Identifying associations between the social network index, its components, and the prevalence of cardiovascular diseases in Polish adults. Results of the cross-sectional WOBASZ II study.

BACKGROUND: Psychosocial risk factors are important determinants of cardiovascular diseases (CVDs): people involved in positive relationships live longer than those with low social support (SS). AIMS: Our study aimed to evaluate the association between SS, components of the social network, and CVDs. METHODS: A cross-sectional population-based survey WOBASZ II conducted in the years 2013-2014 included a sample of 6043 individuals, aged 20 and over, who completed the Berkman-Syme questionnaire to assess SS using the social network index (SNI). RESULTS: Higher percentage of low SS was observed in women (52.15%) compared to men (45.4%) (P <0.001). People with a low SNI had a worse CVD risk factor profile. None of the analyzed social contacts (with children, relatives, or friends), regardless of how satisfactory they were, was associated with CVDs in men. In women, satisfying contact with children or relatives appeared to be associated with better cardiovascular health. Furthermore, active participation in organized social activity increased the chance of arrhythmia in both sexes: 1.50 (1.04-2.15); P = 0.029 in men; 1.47 (1.11-1.95); P = 0.007 in women. Although a low SNI was associated with analyzed CVDs in the univariate analysis, it was not confirmed in the fully adjusted model. CONCLUSIONS: More women had low SS compared to men. People with low SS had a worse CVD risk factor profile. There was a significant independent relationship between different components of the SNI, such as social contacts and CVDs in women and active participation in organized social activity and arrhythmia in both sexes.

Genetic investigation of fibromuscular dysplasia identifies risk loci and shared genetics with common cardiovascular diseases.

Fibromuscular dysplasia (FMD) is an arteriopathy associated with hypertension, stroke and myocardial infarction, affecting mostly women. We report results from the first genome-wide association meta-analysis of six studies including 1556 FMD cases and 7100 controls. We find an estimate of SNP-based heritability compatible with FMD having a polygenic basis, and report four robustly associated loci (PHACTR1, LRP1, ATP2B1, and LIMA1). Transcriptome-wide association analysis in arteries identifies one additional locus (SLC24A3). We characterize open chromatin in arterial primary cells and find that FMD associated variants are located in arterial-specific regulatory elements. Target genes are broadly involved in mechanisms related to actin cytoskeleton and intracellular calcium homeostasis, central to vascular contraction. We find significant genetic overlap between FMD and more common cardiovascular diseases and traits including blood pressure, migraine, intracranial aneurysm, and coronary artery disease.

Suicide Risk Factors among Polish Adults Aged 65 or Older in 2000-2018 Compared with Selected Countries Worldwide.

The aim of this study was to determine the tendencies of change in suicide frequency among Polish adults aged 65 or older, recognize the importance of available socio-demographic data (age, sex, marital status, and education attainment level) and provide an in-depth psychological understanding of the obtained results. We analysed the influence of education and marital status on suicide risk in the Polish adult population aged 65 or older, which has not been previously presented in publications related to the Central Statistical Office or any other research. Our results indicated that male adults aged 65 or older that were single or divorced and with a lower education had a higher risk of death by suicide. In female adults aged 65 or older, those with higher education and who were divorced or married had a higher risk of fatal suicide behaviour meanwhile, single women and widows had a lower risk. The dominant method of suicide among Polish older adults was suicide by hanging, regardless of sex; female older adults were more likely to die by suicide by poisoning or jumping from a height, and male older adults were more likely to die by shooting with a firearm. Although data from recent years highlights a downward trend for suicide rates in Polish older adults, the problem cannot be considered solved.

Association between cardiovascular diseases and depressive symptoms in adults. A pooled analysis of population-based surveys: WOBASZ, NATPOL 2011, and WOBASZ II.

