Trends in cardiovascular risk factor prevalence among Lithuanian middle-aged adults between 2009 and 2018.

BACKGROUND AND AIMS: The aim of the study was to estimate trends and differences in cardiovascular disease (CVD) risk factor prevalence among middle-aged men and women based on the data from the Lithuanian High Cardiovascular Risk (LitHiR) primary prevention program between 2009 and 2018. METHODS: A community-based cross-sectional study included men aged 40-54 years and women aged 50-64 years without overt CVD. Nationally representative data comprised 110,370 Lithuanian adults (42.4% men and 57.6% women) examined in the period 2009-2018. Prevalences of major CVD risk factors, such as dyslipidaemia, arterial hypertension, diabetes mellitus, obesity, metabolic syndrome and smoking, were assessed. RESULTS: The study showed a significant drop in the prevalence of dyslipidaemia and TC levels among men (p = 0.030 and p < 0.001) and no significant change among women (p = 0.594 and p = 0.799). The prevalence of AH significantly decreased in both gender groups (p < 0.001 in women and p < 0.001 in men). Obesity rates declined among women while it remained constant among men (p < 0.001 and p = 0.100 respectively). There was a significant decline among women and a significant increase among men in the prevalence of metabolic syndrome (p < 0.001 and p = 0.016 respectively). The prevalence of diabetes increased until 2013, after which it started decreasing in the whole group (p = 0.005). The study showed a significant increase in the percentage of smoking women (p < 0.001), although the number of smoking men remained much higher (about 40%) (p < 0.001). CONCLUSIONS: In our observational study, we have documented a high prevalence of all CVD risk factors in 2009 with a slight decrease during the period in most prevalence rates, except in dyslipidaemia and smoking levels.

The chronic ischaemic cardiovascular disease ESC Pilot Registry: Results of the six-month follow-up.

Aim Chronic ischaemic cardiovascular disease (CICD) remains a leading cause of morbidity and mortality worldwide. The CICD Pilot Registry enrolled 2420 patients across 10 European Society of Cardiology countries prospectively to describe characteristics, management strategies and clinical outcomes in this setting. We report here the six-month outcomes. Methods and results From the overall population, 2203 patients were analysed at six months. Fifty-eight patients (2.6%) died after inclusion; 522 patients (23.7%) experienced all-cause hospitalisation or death. The rate of prescription of angiotensin-converting enzyme inhibitors, beta-blockers and aspirin was mildly decreased at six months (all P < 0.02). Patients who experienced all-cause hospitalisation or death were older, more often had a history of non-ST-segment elevation myocardial infarction, of chronic kidney disease, peripheral revascularisation and/or chronic obstructive pulmonary disease than those without events. Independent predictors of all-cause mortality/hospitalisation were age (hazard ratio (HR) 1.17, 95% confidence interval (CI) 1.07-1.27) per 10 years, and a history of previous peripheral revascularisation (HR 1.45, 95% CI 1.03-2.03), chronic kidney disease (HR 1.31, 95% CI 1.0-1.68) or chronic obstructive pulmonary disease (HR 1.42, 95% CI 1.06-1.91, all P < 0.05). We observed a higher rate of events in eastern, western and northern countries compared to southern countries and in cohort 1. Conclusion In this contemporary European registry of CICD patients, the rate of severe clinical outcomes at six months was high and was influenced by age, heart rate and comorbidities. The medical management of this condition remains suboptimal, emphasising the need for larger registries with long-term follow-up. Ad-hoc programmes aimed at implementing guidelines adherence and follow-up procedures are necessary, in order to improve quality of care and patient outcomes.

The fear of dying and occurrence of posttraumatic stress symptoms after an acute coronary syndrome: A prospective observational study.

