Secondary prevention in diabetic and nondiabetic coronary heart disease patients: Insights from the German subset of the hospital arm of the EUROASPIRE IV and V surveys.

BACKGROUND: Patients with coronary heart disease (CHD) with and without diabetes mellitus have an increased risk of recurrent events requiring multifactorial secondary prevention of cardiovascular risk factors. We compared prevalences of cardiovascular risk factors and its determinants including lifestyle, pharmacotherapy and diabetes mellitus among patients with chronic CHD examined within the fourth and fifth EUROASPIRE surveys (EA-IV, 2012-13; and EA-V, 2016-17) in Germany. METHODS: The EA initiative iteratively conducts European-wide multicenter surveys investigating the quality of secondary prevention in chronic CHD patients aged 18 to 79 years. The data collection in Germany was performed during a comprehensive baseline visit at study centers in Würzburg (EA-IV, EA-V), Halle (EA-V), and Tübingen (EA-V). RESULTS: 384 EA-V participants (median age 69.0 years, 81.3% male) and 536 EA-IV participants (median age 68.7 years, 82.3% male) were examined. Comparing EA-IV and EA-V, no relevant differences in risk factor prevalence and lifestyle changes were observed with the exception of lower LDL cholesterol levels in EA-V. Prevalence of unrecognized diabetes was significantly lower in EA-V as compared to EA-IV (11.8% vs. 19.6%) while the proportion of prediabetes was similarly high in the remaining population (62.1% vs. 61.0%). CONCLUSION: Between 2012 and 2017, a modest decrease in LDL cholesterol levels was observed, while no differences in blood pressure control and body weight were apparent in chronic CHD patients in Germany. Although the prevalence of unrecognized diabetes decreased in the later study period, the proportion of normoglycemic patients was low. As pharmacotherapy appeared fairly well implemented, stronger efforts towards lifestyle interventions, mental health programs and cardiac rehabilitation might help to improve risk factor profiles in chronic CHD patients.

Factors associated with smoking cessation in patients with coronary heart disease: a cohort analysis of the German subset of EuroAspire IV survey.

BACKGROUND: Tobacco smoking is one of the most important risk factors of coronary heart disease (CHD). Hence, smoking cessation is considered pivotal in the prevention of CHD. The current study aimed to evaluate smoking cessation patterns and determine factors associated with smoking cessation in patients with established CHD. METHODS: The fourth European Survey of Cardiovascular Disease Prevention and Diabetes investigated quality of CHD care in 24 countries across Europe in 2012/13. In the German subset, smoking cessation patterns and clinical characteristics were repetitively assessed a) during index event due to CHD by medical record abstraction, b) as part of a face-to-face interview 6 to 36 months after the index event (i.e. baseline visit), and c) by telephone-based follow-up interview two years after the baseline visit. Logistic regression analysis was performed to search for factors determining smoking status at the time of the telephone interview. RESULTS: Out of 469 participants available for follow-up, 104 (22.2%) had been classified as current smokers at the index event. Of those, 65 patients (62.5%) had quit smoking at the time of the telephone interview, i.e., after a median observation period of 3.5 years (quartiles 3.0, 4.1). Depressed mood at baseline visit and higher education level were less prevalent amongst quitters vs non-quitters (17.2% vs 35.9%, p = 0.03 and 15.4% vs 33.3%, p = 0.03), cardiac rehabilitation programs were more frequently attended by quitters (83.1% vs 48.7%, p < 0.001), and there was a trend for a higher prevalence of diabetes at baseline visit in quitters (37.5% vs 20.5%, p = 0.07). In the final multivariable model, cardiac rehabilitation was associated with smoking cessation (OR 5.19; 95%CI 1.87 to 14.46; p = 0.002). DISCUSSION: Attending a cardiac rehabilitation program after a cardiovascular event was associated with smoking cessation supporting its use as a platform for smoking cessation counseling and relapse prevention.

Smoking cessation in European patients with coronary heart disease. Results from the EUROASPIRE IV survey: A registry from the European Society of Cardiology.