INTRODUCTION Psychosocial risk factors play an important role in the origins of cardiovascular risk. OBJECTIVES The aim of the study was to evaluate the prevalence of depressive symptoms (DSs) in relation to some sociodemographic characteristics and selected cardiovascular diseases (CVDs) and to assess the relationship between self­reported CVDs and the severity of DSs. PATIENTS AND METHODS Three cross­sectional population­based surveys: WOBASZ (2003-2005), NATPOL 2011 (2011), and WOBASZ II (2013-2014) covered a total sample of 20 514 participants (9614 men and 10 900 women), aged 20 to 74 years, who all completed the Beck Depression Inventory. RESULTS One­fifth of men and one­third of women had DSs. The prevalence of DSs increased with age, was higher in unmarried persons and in individuals with a medical history of CVDs, and decreased with increasing education level. Individuals with DSs, both men and women, even those with borderline depression, had from 1.5- to more than 2­fold higher odds of either coronary artery disease or arrhythmia, and 2- to almost 4­fold higher chance of previous stroke in their medical history. CONCLUSIONS This study showed that DSs were a frequently observed condition in the general Polish population including patients with CVDs. We also demonstrated that there is a relationship between self­reported CVDs and severity of DSs regardless of age, marital status, education, and concomitant disorders.

Ten-year changes in adherence to a healthy lifestyle: the results of the WOBASZ surveys.

INTRODUCTION: The evidence on the beneficial role of low­risk characteristics is well established. However, data on trends in lifestyle patterns in Central Europe are limited. OBJECTIVES: The aim of this report was to determine changes in lifestyle patterns among adults in Poland between 2003 and 2014. PATIENTS AND METHODS: The study sample comprised 12 857 adults aged 20 to 74 years (5986 men and 6871 women) participating in 2 nationwide representative surveys, the WOBASZ (2003-2005) and WOBASZ II (2013-2014). Low­risk characteristics included: nonsmoking, nonobese waist circumference, satisfactory physical activity, good-quality diet, and low saturated fat intake. The 5 characteristics cre­ ated a lifestyle index ranging from 0 to 5. A poor lifestyle was defined as the lifestyle index from 0 to 1. RESULTS: About 2% of the participants followed a healthy lifestyle, and 25%, a poor lifestyle in both surveys. The proportion of nonsmokers significantly increased (from 57.8% to 66.9% for men and from 72.6% to 77.1% for women). There was a significant decrease in the prevalence of nonobese waist circumference (from 75.4% to 71.3% among men and from 61.2% to 57.9% among women), adequate physical activity (from 37.5% to 27.5% among men and from 31.5% to 29% among women), and low saturated fat consumption (from 23.4% to 20.2% among men and from 26.1% to 23.7% among women). Lower educational attainment was the strongest sociodemographic factor contributing to a poor lifestyle (P <0.001). CONCLUSIONS: The ultimate goal for the healthcare system should be to implement more effective interventions focused on promoting healthy lifestyle as a whole.

Population prevalence of electrocardiographic abnormalities: results of the Polish WAW­KARD study.

BACKGROUND: Electrocardiogram (ECG) is a very important instrument in the diagnostic workup of the heart disease, both in clinical and epidemiological studies. AIMS: The aim of the study was to evaluate ECG abnormalities in adult residents of Warsaw and to determine the time trends of ECG abnormalities in the years 1984 to 2012. METHODS: A total of 1081 individuals aged 20 years of older were examined in the years 2011 to 2012. All of them had resting ECG obtained, later coded using the Minnesota Code. To determine time trends, we additionally used the ECG data from Pol­MONICA studies. RESULTS: More than one­third of individuals had normal ECG, and that number increased to half of them when heart rate was ignored as the only abnormality (in young persons 44% and 69.8%, respectively, and in asymptomatic individuals 45.9% and 68.1%, respectively). The most prevalent abnormality in men was intraventricular conduction disturbances, and in women ST­segment depression and negative T­wave changes (repolarization changes). QRS­axis deviation and R wave of high amplitude were observed significantly more often in men compared with women. The frequency of ECG abnormalities and simultaneous occurrence of several ECG changes increased with the age of the study participants. CONCLUSIONS: Normal ECG was observed only in one­third of adult residents of Warsaw, and in half of those who were young or asymptomatic. The most frequent ECG abnormalities in men were intraventricular conduction disturbances and repolarization changes in women. Atrial fibrillation was the most prevalent arrhythmia. We did not find significant time trends for repolarization changes, conduction disturbances, and arrhythmia.