The purpose of the study was to investigate whether experiencing fear of dying after acute coronary syndrome predicts later posttraumatic stress symptoms. We enrolled 90 patients hospitalized with main diagnosis of acute coronary syndrome and assessed baseline characteristics. One month after discharge, we collected the Posttraumatic Stress Scale. A total of 24 patients (26.7%) developed posttraumatic stress symptoms 1 month after the acute coronary syndrome event. Patients with posttraumatic stress symptoms reported significantly greater fear of dying, helplessness, avoidance-focused coping, and severe anxiety. In our prospective study, fear of dying was associated with occurrence of posttraumatic stress symptoms in patients hospitalized with acute coronary syndrome.

Dobutamine-stress echocardiography speckle-tracking imaging in the assessment of hemodynamic significance of coronary artery stenosis in patients with moderate and high probability of coronary artery disease.

BACKGROUND AND OBJECTIVE: Myocardial deformation indices are considered as sensitive markers of ischemia and may be useful in the quantification of hemodynamic significance of coronary artery disease (CAD). We sought to determine the diagnostic value of speckle-tracking echocardiography derived myocardial deformation parameters at rest and during stress to determine hemodynamically significance coronary artery stenosis in patients with moderate and high probability of CAD. MATERIALS AND METHODS: In 81 patients (mean age, 64±8.6 years) with stable CAD inducible myocardial ischemia was evaluated by dobutamine stress echocardiography (DSE) and adenosine magnetic resonance imaging (AMRI). Based on AMRI patients were divided into two groups: nonpathologic (n=41) and pathologic (n=40). Strain and strain rate (SR) parameters and their changes from the rest (BASE) to low stress (MIN), peak stress (MAX), and recovery (REC) were analyzed using 2D speckle-tracking imaging (STI). RESULTS: In the nonpathologic group, systolic longitudinal and circumferential strain increased significantly from BASE to MIN, as well as systolic SR from BASE to MIN and from MIN to MAX in longitudinal plane. In contrast, in the pathologic group, insignificant longitudinal systolic SR increase and radial and circumferential systolic SR decrease from MIN to MAX was observed. Discriminant function analysis revealed that select STI derived parameters best classify patients into predefined AMRI groups (pathologic and nonpathologic) with the accuracy respectively 90.9% and 83.3%. According to ROC analysis these myocardial deformation parameters had the greatest predictive value of significant coronary artery stenoses: longitudinal strain at high dose (AUC 0.811, sensitivity 89.4%, specificity 64.7%), longitudinal strain rate at high dose (AUC 0.855, sensitivity 88.1%, specificity 71.0% at high doses). The sensitivity and specificity of inducible wall motion abnormalities were 74.0% and 85.0% (AUC 0.798) and was lower compared with the diagnostic value of longitudinal myocardial deformation parameters. CONCLUSIONS: Left ventricular strain and strain rate analyses during DSE can be used in the assessment of hemodynamic significance of coronary artery stenosis in patients with moderate and high risk for CAD.

Early and late diastolic strain rate vs global longitudinal strain at rest and during dobutamine stress for the assessment of significant coronary artery stenosis in patients with a moderate and high probability of coronary artery disease.

BACKGROUND: The aim of this prospective study was to assess the usefulness of global longitudinal strain (GLS), regional diastolic and systolic strain, strain rate (SR) parameters at rest and during dobutamine stress echocardiography for detecting significant coronary artery stenosis in patients with a moderate or high probability of coronary artery disease (CAD). METHODS: Dobutamine stress echocardiography and adenosine magnetic resonance imaging (AMRI) were performed on 127 patients with a moderate and high probability of CAD and left ventricle ejection fraction ≥55%. CAD was defined as ≥70% diameter stenosis on coronary angiography validated as hemodynamically significant by AMRI. Patients were grouped according to coronary angiography and AMRI results: CAD (-) n=67 (52.8%) vs CAD (+) n=60 (47.2%). RESULTS: There were no significant differences of clinical characteristics, conventional echocardiography, and deformation parameters between the two groups at rest except that GLS was higher in the CAD (-) group (-21.5±2.4% vs -16.2±2.1%, P=.00). GLS at high dobutamine doses had the highest area under the ROC curve (AUC) (AUC 0.955, sensitivity 94%, specificity 92%). Radial late diastolic SR at low doses performed best out of all diastolic parameters with an AUC of 0.789, sensitivity 76.7%, specificity 91.7%. Other deformation parameters including visual assessment were inferior. CONCLUSIONS: Global longitudinal strain is highly sensitive and specific in detecting hemodynamically significant coronary artery stenosis in moderate- to high-risk patients without known CAD. This is the first study showing that GLS is more sensitive and specific compared with early and late diastolic SR parameters or visual assessment in detecting CAD.

