Prevalence of chronic kidney disease in a representative sample of the Polish population: results of the NATPOL 2011 survey.

BACKGROUND: Chronic kidney disease (CKD) has been proven to be a major risk factor of cardiovascular disease (CVD). Until now, data on the prevalence of CKD among adults in Poland were limited. The NATPOL 2011 survey is a cross-sectional observational study designed to assess the prevalence and control of CVD risk factors in Poland, and the first study capable of evaluating CKD prevalence in adult Polish citizens. METHODS: Serum creatinine concentration and the urine albumin-to-creatinine ratio (ACR) were measured in 2413 randomly selected participants (ages 18-79 years) from a national survey study. CKD was diagnosed if the estimated glomerular filtration rate (eGFR) was <60 mL/min/1.73 m(2) or ≥60 mL/min/1.73 m(2) with coexisting albuminuria (ACR ≥ 30 mg/g). Additionally, comorbidities and anthropometric and social factors related to the prevalence of CKD were analysed. RESULTS: The prevalence of CKD was estimated at 5.8% [95% confidence interval (95% CI) 4.6-7.2] using Chronic Kidney Disease Epidemiology Collaboration formula. The general prevalence was higher when the MDRD was applied [6.2% (95% CI 4.0-7.6)]. An eGFR <60 mL/min/1.73 m(2) was found in 1.9% (95% CI 1.5-2.5) of the studied population. This was accompanied by low awareness of this condition (14.9%). The frequency of albuminuria was estimated at 4.5% (95% CI 3.4-5.9). Diabetes mellitus (DM) and arterial hypertension (AH) were more frequent among respondents with diagnosed CKD compared with those without CKD [18.5 versus 4.5% (P < 0.001) and 67.8 versus 29.0% (P < 0.001) respectively]. DM and AH were, apart from increasing age, the two greatest risk factors of CKD. CONCLUSION: The estimated prevalence of CKD among adults in Poland is 5.8% (∼1 724 960 patients). Its prevalence was lower than expected. CKD is more frequent in older subjects, smokers and people with comorbidities such as AH and DM.

Obesity and diet awareness among Polish children and adolescents in small towns and villages.

BACKGROUND: In addition to genetic predispositions and environmental factors, healthy lifestyle education is very important for children and adolescents. The purpose of this research was to estimate the number of overweight and obese children and adolescents from small towns and villages and to find out an association between health awareness in children and the risk of becoming overweight or obese. METHODS: The research was conducted in 1,515 healthy children aged 6-18 years from small towns and villages in Poland. Overweight was diagnosed when BMI for age and sex was over the 90th percentile; obesity--when it was over the 95th percentile. The study consisted of a lifestyle interview and anthropometrical measurements. The lifestyle interview was conducted with the use of an anonymous questionnaire form and included questions about food frequency, diet habits and physical activity. The research was analysed using the SAS System for Windows, release 8.02. RESULTS: Overweight status was diagnosed in 9.0% and obesity in 5.1% of respondents. Excess body mass was statistically more frequently diagnosed in girls than in boys aged 14-18 years. Girls of this age group significantly more frequently chose wholemeal bread, smoked sausages, meat and poultry as products that are believed to keep them fit. Older children substantially more often indicated that stress, smoking cigarettes, consuming fatty meat, sweets, being obese, and a lack of physical activity are factors that damage health. Boys spent more time in front of a computer or TV than girls; in the older group of children, the phenomenon even intensified. CONCLUSION: Awareness of healthy lifestyle behaviour is not sufficient to maintain optimal body mass. Knowledge about proper eating habits is better among girls than among boys, especially in the older age groups. However, in older groups, there was less physical activity due to spending more time in front of TV or the computer. High percentage of obese/overweight children and insufficient knowledge of nutrition may consequently result in increased risk of cardio-vascular diseases in adult population.

Inverse association of serum bilirubin with metabolic syndrome and insulin resistance in Polish population.

