascular Mortality Risk in Men: Results from a Long-Term Cohort Study in Lithuania.

AIM: To evaluate the additional prognostic value of family history for the estimation of cardiovascular (CVD) mortality risk in middle-aged urban Lithuanian men. METHODS: The association between family history of CVD and the risk of CVD mortality was examined in a population-based cohort of 6,098 men enrolled during 1972-1974 and 1976-1980 in Kaunas, Lithuania. After up to 40 years of follow-up, 2,272 deaths from CVD and 1,482 deaths from coronary heart disease (CHD) were identified. Multivariate Cox proportional hazards models were used to estimate hazard ratios (HR) for CVD and CHD mortality. RESULTS: After adjustment for traditional CVD risk factors, the HR for CVD mortality was 1.24 (95% CI 1.09-1.42) and for CHD mortality 1.20 (1.02-1.42) in men with first-degree relatives having a history of myocardial infarction (MI), compared to men without positive family history. A significant effect on the risk of CVD and CHD mortality was also observed for the family history of sudden cardiac death and any CVD. Addition of family history of MI, sudden death, and any CVD to traditional CVD risk factors demonstrated modest improvement in the performance of Cox models for CVD and CHD mortality. CONCLUSIONS: Family history of CVD is associated with a risk of CVD and CHD mortality significantly and independently of other risk factors in a middle-aged male population. Addition of family history to traditional CVD risk factors improves the prediction of CVD mortality and could be used for identification of high-risk individuals.

Anthropometric trends and the risk of cardiovascular disease mortality in a Lithuanian urban population aged 45-64 years.

AIMS: To estimate trends in anthropometric indexes from 1992 to 2008 and to evaluate the risk of cardiovascular disease mortality in relation to anthropometric indexes (body mass index, waist circumference, waist:hip ratio, waist:height ratio). METHODS: Data from the three surveys (1992-2008) are presented. A random sample of 5147 subjects aged 45-64 years was selected for statistical analysis. During follow-up there were 141 deaths from cardiovascular disease (excluding those with cardiovascular disease at entry). Cox's regression was used to estimate the associations between anthropometric indexes and cardiovascular disease mortality. RESULTS: During a 17-year period among men, the prevalence of obesity (body mass index ⩾ 30 kg/m(2)) increased from 18.4% to 32.1% (p < 0.001) and a high level of waist:hip ratio (> 0.9) from 59.3% to 72.9% (p < 0.001). The risk profile of obesity did not change in women, but prevalence of a high level of waist:hip ratio (> 0.85) increased from 25.9% to 41.5% (p < 0.001). Multivariable-adjusted Cox's regression models showed that body mass index, waist circumference, waist:hip ratio, waist:height ratio were associated with cardiovascular disease mortality risk only in men (hazard ratios 1.40, 1.45, 1.49, 1.46 respectively (p < 0.01)). CONCLUSIONS: Our data indicate that anthropometric measures such as body mass index, waist circumference, waist:hip ratio and waist:height ratio are good indicators of cardiovascular disease mortality risk only in men aged 45-64 years.

Health factors and risk of all-cause, cardiovascular, and coronary heart disease mortality: findings from the MONICA and HAPIEE studies in Lithuania.

AIMS: This study investigated the trends and levels of the prevalence of health factors, and the association of all-cause and cardiovascular (CVD) mortality with healthy levels of combined risk factors among Lithuanian urban population. METHODS: Data from five general population surveys in Kaunas, Lithuania, conducted between 1983 and 2008 were used. Healthy factors measured at baseline include non-smoking, normal weight, normal arterial blood pressure, normal level of total serum cholesterol, normal physical activity and normal level of fasting glucose. Among 9,209 men and women aged 45-64 (7,648 were free from coronary heart disease (CHD) and stroke at baseline), 1,219 death cases from any cause, 589 deaths from CVD, and 342 deaths from CHD occurred during follow up. Cox proportional hazards regression was used to estimate the association between health factors and mortality from all causes, CVD and CHD. RESULTS: Between 1983 and 2008, the proportion of subjects with 6 healthy levels of risk factors was higher in 2006-2008 than in 1983-1984 (0.6% vs. 0.2%; p = 0.09), although there was a significant increase in fasting glucose and a decline in intermediate physical activity. Men and women with normal or intermediate levels of risk factors had significantly lower all-cause, CVD and CHD mortality risk than persons with high levels of risk factors. Subjects with 5-6 healthy factors had hazard ratio (HR) of CVD mortality 0.35 (95% confidence interval (CI) 0.15-0.83) compared to average risk in the whole population. The hazard ratio for CVD mortality risk was significant in men (HR 0.34, 95% CI 0.12-0.97) but not in women (HR 0.38, 95% CI 0.09-1.67). CONCLUSIONS: An inverse association of most healthy levels of cardiovascular risk factors with risk of all-cause and CVD mortality was observed in this urban population-based cohort. A greater number of cardiovascular health factors were related with significantly lower risk of CVD mortality, particularly among men.