Clinical relevance of high sensitivity C-reactive protein in cardiology.

Coping with cardiovascular diseases (CVD), which are of the main causes of death worldwide, has influenced investigation of high sensitivity CRP (hsCRP) and its role in pathogenesis, prognosis and prevention of CVD. hsCRP can be synthesized in vascular endothelium, atherosclerotic plaques, and theory of inflammatory origin of atherosclerosis is being more widely debated, raising questions, whether higher hsCRP plasma concentration might be the cause or the consequence. Summing up controversial data from multiple studies, guidelines recommend hsCRP testing for both, primary (stratifying CVD risk groups, selecting patients for statin therapy) and secondary CVD prevention (prognosis of CVD and its treatment complications, evaluation of treatment efficacy in moderate CVD risk group). hsCRP testing also has role in heart failure, atrial fibrillation, arterial hypertension, valve pathology and prognosis of coronary stent thrombosis or restenosis. Medications (the well-known and the new specific - CRP binding) affecting its concentration are being investigated as well.

EURObservational Research Programme: the Chronic Ischaemic Cardiovascular Disease Registry: Pilot phase (CICD-PILOT).

AIMS: Chronic ischaemic cardiovascular disease (CICD) is a major cause of mortality and morbidity worldwide. The primary objective of the CICD-Pilot registry was to describe the clinical characteristics and management modalities across Europe in a broad spectrum of patients with CICD. METHODS AND RESULTS: The CICD-Pilot registry is an international prospective observational longitudinal registry, conducted in 100 centres from 10 countries selected to reflect the diversity of health systems and care attitudes across Europe. From April 2013 to December 2014, 2420 consecutive CICD patients with non-ST-elevation acute coronary syndrome (n = 755) and chronic stable coronary artery disease (n = 1464), of whom 933 (63.7%) were planned for elective coronary intervention, or with peripheral artery disease (PAD) (n = 201), were enrolled (30.5% female patients). Mean age was 66.6 ± 10.9 years. The following risk factors were reported: smoking 54.6%, diabetes mellitus 29.2%, hypertension 82.6%, and hypercholesterolaemia 74.1%. Assessment of cardiac function was made in 69.5% and an exercise stress test in 21.2% during/within 1 year preceding admission. New stress imaging modalities were applied in a minority of patients. A marked increase was observed at discharge in the rate of prescription of angiotensin-converting enzyme-inhibitors/angiotensin receptor blockers (82.8%), beta-blockers (80.2%), statins (92.7%), aspirin (90.3%), and clopidogrel (66.8%). Marked differences in clinical profile and treatment modalities were observed across the four cohorts. CONCLUSION: The CICD-Pilot registry suggests that implementation of guideline-recommended therapies has improved since the previous surveys but that important heterogeneity exists in the clinical profile and treatment modalities in the different cohorts of patients enrolled with a broad spectrum of CICDs.

Associations between risk factors in childhood (12-13 years) and adulthood (48-49 years) and subclinical atherosclerosis: the Kaunas Cardiovascular Risk Cohort Study.