BACKGROUND: Bilirubin has got a potential anti-oxidant, anti-inflammatory and cytoprotective effect. It has been shown that its concentration is inversely related to cardiometabolic diseases. Recent studies have revealed the association between serum bilirubin concentrations and metabolic syndrome (MS) among children and adolescents in U.S. and among Korean adults. The aim of this study was to evaluate the association of total serum bilirubin level with MS and insulin resistance in Poland. METHODS: We examined 1568 patients aged 18 to 93 years. The tested population was a nationally representative sample of Polish adults. They were derived from cross-sectional study, when serum total bilirubin level and risk factors of cardiovascular diseases were determined. RESULTS: The prevalence of MS in bilirubin level quartiles (95% CI in parentheses) was 28.9% (24.5%-33.3%), 32.6% (28.3%-36.9%), 23.4% (19.0%-27.8%), 21.8% (17.5%-26.2%) respectively for quartiles 1-4 (p = 0.002) The multivariate analysis showed odds ratio for MS in third and fourth quartile of bilirubin level equal to 0.70 (0.50-0.99) and 0.68 (0.48-0.95) respectively in comparison to the lowest quartile. The more criteria of metabolic syndrome were fulfilled by the patient, the lower was mean total bilirubin level (p = 0.012). In study group there was also a strong, independent association of bilirubin level with fasting insulin level and insulin resistance (HOMA-IR). The odds ratio of insulin resistance was 0.53 (0.38-0.74) for the fourth quartile in reference to the lowest quartile of bilirubin. CONCLUSION: In Polish adults serum total bilirubin level is inversely related to the prevalence of MS and insulin resistance.

Access to selected diagnostic procedures in the management of heart failure patients in Poland - POLKARD 2005.

BACKGROUND: Polish heart failure surveys from 1999 and 2005 indicated that non-invasive and invasive diagnostic procedures in heart failure patients are underused, mostly due to limited availability. AIM: To assess the access to procedures used for the diagnosis and treatment of heart failure in randomly selected outpatient clinics and hospital wards in Poland. METHODS: The study was undertaken in 2005, as a part of the National Project of Prevention and Treatment of Cardiovascular Diseases - POLKARD. The data on non-interventional and interventional procedures were collected from 400 primary care units, 396 secondary outpatient clinics and 259 hospitals, and included cardiology or internal medicine departments. Additionally, the last five patients with diagnosed heart failures were identified, who visited outpatient clinics or were discharged from the hospitals, and their medical records of diagnostic procedures were analysed. RESULTS: Echocardiography was not available in approximately 10% of hospital wards and 13-37% of outpatient clinics, both primary and secondary. Generally, the waiting time for echocardiography in Poland varied from region to region. A one-month waiting time was declared by more than 50% of secondary outpatient clinics and only 11-18% of primary care units, regardless of the community size. On the first day of hospital admission, echocardiography was performed in approximately 10% of patients of internal medicine wards and up to 36% of patients in cardiology departments. The assessment of B-type natriuretic peptide (BNP) or N-terminal pro-B-type natriuretic peptide (NT-proBNP) was generally performed only in a few hospitals, usually in cardiology departments. In primary care units, it was practically not available. Percutaneous coronary interventions, pacemaker or cardioverter-defibrillator implantations were available in approximately 20% of city hospitals, 30-40% of province hospitals, and 60-70% of clinical wards of medical universities. CONCLUSIONS: These data show limited availability of echocardiography in primary care units. It is necessary to continue actions for better accessibility and frequency of performing interventional procedures in patients with heart failure in Poland.

Social support level in relation to metabolic syndrome--results of the SOPKARD study.

BACKGROUND: Low level of social support is one of the psychosocial cardiovascular risk factors. Moreover, social support level (SSL) has been reported to be associated with components of metabolic syndrome (MS). AIM: To evaluate the association of SSL with MS in 50- and 60-year-old citizens of Sopot. METHODS: The study covered 476 citizens of Sopot (218 males - M; 258 females - F), aged 50-60 years, invited to take part in the screening project SOPKARD aimed at increasing detectability of hypertension, dyslipidaemia and diabetes mellitus in 2002-2003. Patients with MS were diagnosed according to the AHA/NHLBI criteria (2007). The Berkman and Syme's questionnaire was used for assessment of SSL which was categorised into 3 groups: low, medium and high. RESULTS: Metabolic syndrome was diagnosed in 34% (W 29%, M 39%, p <0.05) of examined subjects. The prevalence of MS criteria was as follows: elevated blood pressure 68% (F 67%, M 69%, NS), elevated fasting glucose 48% (W 45%, M 53%, p=0.08), elevated waist circumference 30% (W 33%, M 25%, p=0.06), hypertriglyceridaemia 42% (F 41%, M 42%, NS) and low level of HDL cholesterol (HDL-C) 23% (W 23%, M 23%, NS). Low SSL was observed in 50% of studied subjects (W 58%, M 39%), middle SSL in 31% (F 29%, M 35%) and high in 19% (F 13%, M 26%). In men with low SSL, MS and low level of HDL-C were found twice as frequent as in men with high SSL (45 vs. 22%, p <0.05; 24 vs. 12%, p <0.05). High level of triglycerides was observed significantly more frequently in women with low SSL than in those with high SSL (51 vs. 21%, p <0.05). Results of regression analysis showed that in men (all and 60-year olds) SSL was significantly associated with MS prevalence (p <0.05). In women, SSL was related to elevated fasting glucose prevalence (p <0.001). Moreover, in 50-year-old women SSL was significantly associated with MS (p=0.05) and elevated waist circumference (p <0.0001). All these relationships were independent of education. CONCLUSIONS: The examined group of middle-aged persons, especially women, was characterised by high frequency of low SSL. Metabolic syndrome and its components were found more frequently in persons with low SSL, compared to those with high SSL. Low SSL was significantly associated with occurrence of MS and dyslipidaemia in men and women, and elevated fasting glucose and elevated waist circumference in 50-year old women.