Depressive symptoms and cardiovascular diseases in the adult Polish population. Results of the NATPOL2011 study.

BACKGROUND: Poland is a country of high cardiovascular risk. Because depression was found to be a predictor of coronary artery disease and the prevalence of depressive symptoms (DSs) has risen worldwide, their monitoring in the population is desirable. AIM: We sought to evaluate the prevalence of DSs in relation to the socio-demographic status and selected types of cardio-vascular diseases in the adult Polish population. METHODS: A country-representative random sample of 2413 subjects, aged 18 to 79 years, was examined in 2011. Rates of self-reported cardiovascular conditions including hypertension (HT), coronary artery disease (CAD), previous myocardial infarction (MI), heart failure, atrial fibrillation (AF), and stroke were assessed by a questionnaire, and the prevalence of DSs was assessed by Beck Depression Inventory (BDI), separately in men and women. DSs were defined as BDI score ≥ 10 points. RESULTS: Depressive symptoms were found in 23.4% of men and 33.4% of women (p < 0.0001). The prevalence of DSs increased with age, from 16.5% in the youngest group of men to 48.3% in the oldest group of women. We found that DSs were significantly more prevalent in subjects suffering from HT, CAD, stroke, AF, and diabetes, and also in women after MI. The rates of DSs in women with a history of MI or stroke were extremely high (76.3% and 83.3%, respectively). Age and primary education level were associated with DSs, as was history of stroke in women. DSs were more often found in older persons and in those with primary level of education. CONCLUSIONS: Depressive symptoms were more prevalent in women compared to men, and they were significantly and inde-pendently associated with age and primary education level in both sexes, and with a history of stroke in women.

Cardiovascular health knowledge of the Polish population. Comparison of two national multi-centre health surveys: WOBASZ and WOBASZ II.

BACKGROUND AND AIM: To compare the cardiovascular health knowledge (CHK) of the adult Polish population in the years 2003-2005 and 2013-2014, and to evaluate the CHK determinants in the Polish adult population. METHODS: Data came from the two random samples of the Polish population, screened in 2003-2005 in the WOBASZ health survey (6392 men and 7153 women, aged 20-74 years) and in 2013-2014 in the WOBASZ II health survey (2751 men and 3418 women, aged 20+ years). For the present analysis, the population of WOBASZ II was limited to persons aged 20-74 years. A CHK score (CHKs) was constructed based on questionnaire answers of responders, and the results of physical examination and ranged from -1 (lowest knowledge) to +6 (highest knowledge). RESULTS: Women had greater CHK than men. In both studies, about 30% of women and 40% of men did not know their blood pressure (BP). About 20% of men and women that declared their BP awareness was not able to classify it correctly to the normal or high category. Most persons that declared body weight awareness could give their body weight to within 2 kg and could correctly classify it as normal or overweight/obesity. The mean CHKs raised in men from 1.74 in WOBASZ to 1.93 in WOBASZ II (in women, respectively, from 2.10 to 2.23). The chance of having CHK greater than mean value of CHKs increased in men by 31% and in women by 27% in WOBASZ II compared to WOBASZ (ORCHK = 1.31, p < 0.0001 in men; ORCHK = 1.27, p < 0.0001 in women). Younger, better educated persons and men with coronary artery disease history and persons with familial history of death from myocardial infarction or stroke had greater health knowledge. CONCLUSIONS: Since 2003 Polish adults significantly advanced their knowledge and awareness of cardiovascular risk factors. Gender, age, education level, coronary artery disease history, and family history of cardiovascular disease death are significant determinants of CHK. From 20% to 30% of studied persons who declared their awareness, were shown to be unaware of their own cardiovascular disease risk factors.