Body mass index, cholesterol level and risk of lung cancer in Lithuanian men.

OBJECTIVE: Our objective was to investigate the association between body mass index (BMI), total serum cholesterol (TSC) level and risk of lung cancer in a Lithuanian population-based cohort study. MATERIALS AND METHODS: The study included 6729 men initially free from cancer. During the follow-up (1978-2008), 358 lung cancer cases were identified. Cox proportional hazards models were used to estimate hazard ratios (HR) and corresponding 95% confidence intervals (95% CI). RESULTS: Following adjustment for age, smoking, alcohol consumption, and education, BMI 25-29.9 and ≥30.0kg/m(2) hazard ratios (HR) were significantly associated with decreasing risk for lung cancer, HR=0.73; 95% CI: 0.59, 0.91 and 0.62; 95% CI: 0.45, 0.87, respectively (ptrend=0.001) compared to BMI<25 kg/m(2). Inverse association between BMI and lung cancer was observed among current smokers. We found no evidence that BMI was associated with decreased lung cancer risk in never smokers, although small sample size precluded meaningful analysis. Not significantly lower risk of lung cancer among participants in the 5th quintile compared with the 1st quintile of TSC concentrations was observed. HR per 1 mmol/l increase of TSC was 0.90; 95% CI: 0.82, 1.00. Findings suggest consistent effects of BMI and TSC when follow-up was 1993-2008. CONCLUSION: Our results show an inverse dose-dependent association between lung cancer risk and BMI in Lithuanian men, especially among current smokers. The inverse association could not be attributed to preclinical cancer effect hypothesis. TSC level was not statistically significantly related to a lung cancer incidence.

The relationship of green space, depressive symptoms and perceived general health in urban population.

AIMS: To assess the relationship between green space proximity, use of green space and depressive symptoms and perceived general health among a random sample men and women. METHODS: Cross-sectional study of a population-based sample of 6,944 45-72 year old Kaunas city residents. Self-reported questionnaires provided information on sociodemographic variables, health behaviours, depressive symptoms and poor and very poor perceived general health. Residential proximity to green spaces was defined as living less than 300 m, within interval of 300-999 m, and equal or more than 1 km from a park. The use of the park was divided into two categories: no park use or use <4hrs/week and use of the park ≥4 h/week. The study received approval from the Kaunas Regional Research Ethics Committee. Multiple logistic regression assessed the associations controlling for confounding variables. RESULTS: The prevalence of depressive symptoms and poor and or very poor perceived general health was higher in women than in men. The association between the use of the park and residential proximity to the park revealed that women living >300 m from a green space and who used the space ≥4 h/week showed higher odds 1.92 (1.11-3.3) and 1.68 (0.81-3.48) of depressive symptoms and poor and very poor perceived general health as compared to those who used the park <4 hrs/week and residential proximity was >300 m. CONCLUSIONS: The results of our study confirmed an association between use of the green space, residential proximity, and depressive symptoms and poor and very poor perceived general health among women only.

Cigarette smoking, educational level and total and site-specific cancer: a cohort study in men in Lithuania.

Smoking is an established risk factor for cancer. However, most studies have been carried out on western populations, and less is known about the impact in central and eastern Europe. Our objective was to investigate the association between cigarette smoking, educational level and risk of cancer in a Lithuanian population-based cohort study. The study included 6976 men initially free from cancer. During the follow-up (1978-2008), 1780 cancer cases were identified. Cox proportional hazards models were used to estimate hazard ratios (HRs) and corresponding 95% confidence intervals (95% CIs). In addition, the burden of cancer attributable to smoking was assessed by the population attributable fraction. Following adjustment for age, education, alcohol consumption and BMI, for current compared with never smokers, highly significant and strongly elevated estimates were found for total (HR=1.79, 95% CI 1.59-2.02), tobacco-related (HR=2.52, 95% CI 2.16-2.95), upper aerodigestive tract (UADT) (HR=5.77, 95% CI 2.73-12.21), lung (HR=10.47, 95% CI 6.74-16.25), bladder (HR=3.31, 95% CI 1.71-6.41) and liver (HR=4.64, 95% CI 1.53-14.08) cancer. Findings suggest a lower risk of prostate cancer in current smokers. In addition, the occurrence of lung and UADT cancer was significantly elevated in men in the lowest educational attainment category. If smoking had not occurred, ∼23% of total cancer, 37% of tobacco-related, 77% of lung, 58% of UADT, 43% of liver and 45% of bladder cancer cases could have been prevented in this cohort of men. Cancer-control strategies focused on reducing smoking should be a public health priority.