Screening for major cardiovascular risk factors among Members of Polish Parliament as a continuation of health marketing for effective cardiovascular prevention in Poland. Warsaw, May 2006.

BACKGROUND: Cardiovascular diseases are the most common cause of mortality in Poland. To improve the situation in this area, a national cardiovascular preventive project is necessary, and it can be done by close cooperation between medical and political agencies. AIM: To present the current epidemiological situation in Poland to political and key opinion leaders and also to assess individual cardiovascular risk among Members of Polish Parliament. METHODS: The Project was carried out on 23-24 May 2006 in the residence of the Polish Parliament. Anthropometric, blood pressure and cholesterol measurements and a short questionnaire were performed. RESULTS: Survey and educational programme were carried out on 310 out of 460 Members of the Polish Parliament (females 59, males 251). Awareness of one's own blood pressure was declared by 70% of subjects, 39% declared earlier detected arterial hypertension, 21% had new detected elevated blood pressure, 31% declared earlier detected elevated cholesterol level and 32% had new detected elevated cholesterol level. Obesity was found in 40%, smoking was declared by 16.5%. The results were compared with those obtained in corresponding age-groups in the general population. CONCLUSIONS: 1. The results of screening survey in the Polish Parliament in 2006 indicate that, in comparison with nationwide adult population and Parliament Members examined in the year of 2000, present Parliament Members are more often diagnosed with obesity. However, they present with a better awareness of their own blood pressure and better control of arterial hypertension, as well as much lower percentage of those who admit smoking cigarettes. 2. Drawing Parliament Members attention to the problem of high prevalence and insufficient control of cardiovascular risk factors should result in positive outcome of future legislation process and make the battle with the epidemic of heart attacks and strokes in Poland more successful.

Relationship between the prevalence of depressive symptoms and metabolic syndrome. Results of the SOPKARD Project.

INTRODUCTION: Depression is a newly recognised risk factor for ischaemic heart disease (IHD). The results of many studies show that depression may contribute to the development of components of metabolic syndrome, such as arterial hypertension, obesity and glycaemic abnormalities. Thus it may have a significant impact on IHD development and worsen the course of an already established disorder. AIM: Evaluation of the prevalence of metabolic syndrome and depression among Sopot inhabitants aged 50 or 60 years. METHODS: This study involved 795 consecutive inhabitants of Sopot (477 female and 318 male) who were invited in 2003 and 2004 to participate in screening examinations in the programme of primary prevention of arterial hypertension, diabetes and lipid abnormalities -- SOPKARD. Metabolic syndrome was diagnosed according to the NCEP ATP III guidelines. Beck's Depression Inventory was used for the assessment of depressive symptoms. RESULTS: Metabolic syndrome was recognised in 32% of participants (in 31% of women and in 33% of men). The distribution of particular elements of metabolic syndrome was as follows: elevated blood pressure was found in 63% of subjects (female -- 58%, male -- 70%), abnormal fasting glucose in 24% (female -- 21%, male -- 28%), visceral (abdominal) obesity in 33% (female -- 38%, male -- 26%), elevated triglyceride level in 34% (female - 28%, male - 42%) and decreased HDL level in 26% (female -- 28%, male -- 23%). Symptoms of depression were found in 37% of studied subjects (42% of females, 28% of males). Metabolic syndrome was observed more frequently in subjects with depressive symptoms compared to those without depressive symptoms in the whole group (35% vs 28%, p <0.05) and in males (44% vs 28%, p <.05). This difference was not statistically significant in females (31% vs 28%, ns). Visceral obesity was observed more frequently in males with depressive symptoms than in those without depressive symptoms (37% vs 21%, p <0.001). It was not observed in the whole group and in females. The studied females group with depression more often had a higher fasting serum glucose concentration when compared to those without depression (25% vs 18%, p<0.05). Such a relationship was not observed in the male group and whole group. CONCLUSIONS: In the studied group of middle-aged subjects, especially among women, a high prevalence of depression symptoms was noted. Statistically significant correlations between the prevalence of depressive symptoms and visceral obesity in men and an elevated glucose level in women were shown.