OXTR polymorphism in depression and completed suicide-A study on a large population sample.

In the light of contradictory results concerning OXTR polymorphism rs53576 and depression, we decided to verify the potential association between the two on 1) a large, ethnically homogenous sample of 1185 individuals who completed the Beck Depression Inventory (BDI), as well as on 2) a sample of 763 suicide victims. In the population sample, AA males showed significantly lower BDI scores (p=0.005, pcor=0.030). Exploratory analyses suggested that this effect was limited to a subgroup within 0-9 BDI score range (p=0.0007, U-Mann Whitney test), whereas no main effect on depressive symptoms (BDI>9) was found. In the suicide sample no association with rs53576 genotype was present. Exploratory analyses in suicides revealed higher blood alcohol concentration (BAC) among AA than GG/GA males (p=0.014, U-Mann Whitney test). Our results show that the OXTR rs53576 variant modulates the mood in male individuals and may positively correlate with alcohol intake among male suicides, but is not associated with suicide or depression. The study adds to the growing knowledge on rs53576 genotype characteristics.

Ten-Year Changes in the Prevalence and Socio-Demographic Determinants of Physical Activity among Polish Adults Aged 20 to 74 Years. Results of the National Multicenter Health Surveys WOBASZ (2003-2005) and WOBASZ II (2013-2014).

INTRODUCTION: The aim of the study was to estimate ten-year changes in physical activity (PA) patterns and sociodemographic determinants among adult residents of Poland. METHODS: The study comprised two independent samples of randomly selected adults aged 20-74 years participating in the National Multicentre Health Survey WOBASZ (2003-2005; n = 14572) and WOBASZ II (2013-2014; n = 5694). In both surveys the measurements were performed by six academic centers in all 16 voivodships of Poland (108 measurement points in each survey). Sociodemographic data were collected by an interviewer-administered questionnaire in both surveys. Physical activity was assessed in three domains: leisure-time, occupational and commuting physical activity. RESULTS: Leisure-time PA changed substantially between the surveys (p<0.001). The prevalence of subjects being active on most days of week fell in both genders in the years 2003-2014 (37.4% vs 27.3% in men); 32.7% vs 28.3% in women. None or occasional activity increased from 49.6% to 56.8% in men, while remained stable in women (55.2% vs 54.9%). In both WOBASZ surveys the likelihood of physical inactivity was higher in less educated individuals, smokers and those living in large agglomerations (p<0.01). No significant changes were observed in occupational activity in men between the surveys, while in women percentage of sedentary work increased from 43.4% to % 49.4% (p<0.01). Commuting PA decreased significantly in both genders (p<0.001). About 79.3% of men and 71.3% of women reported no active commuting in the WOBASZ II survey. CONCLUSIONS: The observed unfavourable changes in PA emphasize the need for novel intervention concepts in order to reverse this direction. Further detailed monitoring of PA patterns in Poland is of particular importance.

DISC1 as a Possible Genetic Contribution to Opioid Dependence in a Polish Sample.

OBJECTIVE: Disrupted-in-schizophrenia 1 (DISC1) has been linked to vulnerability to a variety of psychiatric disorders and neuropsychiatric phenotypes. However, DISC1 has not been frequently examined as a potential risk factor for substance dependence. An association between opioid dependence and DISC1 rs2738888 polymorphism has been recently reported. In addition, opioid dependence was associated with rs6419156 located close to the protein phosphatase 3 catalytic subunit alpha isoform (PPP3CA) gene. The aim of the present study was to examine the associations between opioid dependence with rs2738888 and rs6419156 in an independent sample. METHOD: The selected polymorphisms were genotyped in a sample of 392 individuals (69.9% male) diagnosed as alcohol- and/or opioid-dependent. A control group (n = 257; 67.7% male) was derived from the Polish National Health Survey (N = 14,350). RESULTS: The frequency of rs2738888 C allele was higher in controls than in opioid-dependent cases (OR = 0.65, p = .045). Phenotypic-oriented analyses performed within opioid-dependent individuals revealed the association between lifetime suicide attempt and rs2738888. The C allele of rs2738888 had a protective effect on lifetime suicide attempt in opioid-dependent patients (OR = 0.25, p = .003). Rs6419156 was not associated with substance dependence in the examined sample. CONCLUSIONS: The DISC1 may play an important role in vulnerability to opioid dependence. In addition, DISC1 may also be a genetic risk factor for suicide attempt in opioid-dependent individuals.