OBJECTIVE: We investigated smoking cessation rates in coronary heart disease (CHD) patients throughout Europe; current and as compared to earlier EUROASPIRE surveys, and we studied characteristics of successful quitters. METHODS: Analyses were done on 7998 patients from the EUROASPIRE-IV survey admitted for myocardial infarction, unstable angina and coronary revascularisation. Self-reported smoking status was validated by measuring carbon monoxide in exhaled air. RESULTS: Thirty-one percent of the patients reported being a smoker in the month preceding hospital admission for the recruiting event, varying from 15% in centres from Finland to 57% from centres in Cyprus. Smoking rates at the interview were also highly variable, ranging from 7% to 28%. The proportion of successful quitters was relatively low in centres with a low number of pre- event smokers. Overall, successful smoking cessation was associated with increasing age (OR 1.50; 95% CI 1.09-2.06) and higher levels of education (OR 1.38; 95% CI 1.08-1.75). Successful quitters more frequently reported that they had been advised (56% vs. 47%, p < .001) and to attend (81% vs. 75%, p < .01) a cardiac rehabilitation programme. CONCLUSION: Our study shows wide variation in cessation rates in a large contemporary European survey of CHD patients. Therefore, smoking cessation rates in patients with a CHD event should be interpreted in the light of pre-event smoking prevalence, and caution is needed when comparing cessation rates across Europe. Furthermore, we found that successful quitters reported more actions to make healthy lifestyle changes, including participating in a cardiac rehabilitation programme, as compared with persistent smokers.

Outcomes of an integrated community-based nurse-led cardiovascular disease prevention programme.

BACKGROUND: National guidance for England recommends that cardiovascular disease (CVD) should be managed as a family of diseases in the community. Here, we describe the results of such an approach. METHODS: Patients with established CVD or who were at high multifactorial risk (HRI) underwent a 12-week community-based nurse-led prevention programme (MyAction) that included lifestyle and risk factor management, prescription of medication and weekly exercise and education sessions. RESULTS: Over a 6-year period, 3232 patients attended an initial assessment; 63% were male, and 48% belonged to black and minority ethnic groups. 56% attended an end-of-programme assessment, and 33% attended a one year assessment. By the end of the programme, there was a significant reduction in smoking prevalence but only in HRI (-3.7%, p<0.001). Mediterranean diet score increased in both CVD (+1.2, p<0.001) and HRI (+1.5; p<0.001), as did fitness levels (CVD +0.8 estimated Mets maximum, p<0.001, HRI +0.9 estimated Mets maximum, p<0.001) and the proportions achieving their physical activity targets (CVD +40%, p<0.001, HRI +37%, p<0.001). There were significant increases in proportions achieving their blood pressure (CVD +15.4%, p<0.001, HRI +25%, p<0.001 and low-density lipoprotein cholesterol targets (CVD +6%, p=0.004, HRI +23%, p<0.001). Statins and antihypertensive medications significantly increased in HRI. Significant improvements in depression scores and quality-of-life measures were also seen. The majority of improvements were maintained at 1 year. CONCLUSION: These results demonstrate that an integrated vascular prevention programme is feasible in practice and reduces cardiovascular risk in patients with established CVD and in those at high multifactorial risk.

Lipid lowering drug therapy in patients with coronary heart disease from 24 European countries--Findings from the EUROASPIRE IV survey.

OBJECTIVE: Since dyslipidaemia is one of the most important risk factors for coronary heart disease (CHD), lowering of LDL-cholesterol (LDL-C) causes significant reduction in morbidity and mortality, particularly in patients with established CHD. The aim of this survey was to assess how statins were prescribed in CHD patients at discharge after a coronary event from hospitals throughout Europe and how the intake of these drugs was reported by the patients when they were seen more than one year later in relationship with their achieved LDL-C levels. METHODS: 6648 CHD patients' data from centres in 24 European countries were gathered using standardized methods. Lipid measurements were performed in one central laboratory. Patients were divided in three groups: high-intensity statin therapy, moderate or low intensity statin therapy and no statin therapy at all. RESULTS: 90.4% CHD patients were on statin therapy at the time of discharge from the hospital which decreased to 86% one year later. Only 37.6% of these patients were prescribed a high-intensity statin at discharge which even decreased to 32.7% later. In only 6 countries (all of them high-income countries) the number of patients on a high-intensity statin therapy increased substantially after the hospital discharge. It is worrying that statin therapy was discontinued in 11.6% and that only 19.3% of all CHD patients achieved target values of LDL-C < 1.8 mmol/L at the time of interview. CONCLUSIONS: Too many CHD patients with dyslipidaemia are still inadequately treated and most of these patients on statin therapy are not achieving the treatment targets. Therapeutic control of LDL-C is clearly related to the intensity of lipid lowering drug regimen after the CHD event indicating that a considerable potential still exists throughout Europe to reduce CHD mortality and morbidity rates through more efficient LDL-C lowering.