Correlates of depressive symptoms in urban middle-aged and elderly Lithuanians.

PURPOSE: The study aimed to examine the prevalence of depressive symptoms and their correlates in urban middle-aged and elderly Lithuanian adults. METHODS: Data from the survey was collected within the framework of the international project HAPIEE (Health, Alcohol and Psychosocial Factors in Eastern Europe). A random sample of 7,115 individuals aged 45-72 years was screened in 2006-2008. RESULTS: Depressive symptoms were differently associated with independent variables by sex. In men, deprivation (OR 1.85, 95 % CI 1.54-2.17), being divorced (OR 2.34, 95 % CI 1.61-3.39) or widowed (OR 3.64, 95 % CI 2.40-5.52), physical inactivity (OR 1.30, 95 % CI 1.02-1.65), having a history of spine and joint disease (OR 1.72, 95 % CI 1.36-2.17), average perceived health (OR 2.14, 95 % CI 1.55-2.95), poor perceived health (OR 5.13, 95 % CI 3.39-7.76), average quality of life (OR 2.0, 95 % CI 1.55-2.95), or poor quality of life (OR 8.86, 95 % CI 5.19-15.13) were significantly associated with depressive symptoms. In women, deprivation (OR 1.28, 95 % CI 1.15-1.43), being widowed (OR 1.52, 95 % CI 1.23-1.88), mean dose of alcohol per occasion 40-79.9 g (OR 1.65, 95 % CI 1.18-2.30) and more than 80 g (OR 2.09, 95 % CI 1.14-3.82), physical inactivity in leisure time (OR 1.27, 95 % CI 1.04-1.57), having a history of spine and joint disease (OR 1.26, 95 % CI 1.06-1.51), average perceived health (OR 2.56, 95 % CI 1.89-2.72), poor perceived health (OR 5.07, 95 % CI 3.62-7.11), average quality of life (OR 2.27, 95 % CI 1.89-2.72), or poor quality of life (OR 7.21, 95 % CI 4.73-11.00) were significantly associated with depressive symptoms. CONCLUSIONS: Health status and lifestyle factors are associated with depressive symptoms. Associations between depressive symptoms and long-term health problems are partially mediated by self-rated quality of life and self-rated health.

Consumption of alcohol and risk of cancer among men: a 30 year cohort study in Lithuania.

Studies have indicated hazardous consumption of large quantities of alcohol among adults in Lithuania. We assessed the associations of alcohol consumption at baseline with cancer incidence among men in a population-based cohort study, using Cox models adjusted for smoking, education and body mass index. Attained age was used as a time-scale. During follow-up (1978-2008) 1,698 men developed cancer. A higher amount of alcohol consumption (≥140.1 g/week vs. 0.1-10.0 g/week) was positively associated with increased risk of total cancer [hazard ratio (HR) = 1.36, 95 % confidence interval (95 % CI) 1.11, 1.65], upper aerodigestive tract cancer (HR = 2.79, 95 % CI 1.23, 6.34) and alcohol-related cancers (i.e. oral cavity, pharynx, larynx, oesophagus, colorectal and liver cancer) (HR = 1.88, 95 % CI 1.25, 2.85). Compared to occasional drinkers (a few times/year), drinkers 2-7 times/week showed an increased risk of total (HR = 1.45, 95 % CI 1.16, 1.83), alcohol-related (HR = 1.83 95 % CI 1.14, 2.93) and other cancers (HR = 1.35, 95 % CI 1.04, 1.76). Our results showed no statistically significant associations between quantity of alcohol intake per one occasion and risk of cancer. About 13 % of total, 35 % of upper aerodigestive tract, 22 % of alcohol-related and 10 % of other cancer cases were due to alcohol consumption in this cohort of men.