Population Effect of Differences in Cholesterol Guidelines in Eastern Europe and the United States.

IMPORTANCE: The American College of Cardiology/American Heart Association (ACC/AHA) guidelines for the management of blood cholesterol and the current European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines differ in how they identify adults in need of statin therapy; furthermore, it is unclear how this difference translates into numbers and characteristics of patients recommended for treatment. OBJECTIVE: To determine the effect of the ACC/AHA and ESC/EAS cholesterol guidelines when applied to a population-based sample. DESIGN, SETTING, AND PARTICIPANTS: We used nationally representative data for 3055 adults aged 40 to 65 years from the 2007-2012 National Health and Nutrition Examination Surveys (NHANES) for the United States and for 1060 adults aged 40 to 65 years from the 2011 Nadcisnienie Tetnicze w Polsce survey for Poland. Data analysis was conducted from May 1, 2014, to December 31, 2015. MAIN OUTCOMES AND MEASURES: The number and characteristics of adults recommended for statin therapy according to the ACC/AHA and ESC/EAS guidelines were evaluated, and characteristics were compared between adults with discordant recommendations. RESULTS: The 3136 US adults in NHANES (2007-2012) aged 40 to 65 years represented 100.1 million adults; after excluding the 81 patients with missing data, these population estimates translate to 97.9 million adults. Similarly, the 1060 Polish adults in NATPOL (2011) aged 40 to 65 years represent 13.5 million adults. Using weighted data, in the United States, 43.8% (95% CI, 40.9%-46.7%) of adults would be recommended for statin therapy according to ACC/AHA guidelines and 39.1% (95% CI, 36.4%-41.8%) according to ESC/EAS guidelines. In Poland, 49.9% (95% CI, 46.9%-52.9%) of adults would be recommended for statin therapy under ACC/AHA guidelines compared with 47.6% (95% CI, 44.6%-50.7%) under ESC/EAS guidelines. Among individuals without cardiovascular disease and not currently taking statins, 11.0% of US and 10.5% of Polish adults had discordant guideline recommendations. Compared with individuals recommended for statin therapy by the ESC/EAS guidelines but not the ACC/AHA guidelines, those recommended for statin therapy under the ACC/AHA guidelines only had less chronic kidney disease; however, these individuals were also more likely to smoke, have lower high-density lipoprotein cholesterol levels, and have higher predicted 10-year risk of cardiovascular disease. CONCLUSIONS AND RELEVANCE: Despite differences in the ACC/AHA and EAS/ESC guidelines, the numbers of adults aged 40 to 65 years recommended for cholesterol-lowering therapy under each guideline were similar when applied to nationwide representative samples from both the United States and Poland. Discordant recommendations were driven by differences in the risk equations used in the 2 guidelines and different recommendations for adults with chronic kidney disease.

Prevalence, awareness, and control of hypertension in elderly and very elderly in Poland: results of a cross-sectional representative survey.

OBJECTIVE: The aim of the study was to examine prevalence, awareness, and control of hypertension in elderly and very elderly in Poland. METHODS: The random sample of 4950 study participants aged 65 or more (age range 65-104 years), equally distributed in six age subgroups, and participated in cross-sectional, nationally representative survey PolSenior. During two separate visits, standardized interviews on awareness of hypertension as well as anthropometric measurements, blood pressure (BP) and heart rate readings were obtained. Hypertension was defined according to 2013 European Society of Hypertension/European Society of Cardiology Guidelines. RESULTS: Mean SBP was highest in men aged 75-79 years (148.3  mmHg) and in women aged 80-84 years (149.9  mmHg), and then steadily decreased, whereas DBP decreased steadily from age 65. Hypertension affected about 80% of septuagenarians. Its prevalence decreased with age to 67% in women and 60% in men aged 90 years or older. In nonagenarians, awareness of hypertension (72% in women and 61% in men) and percentage of treated study participants (64% of women and 54% of men) was the lowest. In contrast, among treated study participants proportion of well controlled (BP < 140/90  mmHg) was the highest in people older than 85 reaching 34% among nonagenarian women and 38% in men. CONCLUSIONS: The results show a reversed trend in prevalence and control of hypertension in people aged 80 years and older when compared with the younger elderly. As awareness and treatment of hypertension decreases with advanced age, it seems reasonable to extend screening programs and antihypertensive initiatives for the elderly and very elderly.