Nurse-coordinated multidisciplinary, family-based cardiovascular disease prevention programme (EUROACTION) for patients with coronary heart disease and asymptomatic individuals at high risk of cardiovascular disease: a paired, cluster-randomised controlled trial.

BACKGROUND: Our aim was to investigate whether a nurse-coordinated multidisciplinary, family-based preventive cardiology programme could improve standards of preventive care in routine clinical practice. METHODS: In a matched, cluster-randomised, controlled trial in eight European countries, six pairs of hospitals and six pairs of general practices were assigned to an intervention programme (INT) or usual care (UC) for patients with coronary heart disease or those at high risk of developing cardiovascular disease. The primary endpoints-measured at 1 year-were family-based lifestyle change; management of blood pressure, lipids, and blood glucose to target concentrations; and prescription of cardioprotective drugs. Analysis was by intention to treat. The trial is registered as ISRCTN 71715857. FINDINGS: 1589 and 1499 patients with coronary heart disease in hospitals and 1189 and 1128 at high risk were assigned to INT and UC, respectively. In patients with coronary heart disease who smoked in the month before the event, 136 (58%) in the INT and 154 (47%) in the UC groups did not smoke 1 year afterwards (difference in change 10.4%, 95% CI -0.3 to 21.2, p=0.06). Reduced consumption of saturated fat (196 [55%] vs 168 [40%]; 17.3%, 6.4 to 28.2, p=0.009), and increased consumption of fruit and vegetables (680 [72%] vs 349 [35%]; 37.3%, 18.1 to 56.5, p=0.004), and oily fish (156 [17%] vs 81 [8%]; 8.9%, 0.3 to 17.5, p=0.04) at 1 year were greatest in the INT group. High-risk individuals and partners showed changes only for fruit and vegetables (p=0.005). Blood-pressure target of less than 140/90 mm Hg was attained by both coronary (615 [65%] vs 547 [55%]; 10.4%, 0.6 to 20.2, p=0.04) and high-risk (586 [58%] vs 407 [41%]; 16.9%, 2.0 to 31.8, p=0.03) patients in the INT groups. Achievement of total cholesterol of less than 5 mmol/L did not differ between groups, but in high-risk patients the difference in change from baseline to 1 year was 12.7% (2.4 to 23.0, p=0.02) in favour of INT. In the hospital group, prescriptions for statins were higher in the INT group (810 [86%] vs 794 [80%]; 6.0%, -0.5 to 11.5, p=0.04). In general practices in the intervention groups, angiotensin-converting enzyme inhibitors (297 [29%] INT vs 196 [20%] UC; 8.5%, 1.8 to 15.2, p=0.02) and statins (381 [37%] INT vs 232 [22%] UC; 14.6%, 2.5 to 26.7, p=0.03) were more frequently prescribed. INTERPRETATION: To achieve the potential for cardiovascular prevention, we need local preventive cardiology programmes adapted to individual countries, which are accessible by all hospitals and general practices caring for coronary and high-risk patients.

Treatment potential for cholesterol management in patients with coronary heart disease in 15 European countries: findings from the EUROASPIRE II survey.

BACKGROUND: During the last decade, the evidence of beneficial effects of cholesterol lowering in patients with coronary heart disease (CHD) has been proven in several clinical trials. This has prompted international guidelines on prevention of CHD to include recommendations on dietary and pharmacological treatment of hyperlipidaemia with set goals on total- and LDL-cholesterol. METHODS: The first EUROASPIRE survey performed in 1995/1996 showed poor adherence to the European recommendations on lipid-lowering in patients with CHD. The second survey was carried out in 1999/2000 in 15 European countries and enrolled 8181 patients with CHD. Medical records were assessed and clinical examinations of risk factors including serum lipids were performed. The aim of this survey is to describe the treatment of hyperlipidaemia among CHD patients in Europe. RESULTS: The proportion of patients not reaching the target of 5.0mmol/l was 58.3% with significant variations between countries. The use of lipid-lowering drugs was relatively high (60.9%). However, the most frequently used doses of lipid-lowering agents were much lower than the doses of proven effect used in clinical trials. CONCLUSIONS: Although the treatment of hyperlipidaemia in CHD patients seems to be improving as compared to the first survey, a significant number of patients do not reach treatment goals. If the full potential of lipid-lowering therapy was utilised with all eligible patients treated and doses titrated correctly, more patients would benefit in terms of reduced morbidity and mortality of CHD.