BACKGROUND: The data on the childhood determinants of adult cardiovascular disease (CVD) are lacking in populations of Eastern Europe that are characterised by substantially high CVD mortality. From a public health perspective, it is important to identify high-risk individuals as early as possible in order to have the greatest benefit of preventive interventions. The aim of this study was to evaluate the associations of childhood and adulthood traditional risk factors with subclinical atherosclerosis and arterial stiffness in a Lithuanian cohort followed up for 35 years. METHODS: The study cohort consisted of 380 adults aged 48-49 from Kaunas Cardiovascular Risk Cohort study, who were followed up since childhood (12-13 years). The baseline survey (1977) included blood pressure (BP) and anthropometric measurements and sexual maturity scale. In the follow-up survey (2012), BP, anthropometric and lipids measurements, interview about smoking, measurement of carotid intima-media thickness (IMT) and determination of pulse wave velocity (PWV) were performed. Two types of general linear models were applied to test the associations of childhood and adulthood risk factors with IMT and PWV. Model 1 included only childhood variables. In model 2, adulthood variables were added to childhood variables. RESULTS: In linear regression model with childhood variables childhood systolic BP (ß = 0.014; p = 0.016) and BMI (ß = 0.006; p = 0.003) were directly associated with IMT only in women. When adulthood variables were included into regression model, the association between childhood systolic BP and IMT remained significant (ß = 0.013; p = 0.021), while childhood BMI was not associated with IMT (ß = 0.003; p = 0.143). Additionally, association of adult smoking and IMT was found in women (ß = 0.033; p = 0.018). IMT of men was directly related to adult systolic BP (ß = 0.022; p = 0.018) and inversely to HDL cholesterol level (ß = -0.044; p = 0.021). PWV was directly associated only with adult systolic BP in both genders (ß = 0.729 for men and ß = 0.476 for women; p = 0.001). CONCLUSIONS: Sex differences in the associations between childhood and adulthood risk factors and subclinical atherosclerosis were found. The results of the study support efforts to reduce conventional risk factors both in childhood and adulthood for the primary prevention of atherosclerosis.

Prevalence of cardiovascular risk factors in Lithuanian middle-aged subjects participating in the primary prevention program, analysis of the period 2009-2012.

BACKGROUND: The aim of this study was to assess the prevalence and changes of cardiovascular risk factors in the middle-aged Lithuanian subjects after conducting the primary prevention program. DESIGN AND METHODS: Four cross-sectional investigations of cardiovascular risk factors were conducted in 2009 (n = 9625), 2010 (n = 7716), 2011 (n = 5018) and 2012 (n = 4348). The program recruited men aged 40-54 and women aged 50-64 without overt cardiovascular disease. RESULTS: During the period 2009-2012, the mean number of risk factors significantly increased (from 3.95 to 4.03, p < 0.001), while the numbers of people having metabolic syndrome (from 34.1% to 28.7%; p < 0.001), arterial hypertension (from 60.2% to 54.5%; p < 0.001), the average body mass index (BMI) value (from 29.17 to 28.92 kg/m(2); p = 0.001) and abdominal obesity (from 48.4% to 45.3%; p < 0.001) significantly decreased. The percentage of subjects with dyslipidemia, as well as the average values of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglycerides, remained unchanged. The percentage of smoking subjects have significantly increased (from 19.3% to 22.7%; p < 0.001). CONCLUSIONS: The analysis showed that the prevalence of arterial hypertension, metabolic syndrome and obesity in Lithuania is slowly decreasing while conducting the primary prevention program; however, dyslipidemia, diabetes mellitus and smoking are still hard to manage for both genders.

Prognostic value of myocardial perfusion abnormalities for long-term prognosis in patients after coronary artery bypass grafting.