Prevalence of lipid abnormalities in Poland. The NATPOL 2011 survey.

BACKGROUND: Poland represents a country of high cardiovascular (CV) risk. The association between lipid abnormalities and increased CV risk is well established. Therefore, it is important to monitor the prevalence and control of dyslipidaemia. AIM: To evaluate serum lipids concentrations as well as the prevalence, awareness, and control of lipid abnormalities in a representative sample of adults in Poland. METHODS: In 2011, in a national cross-sectional survey blood samples were collected from 1168 males and 1245 females, aged 18-79 years, for measurement of total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), and triglycerides (TG) in blood serum. Low density lipoprotein cholesterol (LDL-C) was calculated using Friedewald's formula. RESULTS: Mean serum TC concentration was 197.1 mg/dL (95% CI 193.8-200.4) in males (M) and 198.6 mg/dL (95% CI 195.7-201.5) in females (F). Levels of LDL-C were 123.6 mg/dL (120.9-126.2) and 123.7 mg/dL (121.4-126.1), HDL-C - 45.8 mg/dL (44.7-47.0) and 54.1 mg/dL (53.1-55.1), TG - 140.9 mg/dL (133.0-148.8) and 104.0 mg/dL (99.8-108.2) for males and females, respectively. TC ≥ 190 mg/dL was found in 54.3% subjects (M 54.3%; F 54.4%). After adding patients on lipid-lowering treatment, hypercholesterolaemia was present in 61.1% of adults (M 60.8%; F 61.3%). LDL-C ≥ 115 mg/dL was detected in 57.8% of all subjects (M 58.3%; F 57.3%), while HDL-C < 40 mg/dL in 35.2% of males and < 45 mg/dL in 22% of females TG ≥ 150 mg/dL was found in 21.1% of subjects (M 28.4%; F 14.0%). The highest prevalence of elevated TC and LDL-C levels was present in the age group of 40-59-year-olds. Of those with hypercholesterolaemia 58.7% (M 61.5%, F 56.0%) were not aware of the condition; 22.0% (M 21.0%, F 24.5%) were aware but were not being treated; 8.1% (M 7.7%, F 8.5%) were treated but with TC ≥ 190 mg/dL; and only 10.9% (M 10.7%, F 11.0%) were being treated with TC < 190 mg/dL. CONCLUSIONS: The prevalence of dyslipidaemia in Poland continues to be high--over 60% of adults have hypercholesterolaemia, and control remains poor. The results of the NATPOL 2011 survey call for urgent preventive measures.

Arm circumference in adults in Poland as an important factor influencing the accuracy of blood pressure readings.

AIMS: The aim of this study was to assess the distribution of right arm circumference (RAC) in adults in Poland and to establish how often other than standard cuffs should be used in everyday practice. We also wanted to examine whether large cuffs are available in the market in Poland and whether the cuffs comply with WHO and JNC VII recommendations. MATERIAL AND METHODS: In 2002, we conducted a cross-sectional representative survey NATPOL PLUS to examine prevalence and control of cardiovascular risk factors in Poland. The survey included a questionnaire interview, blood pressure (BP) and anthropometric measurements, as well as laboratory tests. The examined representative sample of adults in Poland consisted of 3051 men and women aged 18-94 years. The measurements of RAC were performed in all respondents. Arterial hypertension (AH) diagnosis was based on three separate visits (BP > or =140/90 mmHg or treatment). Subjects with body mass index (BMI) > or =25 kg/m were included to overweight/obese group. RESULTS: The prevalence of AH was 29% and of overweight or obesity, 52%. In 24% of all adults RAC was > or = 32 cm, and in 6% was < 24 cm. In hypertensives, the respective figures were 36 and 3%; and in overweight/obese subjects 40 and 0.6%. Mean RAC was 29.2+/-3.8 cm (males 30.2+/-3.5 cm; females 28.3+/-3.9 cm, P<0.001). Mean RAC was significantly greater (P<0.01) in patients with AH (30.4+/-3.9 cm; males 30.7+/-3.5 cm; females 30.2+/-3.8 cm) than in normotensive subjects (28.4+/-3.7 cm; males 29.9+/-3.4 cm; females 27.3+/-3.5 cm). However, these differences were not statistically significant when the results were adjusted for age and BMI. Additional analysis of sphygmomanometers available in Poland showed that parameters of standard cuffs fulfilled recommendations of JNC VII and WHO/ISH guidelines. However, the sets with large cuffs were usually much more expensive and only one manufacturer made them available as a special order. CONCLUSIONS: One-third of adults in Poland have an arm circumference, which requires use of a 'non-standard' sized cuff. Moreover, in patients with AH or overweight/obese subjects, wider or narrower cuffs should be used in approximately 40% of subjects.