A study in Polish patients with cardiomyopathy emphasizes pathogenicity of phospholamban (PLN) mutations at amino acid position 9 and low penetrance of heterozygous null PLN mutations.

BACKGROUND: In humans mutations in the PLN gene, encoding phospholamban - a regulator of sarcoplasmic reticulum calcium ATPase (SERCA), cause cardiomyopathy with prevalence depending on the population. Our purpose was to identify PLN mutations in Polish cardiomyopathy patients. METHODS: We studied 161 unrelated subjects referred for genetic testing for cardiomyopathies: 135 with dilated cardiomyopathy, 22 with hypertrophic cardiomyopathy and 4 with other cardiomyopathies. In 23 subjects multiple genes were sequenced by next generation sequencing and in all subjects PLN exons were analyzed by Sanger sequencing. Control group included 200 healthy subjects matched with patients for ethnicity, sex and age. Large deletions/insertions were screened by real time polymerase chain reaction. RESULTS: We detected three different heterozygous mutations in the PLN gene: a novel null c.9_10insA:(p.Val4Serfs*15) variant and two missense variants: c.25C > T:(p.Arg9Cys) and c.26G > T:(p.Arg9Leu). The (p.Val4Serfs*15) variant occurred in the patient with Wolff-Parkinson-White syndrome in whom the diagnosis of cardiomyopathy was not confirmed and his mother who had concentric left ventricular remodeling but normal left ventricular mass and function. We did not detect large deletions/insertions in PLN in cohort studied. CONCLUSIONS: In Poland, similar to most populations, PLN mutations rarely cause cardiomyopathy. The 9(th) PLN residue is apparently a mutation hot spot whereas a single dose of c.9_10insA, and likely other null PLN mutations, cause the disease only with low penetrance or are not pathogenic.

Cardiovascular disease (CVD) risk factors in Kraków and in the whole Poland adult population. Results from the WOBASZ study and Polish arm of the HAPIEE project.

In Kraków, the second largest town in Poland, cardiovascular disease (CVD) mortality rate is lower than in most top largest towns in Poland and lower than the rate for total Polish population. AIM: The aim of the present analysis was to compare socioeconomic status (SES), prevalence of CVD risk factors and SCORE assessment of risk in Krakow with residents of other big towns in Poland and with general Polish population. MATERIALAND METHODS: We used data from the two large, population studies which used comparable methods for risk factors assessment: 1) Polish part of the HAPIEE Project in which 10 615 residents of Krakow at age between 45-69 years were examined, and (2) The WOBASZ Study which contributed with a sub-sample 6 888 of residents of Poland at corresponding age group. WOBASZ sample included 992 residents of big towns other than Krakow. Age-standardized proportions of persons with CVD risk factors were compared between Krakow and the other big towns in Poland and between Krakow and the whole Poland using χ2 test. RESULTS: The striking observation was that in Krakow proportions of participants with university education were substantially higher than average for the other big towns and the whole Poland. Also, the proportion of occupationally active men and women was the highest in Krakow. In both sexes, prevalence of smoking, hypercholesterolemia and hypertension in Krakow was similar to the other big towns but the prevalence of hypercholesterolemia and hypertension (in men only) was lower than average for Poland. The distribution by SCORE risk categories were similar in all three samples studied. In general, the distribution by BMI categories was less favourable but the prevalence of central obesity was lower among residents of Kraków than among residents of the other big towns and citizens of the whole Poland. Prevalence of diabetes was higher in Krakow than in the other samples studied. The differences between population of Krakow and population of other parts of Poland in the exposure to the main risk factors were found diverse and not big enough to be followed by differences in the distribution by the categories of SCORE risk assessment. The study suggested the importance of obesity and diabetes which are not used for the SCORE risk assessment and especially the importance of psychosocial and economic factors which may influence CVD risk and contribute more to the explanation of the regional differences in CVD mortality.