AIMS: The objective was to evaluate the prognostic value of exercise myocardial perfusion scintigraphy (MPS) in patients who underwent coronary artery bypass grafting (CABG). SUBJECTS AND METHODS: A retrospective, one-center study of 361 patients with multivessel coronary artery disease was carried out. All the patients underwent MPS after CABG due to worsened health status. MPS was performed at 4.5 years standard deviation (SD: 0.2), based on symptoms. MPS was carried out using Tc-99m methoxy isobutyl isonitrile and following a 1-day protocol (stress-rest). The end points were analyzed at 6.5 years (SD: 3.3) after MPS, on the average. STATISTICAL ANALYSIS USED: SPSS software for Windows, version 13.0. The t-test or the χ(2)-test was used. Survival times were calculated. A multivariate Cox proportional hazards model was developed. RESULTS: During the follow-up, death occurred in 54 patients, and 37 patients experienced major adverse cardiovascular events (MACE). In the multivariate analysis, advanced age hazard ratio (HR: 1.45; 95% confidence interval [CI]: 1.4-2.02; P = 0.027), previous myocardial infarction (HR: 3.17; 95% CI: 1.22-8.2; P = 0.018), left ventricular ejection fraction of <40% (HR: 2.16; 95% CI: 1.2-3.89; P = 0.01), and the summed stress score (SSS) of ≥4 (HR: 1.87; 95% CI: 1.02-3.41; P = 0.04) were independent predictors of all-cause death. The summed difference score (SDS) was the only independent predictor of MACE (HR: 1.26; 95% CI: 1.06-1.48; P = 0.034). CONCLUSIONS: The parameters of MPS were found to have prognostic value in the long-term period after CABG. Advanced age, previous myocardial infarction, decreased left ventricular ejection fraction, and the abnormal SSS were associated with an increased risk of all-cause death. The SDS was found to be the only significant risk factor for MACE.

Prevalence of dyslipidemia in statin-treated patients in the Baltic states (Estonia, Latvia, and Lithuania): results of the Dyslipidemia International Study (DYSIS).

BACKGROUND AND OBJECTIVE: The Baltic nations (Estonia, Latvia, and Lithuania) are profoundly affected by cardiovascular disease (CVD). Studies have indicated that patients may experience persistent dyslipidemia despite chronic statin treatment. Therefore, the aim of this study was to analyze the risk factors for dyslipidemia despite statin-treatment in a large dataset from the Baltic nations. MATERIAL AND METHODS: Patients in primary care centers across the Baltic nations were enrolled into the cross-sectional, observational Dyslipidemia International Study (DYSIS). Patients were ≥ 45 years old and had been treated with statins for at least three months. Patient characteristics and lipid measurements were used to determine variables contributing to dyslipidemia (abnormal low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], or total triglyceride [TG] values). RESULTS: We enrolled 1797 patients with a mean age of 66.1 years and 59.1% being female. Overall 63.4% had cardiovascular disease, 30.1% were diabetic and 77.8% at high risk for cardiovascular complications. LDL-C was not at target level for 80.7%; low HDL-C levels were observed for 26.0%, and elevated TG levels were found in 35.0% of all patients. Multivariate analyses indicated that a BMI ≥ 30 kg/m(2) (OR, 2.12; 95% CI, 1.45-3.08) and hypertension (OR, 2.43; 95% CI, 1.1 6-5.10) were strongly associated with dyslipidemia (involving all three lipids) during statin therapy while age ≥ 70 years (OR, 0.63; 95% CI, 0.42-0.94) and female gender (OR, 0.48; 95% CI, 0.33-0.68) conferred reduced risk. CONCLUSIONS: Our findings indicate many statin-treated patients in Estonia, Latvia, and Lithuania did not meet target lipid levels and had a very high risk of CVD. Combating other well-known CVD risk factors such as obesity and hypertension is vital to reduce the exceptionally high risk for CVD mortality seen in the Baltic nations.

Prevalence of high-risk profile in middle-aged subjects with arterial hypertension: a nationwide survey.

Hypertension is the most common non-communicable disease and the leading cause of cardiovascular disease in the world. It presents an important public health challenge in both economically developed and developing countries. In 2006, the Lithuanian High Cardiovascular Risk programme was launched. The programme recruited men aged 40-54 and women aged 50-64 without overt cardiovascular disease. We analysed a group of 23,204 subjects included in the programme at the primary level. Arterial hypertension was present in 57.6% of the subjects: 63.2% in the females and 49.2% in the males. In the hypertensive middle-aged subjects, grade 1 hypertension was present in 53.1%, grade 2 in 22.4%, and grade 3 in merely 5.9% of the subjects. The prevalence of a minimum of three concomitant risk factors among the hypertensive patients was 78.0%, compared with 52.1% in the patients without hypertension (p < 0.001). Blood pressure goals were attained in 20.8% of the hypertensive women and in 14.4% of the hypertensive men. In Lithuania, a high prevalence of hypertension was characteristic of middle-aged subjects. Although the blood pressure elevation had not reached high levels, the presence of at least three risk factors concomitant to hypertension was more expressed in them compared with the non-hypertensive subjects.