Screening of family members of patients with premature coronary heart disease; results from the EUROASPIRE II family survey.

AIMS: To determine whether the Joint European Societies' recommendations that first degree blood relatives of patients with premature coronary heart disease (CHD) should be screened for coronary risk factors is being followed and, if so, how effectively these relatives are being managed. METHODS AND RESULTS: Using a postal questionnaire, 3322 relatives (siblings and children >/=18 years of age) of 1289 index patients in the EUROASPIRE II survey who had suffered from premature CHD (men under 55 years and women under 65 years) were asked whether screening for coronary risk factors had occurred and, if so, how they were being managed in terms of lifestyle advice and drug therapies. Overall, screening for coronary risk factors because of CHD in the family was only performed in 11.1% of siblings and 5.6% of children. However, prevalences of different cardiac risk factors were high both in relatives and offspring and a clear familial clustering could be documented. Less than 50% of siblings and 25% of children were given some general lifestyle advice regarding cardiac risk factors. Moreover, active interventions such as starting antihypertensive or lipid lowering drugs were rarely carried out, particularly in children of patients with premature CHD. CONCLUSIONS: European physicians rarely screen family members of patients with premature CHD for cardiac risk factors. General lifestyle style advice or active treatment for these risk factors are also rarely given. However, since these family members have a high prevalence and familial clustering of cardiac risk factors, they form an ideal target population for primary prevention of CHD in high-risk patients.

Vascular changes in workers exposed to carbon disulfide.

AIM: To assess the effects of occupational exposure to carbon disulfide (CS2) concentrations below the threshold limit value (31 mg/m3) on the structural and the functional properties of the arteries, heart rate, blood pressure and lipids. METHODS: Study subjects were 85 male workers in the viscose industry and 35 men without such exposure. The CS2 concentration was determined by personal active sampling. From the common carotid artery diameter, the change in diameter (echography) during the heart cycle and the pulse pressure, local arterial distensibility and compliance were calculated. Global large and small artery elasticity were calculated from registrations of radial artery waveforms. Simultaneously, heart rate and blood pressure were recorded and blood samples were collected for lipid measurements. RESULTS: CS2 concentrations ranged from 2.34 to 32.4 mg/m3. No significant effect of CS2 on blood pressure, total cholesterol, HDL and LDL cholesterol or triglycerides was found. Among the vascular parameters under study, common carotid artery distensibility was significantly lower, and heart rate significantly higher in exposed workers compared to controls. The differences remained significant after adjustment for age, body mass index, smoking habits, alcohol consumption, heart rate and systolic blood pressure. Common carotid artery intima media thickness and global arterial indices did not differ significantly between the two groups. CONCLUSIONS: Exposure to CS2 under the current level may already cause alterations in common carotid artery elastic properties in apparently healthy individuals. Even before biochemical and clinical findings occur, important functional changes in the vessel wall were observed, at least in some vascular territories.

Decreased carotid artery distensibility as a sign of early atherosclerosis in viscose rayon workers.

Carbon disulphide (CS(2)) is known to accelerate atherosclerosis and to increase the risk for cardiovascular diseases. To assess the effect of CS(2) on the functional (distensibility and compliance) and the structural (intima media thickness) properties of the common carotid artery, and blood pressure and lipid metabolism parameters, a cross-sectional study on 85 workers from a viscose rayon factory and 37 controls was carried out. Exposure to CS(2) was assessed by personal monitoring and was well below the threshold limit value-time weighted average. Carotid arterial wall properties were determined using a non-invasive ultrasound wall movement detector system. No significant effect of CS(2) on blood pressure, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol or triglycerides was found. Among the vascular parameters studied, only distensibility was significantly lower and heart rate was significantly higher in exposed subjects compared with the controls. In conclusion, occupational exposure to CS(2) may cause early alterations in arterial elastic properties in young individuals, and even before lipid and clinical findings have occurred, important functional changes in the vessel wall are present.

Occupational exposure to low concentrations of carbon disulfide as a risk factor for hypercholesterolaemia.