Is there an association between depressive symptoms and coronary artery disease in the Polish adult population?

BACKGROUND: Evidence-based medicine has confirmed the role of psychosocial factors in the pathogenesis of many diseases, both cardiovascular (CVD) and metabolic. On the other hand, CVD patients often suffer from concomitant diseases. Depression was found to be an independent predictor of coronary artery disease (CAD) in many populations. AIM: To evaluate the association between depressive symptoms (DS) and CAD in the Polish adult population. METHODS: A random sample of the Polish population (6392 men and 7153 women), aged 20-74 years, was examined in 2003-2005 for the presence of DS using the Beck Depression Inventory. RESULTS: In the examined population, CAD was found in 12.1% of men and 11.0% of women. Persons with CAD were older, more often finished their education at the level of primary school and lived in large communes, and more often had obesity, hypertension, diabetes and hyperlipidaemia compared to those without CAD. DS were found twice more often in persons with CAD compared to those without CAD, both in men and women. Subjects with DS were twice more likely to have CAD (men: odds ratio [OR] 2.14, 95% confidence interval [CI] 1.78-2.56; women: OR 2.03, 95% CI 1.70-2.43) and arrhythmia (women), and 1.5-fold more likely to report myocardial infarction and arrhythmia. CONCLUSIONS: A significant association between DS and CAD, myocardial infarction and arrhythmia independent of CVD risk factors was found in the Polish adult population.

Prevalence and control of cardiovascular risk factors in Poland. Assumptions and objectives of the NATPOL 2011 Survey.

BACKGROUND: Cardiovascular diseases (CVD) have been the main cause of death in Poland for the last five decades. In 2010, CVD caused 46.0% of all deaths in Poland. An analysis performed using the IMPACT model, have shown that the reduction in mortality due to ischaemic heart disease, which took place in Poland, was primarily a result of lifestyle changes and of changes affecting risk factors in the population of adults. From the perspective of health policy planning it is very important to know the prevalence of CVD risk factors and to be aware of trends in the population. AIM: The NATPOL 2011 Survey was a cross-sectional observational study aimed to assess the prevalence and control of CVD risk factors in Poland. The aim of this paper is to describe the objectives and methodology of the NATPOL 2011 project. METHODS: The survey was designed as a representative observational study and was carried out on a representative sample of Polish residents aged 18-79 years. The planned size of the research sample was 2,400 subjects. Participants were randomly selected in bundles, in a stratified, proportional draw performed in three stages. The study was composed of a questionnaire interview, blood pressure and anthropometric measurements as well as a blood and urine sample collection. The examination consisted of two visits at subjects' homes and was performed by well-trained nurses. RESULTS AND CONCLUSIONS: Letters of invitation were sent to 4,420 potential participants. Of those, 786 persons could not be contacted because the addresses were wrong, the respondents resided at an address other than their registered place of residence or, in some cases, the respondents died prior to the survey. Among 3,634 addresses of the persons sampled for the study there were 661 (M: 328, F: 333) "closed doors" (the nurse was unable to contact the respondent during three consecutive attempts) and 560 (M: 295, F: 265) direct refusals. Finally, 2,413 subjects participated in the study and 2,401 of them completed all the procedures in the survey. The data mentioned above give the response rate of 66.4%.The structure of the study sample, including age groups and gender is almost identical to the structure of the adult population of Poland in 2010, according to the Central Statistical Office data. The sample reflected the structure of the adult population quite well, therefore the weights' adjustments calculated for epidemiological analyses were in range from 0.36 to 4.11.

Is level of social support associated with health behaviours modifying cardiovascular risk? Results of the WOBASZ study.