High-risk profile in a region with extremely elevated cardiovascular mortality.

INTRODUCTION: Although mortality rates from cardiovascular diseases have shown a remarkable decline in many western countries, cardiovascular mortality in Lithuania has remained high. It is widely accepted that half of the decline in cardiovascular mortality can be attributed to favourable changes in modifiable risk factors. METHODS: In 2006, the Lithuanian High Cardiovascular Risk Programme was started. A two-level approach--primary health care institutions and specialised cardiovascular prevention units--was applied. The cardiovascular risk profile was evaluated for a group of 17,031 middle-aged subjects enrolled into the programme at a primary level and 2908 at a specialised level. RESULTS: Among the persons examined, 61.8% (10,519) were female. Arterial hypertension was present in 60.2% of the subjects. Dyslipidaemia was present in 88.8%. Total cholesterol was 6.02 ± 1.23 mmol/L, LDL cholesterol 3.74 ± 1.09 mmol/L, HDL cholesterol 1.53 ± 0.52 mmol/L, and triglycerides 1.61 ± 1.27 mmol/L. Diabetes mellitus was found in 10.3%, abdominal obesity in 45.4%, and metabolic syndrome in 43.8% of cases. These values were even greater in high-risk subjects. CONCLUSIONS: In middle-aged subjects the prevalence of dyslipidaemia, arterial hypertension, diabetes, and metabolic syndrome was found to be high. We can roughly state that almost nine out of ten middle-aged subjects in Lithuania have established dyslipidaemia, every second one has established arterial hypertension, and four out of ten are obese. Hence, these are the main risk factors that should be considered first of all in daily clinical practice.

The association between phenomena on the sun, geomagnetic activity, meteorological variables, and cardiovascular characteristic of patients with myocardial infarction.

It has been found that solar and geomagnetic activity affects the cardiovascular system. Some evidence has been reported on the increase in the rate of myocardial infarction, stroke and myocardial infarction related deaths during geomagnetic storms. We investigated the association between cardiovascular characteristics of patients, admitted for myocardial infarction with ST elevation (STEMI), and geomagnetic activity (GMA), solar proton events (SPE), solar flares, and meteorological variables during admission. The data of 1,979 patients hospitalized at the Hospital of Lithuanian University of Health Sciences (Kaunas) were analyzed. We evaluated the association between environmental variables and patient's characteristics by multivariate logistic regression, controlling patient's gender and age. Two days after geomagnetic storms the risk of STEMI was over 1.5 times increased in patients who had a medical history of myocardial infarction, stable angina, renal or pulmonary diseases. The dose-response association between GMA level and STEMI risk for patients with renal diseases in history was observed. Two days after SPE the risk of STEMI in patients with stable angina in anamnesis was increased over 1.5 times, adjusting by GMA level. The SPE were associated with an increase of risk for patients with renal diseases in history. This study confirms the strongest effect of phenomena in the Sun in high risk patients.

Incidentally diagnosed malignant coronary artery anomaly: a clinical case.

The incidence of congenital coronary artery anomalies is estimated to range between 1% and 2% in the general population. The separate types of coronary artery anomalies are even rarer - the left main coronary artery arising from the right coronary sinus and passing between the thoracic aorta and the pulmonary artery is one of them. In this case, the segment of the artery that courses between the aorta and the pulmonary artery is prone to compression, especially during heavy exercise. Outcomes may be fatal due to myocardial hypoperfusion, which is associated with sudden cardiac death especially among children, young adults, and athletes. Nowadays, innate coronary artery anomalies may be incidentally diagnosed in older age using new investigation methods such as computed tomography angiography.