OBJECTIVE: The objective of this study was to investigate the effect of occupational exposure to carbon disulfide (CS2) concentrations below threshold limit value (TLV)-time-weighted average (TWA) (31 mg/m3) on total cholesterol, blood pressure and the prevalence of coronary heart disease (CHD). METHODS: A cross-sectional study involving 141 viscose rayon workers (64 men), and 141 age- and gender-matched controls without occupational contact with noxious chemicals, was carried out. The probability for CHD was determined by means of the WHO questionnaire and was 12-lead electrocardiography-coded using Minnesota criteria. Blood pressure was measured by the standardized method of the WHO and blood was examined for total cholesterol. A cumulative exposure index (CS2 index) was calculated for each worker by multiplying the number of years held in a particular job, by the CS2 concentrations in that job-environment. According to the CS2 index, the exposed workers were distributed into two groups: group 1 (CS2 index < 100) and group 2 (CS2 index > or = 100). RESULTS: Depending on the job and specific work place the CS2 concentrations were between 1 and 30 mg/m3. Cholesterol levels were significantly higher in the exposed group (4.9 +/- 0.7) compared with the controls (4.6 +/- 0.7). Adjustment for age, smoking, body-mass index (BMI) and gender showed the significant effect of the CS2 index on the total cholesterol (P < 0.001). The prevalence of hypercholesterolaemia was significantly higher in the exposed group (42.6%), compared with the controls (26.2%); odds ratio (OR) (adjusted for potential confounders) was 2.56, 95% CI 1.47-4.46. Logistic regression showed a significantly increased risk for elevated cholesterol in group 2 (OR 5.52; 95% CI 2.81-10.83). No significant effect of CS2 index on blood pressure and CHD prevalence was found. CONCLUSIONS: The results of our study show that occupational exposure to CS2 concentrations below 31 mg/m3 and a CS2 index > 100 may increase total cholesterol. Our results imply that even the CS2 concentrations below TLV-TWA may produce morbid changes, and suggest the mechanism of the effect of CS2, leading to lipid metabolism disturbances and acceleration of atherosclerosis.

Cardiovascular effects in viscose rayon workers exposed to carbon disulfide.

The objectives of this study were to investigate the cardiovascular effects in workers currently exposed to carbon disulfide (CS2) below the threshold limit value (TLV) of 31 mg/m3 and to determine the prevalence of coronary heart disease (CHD) after long-term exposure. 172 men (91 workers exposed to CS2 in a viscose rayon factory and 81 referent workers) were examined using a medical and job history questionnaire, Rose's questionnaire, and electrocardiography at rest, and by measuring blood pressure and serum lipids and lipoproteins. Personal exposures were monitored simultaneously with active sampling and findings were analyzed according to the NIOSH 1600 method. As a result of technical and organizational improvements, personal CS2 exposures were well below the TLV (5.4-13.02 mg/m3). No significant effect of CS2 on blood pressure or lipids (total cholesterol, HDL and LDL cholesterol, triglycerides, and apolipoproteins AI and B) was found, even after allowance for confounding factors. The prevalence of CHD (ECG abnormalities and chest pain) was higher in the viscose rayon workers than in the workers with no exposure but reached statistical significance for men with exposure histories often years and more only (cumulative CS9 index > or = 150 mg/m3, the most highly exposed group). The findings suggest that the coronary risk is increased in workers previously exposed to high CS2 concentrations but not in those exposed to CS2 levels below the current TLV.

Cardiovascular effects of occupational exposure to carbon disulphide.

The objective of this study was to investigate the effect of occupational exposure to carbon disulphide (CS2) on the total cholesterol, blood pressure and prevalence of coronary heart disease (CHD). A cross-sectional study involving 252 viscose rayon workers and 252 age and sex matched controls was carried out. Depending on the job and specific work place, the CS2 concentrations were between 10 and 64 mg/m3. A cumulative exposure index (CS2 index) was calculated for each worker by multiplying the number of years he had held a particular job with the CS2 concentrations in that job. CHD prevalence among the exposed was higher than among the controls; the difference reaching significance only for highly exposed workers. Cholesterol levels were significantly higher in both highly and moderately exposed groups. In conclusion, the results demonstrated that occupational exposure to CS2 increases total cholesterol and the risk for CHD. While the risk for CHD is increased in workers exposed to high CS2 concentration for many years (CS2 index > or = 300), even the relatively modest exposure (CS2 < 300) may increase the serum cholesterol.

Study of the cardiovascular effects of occupational exposure to organic solvents.