BACKGROUND: Psychosocial risk factors affected the human health both by autonomic, neuroendocrine and immunological mechanisms and by the influence on human lifestyle. Lack of social support can reflect the person's lifestyle to more unhealthy. AIM: To assess if low, compared to high social support level (SSL), contributes to the unhealthy lifestyle in Polish general population. METHODS: The random sample of Polish population of 6164 men and 6915 women, aged 20-74, filled-in the Berkman and Syme questionnaire in 2003-2005 in the frame of National Multicenter Health Survey (WOBASZ). RESULTS: 31% of men and 39% of women had low SSL and they more often had high cardiovascular risk, depressive symptoms and cardiovascular disease risk factors, especially women. Men and women with low SSL more often smoked cigarettes than those with high SSL, rarely try to quit smoking, made regular physical activity, and rarely self-measured their blood pressure. Additionally men more often drank alcohol ≥ 30.0 g/day. They also more often did not take the prescribed medication, although they bought them. Out of unhealthy elements, lack of regular physical activity and blood pressure self-measuring were significantly and independently associated with SSL in both genders and additionally smoking habit and lack of quit smoking in the past in women. CONCLUSIONS: Persons with low SSL had more unhealthy lifestyle than those without. In Polish population the low SSL played a greater role in creating the cardiovascular risk in women than in men.

Do depressive symptoms adversely affect the lifestyle? Results of the WOBASZ study.

BACKGROUND: The negative psychosocial risk factors for cardiovascular (CV) disease, such as low social support or depression, may adversely affect the lifestyle. AIM: To evaluate the lifestyle in terms of anti-health behaviours in patients with depressive symptoms (DS) compared to individuals without DS. METHODS: A total of 6392 men and 7153 women aged 20-74 years were evaluated in the WOBASZ study [a multicentre nationwide study of the Polish population's health]). The presence of DS was assessed with Beck's Depression Inventory (BDI). Depressive symptoms were considered to be present if the patient scored at least 10 points on the BDI scale. RESULTS: The DS were present in 24% of men and 34% of women. In both groups, the mean age of subjects with DS was significantly higher compared to healthy individuals. Compared to healthy individuals, subjects with DS had a more unfavourable CV risk profile (hypertension, diabetes mellitus, obesity and hyperlipidaemia were significantly more prevalent among the subjects with DS), were characterised by a lower socioeconomic status and inhabited small administrative districts. Subjects with DS were also characterised by more anti-health lifestyles than healthy individuals. Of the 6 elements of anti-healthy lifestyle, 3 or more were observed in 18.8% of men with DS and 14.6% of men without DS (p < 0.0001) and in 17.5% of women with DS and 11.3% of women without DS (p < 0.0001). Significantly more men and women with DS than men and women without DS were regular smokers (men [M]: 42.3% vs 37.4%, p < 0.0007; women [W]: 25.6% vs 23.3%, p < 0.0346), were not physically active (M: 37.4% vs 30.2%, p < 0.0001; W: 43.4% vs 34.9%, p < 0.0001), consumed alcohol at least three times a week (M: 3.8% vs 1.7%, p < 0.0097; W: 0.3% vs 0.1%, p = 0.0349), were incompliant with their doctor's recommendations (M: 17.9% vs 12.3%, p < 0.0001; W: 22.2% vs 13.9%, p < 0.0001) and failed to have their blood pressure measured within the past year (M: 19.4% vs 15.0%, p < 0.0003; W: 15.1% vs 11.4%, p < 0.0001). The lack of physical activity and smoking, and - in women - regular consumption of alcohol, were demonstrated to be the lifestyle factors which were significantly and independently related to DS. CONCLUSIONS: A high prevalence of DS, especially among women, has been observed in the Polish population. The DS were found in every fourth man and every third woman. In both groups, subjects with DS were characterised by more anti-health lifestyle compared to healthy individuals. Of all the analysed factors of anti-health lifestyle the following were significantly and independently associated with DS - lack of physical activity and smoking in both sexes and, additionally, regular alcohol consumption in women.