Effectiveness of telemedicine and distance learning applications for patients with chronic heart failure. A protocol for prospective parallel group non-randomised open label study.

INTRODUCTION: Chronic heart failure in Baltic Sea Region is responsible for more hospitalisations than all forms of cancer combined and is one of the leading causes of hospitalisations in elderly patients. Frequent hospitalisations, along with other direct and indirect costs, place financial burden on healthcare systems. We aim to test the hypothesis that telemedicine and distance learning applications is superior to the current standard of home care. METHODS AND ANALYSIS: Prospective parallel group non-randomised open label study in patients with New York Heart Association (NYHA) II-III chronic heart failure will be carried out in six Baltic Sea Region countries. The study is organised into two 6-month follow-up periods. The first 6-month period is based on active implementation of tele-education and/or telemedicine for patients in two groups (active run period) and one standard care group (passive run period). The second 6-month period of observation will be based on standard care model (passive run period) to all three groups. Our proposed practice change is based on translational research with empirically supported interventions brought to practice and aims to find the home care model that is most effective to patient needs. ETHICS AND DISSEMINATION: This study has been approved by National Bioethics Committee (2011-03-07; Registration No: BE-2-11). TRIAL REGISTRATION: This study has been registered in Australian New Zealand Clinical Trials Registry (ANZCTR) with registration number ACTRN12611000834954.

The impact of myocardial revascularization after acute coronary syndromes on one-year cardiovascular mortality.

UNLABELLED: The aim of this observational study was to evaluate the impact of myocardial revascularization performed after acute coronary syndromes on one-year cardiovascular mortality. MATERIAL AND METHODS: The study population comprised 1226 consecutive patients who were admitted to the Clinic of Cardiology in 2005 because of acute coronary syndromes with significant (≥70%) coronary artery stenoses. The relationship between myocardial revascularization and one-year cardiovascular mortality was evaluated by applying multivariable logistic regression. Cardiovascular mortality was evaluated using the Kaplan-Meier method. RESULTS: Of all the patients included into the study, 540 had Q-wave myocardial infarction, 339 patients had non-Q-wave myocardial infarction, and 347 patients were treated for unstable angina pectoris. During hospitalization, 496 patients underwent percutaneous transluminal coronary angioplasty, 373 patients underwent coronary artery bypass grafting within 60 days following acute coronary syndromes, and 357 patients received pharmacological treatment alone. During one-year follow-up, 105 cases of cardiovascular death were registered. The one-year cardiovascular mortality was significantly lower in patients who underwent percutaneous transluminal coronary angioplasty or coronary artery bypass grafting comparing with those patients who received only pharmacotherapy (5.4% and 7.8% vs. 14.3%, P<0.05). Multivariate logistic regression analysis revealed that myocardial revascularization independently reduced one-year cardiovascular mortality (adjusted odds ratio for percutaneous transluminal coronary angioplasty, 0.304; 95% CI, 0.18 to 0.53; P<0.001, and coronary artery bypass grafting, 0.540; 95% CI, 0.32 to 0.90; P=0.018) in patients who were admitted because of acute coronary syndromes. CONCLUSIONS: Myocardial revascularization performed after acute coronary syndromes was significantly associated with the reduction of cardiovascular mortality within one-year period independently of clinical variables.

[Associations between acute heart failure and cardiovascular outcomes]. / Uminio sirdies nepakankamumo sasajos su sirdies ir kraujagysliu sistemos ligu baigtimis.