OBJECTIVE: The objective of the present study was to evaluate the effects of occupational exposure to over-concentrations of some organic solvents on the prevalence of arterial hypertension (AH) and pathologic changes in electrocardiography (ECG). METHODS: We studied 345 workers (250 men) aged between 20 and 60 years at a petrochemical factory, and 345 age- and sex-matched controls with no occupational contact with chemical and physical factors. According to the main chemical pollutants in the working environment, the exposed subjects were divided into three groups: group 1, exposed to benzene; group 2, exposed to xylene and benzene, and group 3, exposed to phenol. Physical examination of the heart and routine resting electrocardiography with 12 leads were performed. The degree of AH was determined according to the classification of the American Heart Association (JNC- V, 1993). Statistical analysis was carried out with a SPSS software package. RESULTS: The mean values of systolic and diastolic blood pressure and the prevalence of AH were significantly higher than in control groups 1 and 2. The prevalence of AH was 30.51% [OR = 2.44; 95% confidence interval (CI) 1.24-4.85; P = 0.0054] in group 1 and 27.92% (OR = 2.00; 95% CI 1.11-3.61; P = 0.0136) in group 2. The same relationship was found for the prevalence of ECG abnormalities: group 1, 17.7% (OR = 2.34; 95% CI 0.99-5.63; P = 0.0344) and group 2, 18.83% (OR = 2.75; 95% CI 1.28-5.97; P = 0.0044). The supraventricular and ventricular ectopic beats were the most frequent, followed by conduction defects and repolarization disturbances. In group 3, the prevalence of AH (23.29%) and ECG changes (13.7%) were higher than in the controls, but the differences were not significant. A significant correlation between the length of service and systolic and diastolic blood pressure (after controlling for major cardiovascular risk factors) was found in groups 1 and 2. CONCLUSIONS: These results show that those workers occupationally exposed to high concentrations of benzene and xylene have an increased prevalence of AH and pathologic changes in ECG. There was no convincing evidence of increased cardiovascular risk associated with occupational exposure to phenol.

[The incidence of arterial hypertension and ischemic heart disease in workers manufacturing nitrogen and phosphorus fertilizers]. / Prouchvane vurkhu chestota na arterialnata khipertoniia i iskhemichnata bolest na surtseto pri rabotnitsi ot proizvodstvo na azotni i fosforni torove.

Examinations are performed on 120 workers from the plant for nitrogen and 253 workers from the plant for phosphorous fertilizers. For comparison is used a control group of 103 persons having no professional contact with chemical noxa. The measuring of the arterial pressure and assessment of the arterial hypertension rate is performed after the standardised method of the World Health Organization (1984). The probability of ischemic disease of the heart is determined on the basis of the electrocardiographic changes (Minnesota code) and the data of the questionnaire of G. A. Rose (WHO, 1984). The results point out, that the arterial hypertension incidence and that of the ischemic disease of the heart in the exposed workers in both plants is insignificantly higher than that of the controls. There is no effect of the specialized length of service on the dissemination of the registered cardio-vascular diseases. The data of the carried out investigation show no presence of heightened risk of arterial hypertension and ischemic heart disease in workers from the nitrogen and phosphorous fertilizers production.

[Epidemiological examinations of the workers at a thermoelectric power station]. / Epidemiologicheskie obsledovaniia rabotaiushchikh na teplovoi élektrostantsii.

Medical and clinico-laboratory examinations were performed of thermoelectric power station (TES) workers who were exposed to the hazardous factors related to the technological process and contamination substances transferred from other industrial sites. Following prepathologic and pathologic states were registered: respiratory functional disorders, ischemic heart disease, arterial hypertension, audiometric state deviations and acoustic nerve neuritis, irritative dermatitis. Basing on the data obtained, risk groups identification was performed.

[A method for the quantitative evaluation of the probability of ischemic heart disease in epidemiological research on workers exposed to harmful effects]. / Metod za kolichestvena otsenka na veroiatnostta za iskhemichna bolest na surtseto pri epidemiologichni izsledvaniia na rabotnitsi, izlozheni na vredni vuzdeistviia.

A method for quantitative evaluation of the probability for ischaemic disease of the heart in epidemiological studies is recommended and the state of risk is determined by riskogram, including 3 parts: 1. Assessment of the electrocardiographic changes after Minnesota code. 2. Integral quantitative interpretation of ECG-changes with the data from the Rose test. 3. Classified quantitative assessment of the probability for ischaemic disease of the heart. The quantitative interpretation of the probability for ischaemic disease of the heart allows the use of various statistical methods, mathematical models and computer processing of data, received at the epidemiological studies. By tracing the dependences "dose-effect" and "dose-response" the maximum admissible duration of the length of service could be predicted in specific conditions of professional exposure, in order to prevent injury of the cardiovascular system from harmful industrial factors.