UNLABELLED: The aim of the study was to determine associations of acute coronary syndrome and acute heart failure with mortality from cardiovascular causes during hospitalization and mortality from cardiovascular causes and chronic heart failure during one-year period. MATERIAL AND METHODS: A total of 1554 consecutive patients with discharge diagnosis of acute coronary syndrome, treated at the Clinic of Cardiology, Hospital of the Lithuanian University of Health Sciences (former Kaunas University of Medicine) in 2005, were prospectively enrolled into the study. For the assessment of patients' status, data from the Cardiac Center Registry database were used. Patients were followed up for one year from admission to hospital. RESULTS: Acute heart failure was diagnosed in 32.3% of patients during hospitalization, and chronic heart failure was diagnosed in 17% during a one-year follow-up period. Myocardial revascularization was performed in 70.8% of patients with coronary artery stenosis of ≥70%. After one year, chronic heart failure was documented in 1039 patients, and it was almost three times more frequent in patients who had acute heart failure at diagnosis of acute coronary syndrome than in patients without acute coronary syndrome during hospitalization (31.4% vs. 11.6%; P<0.05). Death from cardiovascular causes occurred more frequently in patients with acute heart failure than without it during both in-hospital and out-of-hospital periods (11.5% vs. 1.9%, P<0.001; 7.7% vs. 2.3%, P<0.001). CONCLUSION: In the presence of acute coronary syndrome, diagnosed acute heart failure significantly increases the frequency of chronic heart failure during one-year period and mortality rate from cardiovascular diseases during hospitalization and one-year period.

Policy implications of rationalization of statin use in Lithuania.

OBJECTIVES: The aim of this study was to assess the trends and costs of statin use in Lithuania over a 3-year period and perform a cost-minimization and reference price analysis to rationalize the use of financial resources of the National Health Care System. METHODS: The defined daily dose (DDD) methodology was applied for assessment of statin use, which was expressed in DDD/1,000 inhabitants/day. Cost minimization and reference price calculations were used in the economic analysis. RESULTS: Over the 3-year period (2005-2007), the consumption and expenditures of statins in Lithuania doubled. The consumption went up from 3.87 DDD/1,000 inhabitants/day (in 2005) to 8.35 DDD/1,000 inhabitants/day (in 2007). Total expenses of statins increased during the same period from LTL6.186 million in 2005 to LTL12.418 million in 2007. Approximately 68 percent of the estimated costs for statins in 2007 were for atorvastatin. Provided that the calculated reference prices were fixed, the estimated savings would amount to a minimum of LTL1.371 million per year and could reach yearly savings in the order of LTL3.163 million. The total expenses would drop by at least 11 percent, and the decrease in costs could be as high as 25 percent (1 euro = LTL3.4528). CONCLUSIONS: Statins consumption is still very low in Lithuania in comparison with other European Union countries. Implementation of cholesterol education programs and changing reimbursement profile for statins therapy will increase consumption and expenditures. The introduction of reference-based pricing as an indirect cost control policy would help rationalizing the use of statins and their expenditures.

[Diagnostic value of multislice computed tomography coronary angiography in patients with left bundle branch block]. / Vainikiniu arteriju angiografija daugiapjuviu kompiuteriniu tomografu esant kairiosios Hiso pluosto kojytes blokadai.

OBJECTIVE: The aim of present study was to evaluate the diagnostic value of multislice computed tomography coronary angiography in patients with left bundle branch block. MATERIALS AND METHODS: Twenty-four patients who underwent both multislice computed tomography coronary angiography and invasive coronary angiography were enrolled in the study. Findings of these imaging modalities were compared in order to determine the sensitivity, specificity, positive predictive value, and negative predictive value of multislice computed tomography angiography in identifying hemodynamically significant stenoses (> or =50%). All segments > or =2 mm in diameter were visually assessed independently from their degree of calcification and image quality. RESULTS: In total, 328 segments were analyzed. The Spearman correlation coefficient between multislice computed tomography and invasive coronary angiography was 0.76 (P<0.0001). On a per-segment basis, sensitivity, specificity, positive predictive value, and negative predictive value of multislice computed tomography angiography were 75%, 97.7%, 72%, and 98%, respectively; on a per-vessel basis, these values were 77.8%, 92.3%, 70%, and 94.7%, respectively; on a per-patient basis - 81.8%, 84.6%, 81.8%, and 84.6%, respectively. CONCLUSIONS: Multislice computed tomography coronary angiography provides a high diagnostic accuracy in detecting significant coronary artery stenoses in patients with left bundle branch block.