[The role of medical university in modern prevention of cardiovascular diseases. Examples from Medical University of Gdansk]. / Rola uczelni w nowoczesnej prewencji chorób ukladu krazenia na przykladzie programów Akademii Medycznej w Gdansku.

Constant worsening of epidemiological situation in cardiovascular diseases in Poland in the 70's and 80's called for intensive measures in the field of preventive cardiology. Thus in 90's, in order to change this situation, among others, team from Department of Hypertension and Diabetology from Medical University of Gdansk started, in cooperation with other medical universities, important regional and national research programs and preventive interventions. The aim of the educational program carried out in years 1999-2001 for Members of the Polish Parliament, opinion leaders and decision makers was to increase knowledge of the Polish elites about epidemic of cardiovascular diseases in our country. These actions made possible receiving greater support from the government for new epidemiological and preventive programs in this field. Thanks to NATPOL PLUS project, carried out on the representative sample of adults in 2002, we determined for the first time the prevalence and control of main cardiovascular risk factors in Poland. Results of this program helped planning preventive tasks in the National Cardiovascular Diseases Prevention and Treatment Program POLKARD 2003-2005. The aim of the preventive programmes: SOPKARD and Polish Four-Cities Project was to work out standards of modern, comprehensive interventions. They permitted planning and introduction of the largest preventive program: the Polish 400 Cities Project (PP400M). The PP400M is addressed to citizens of all small towns (to 8000 citizens) and surrounding villages in the whole country. All these accomplishments in the field of quickly expanded clinical epidemiology and cardiovascular prevention are directed mainly to Pomeranian and Polish citizens, especially those who are not aware of high risk of myocardial infarction or stroke. The main principle of our strategy is the role of university as an expert in preparation and supervision of the programs, which were carried out by the specialized organizations and firms such as PBS in Sopot. The second important component of our strategy was an intensive cooperation with other leading research centres in Poland that allowed taking advantage of the joint achievements.

A victory for statins or a defeat for diet policies? Cholesterol falls in Poland in the past decade: A modeling study.

AIM: The present study is aimed to examine whether recent changes in population total cholesterol (TC) levels in Poland might be attributed to increased use statins. METHODS: Two independent, nationally representative cross-sectional studies were conducted in adults aged 18-79 years in 2002 (n=2993, mean age 46.2 years) and 2011 (n=2413, mean age 45.8 years), including measurements of TC in venous blood samples. The mean change of TC between 2002 and 2011 was assessed. Then the expected therapeutic reduction in TC level in 2011 attributable to statins only was calculated based on already published statin effectiveness data. Uncertainty was quantified using probabilistic sensitivity analysis. RESULTS: Statin uptake in Poland rose to 11.2% in 2011 (95% Confidence Intervals (CI): 10% to 12.5%) and approximately 32% (95% CI: 28.4 to 36.0%) in subjects aged 60-79 years. Mean TC in Poland in 2002 was 5.35 mmol/l, and fell by 0.21 mmol/l (95% CI: 0.14 to 0.28) by 2011. This fall would have been only 0.03 mmol/l (95% CI: -0.04 to 0.10) for the total adult population and 0.06 mmol/l (95% CI: -0.09 to 0.22) in people aged 60-79 years if statins had not been used. Statin use thus apparently explained approximately 85% (95% CI: 49% to 120%) of the observed decrease. CONCLUSION: Between 2002 and 2011, statin medications apparently explained a large part of the observed fall in population cholesterol level, suggesting very little changes in population TC attributed to dietary changes.

Knowledge and use of hormone replacement therapy among Polish women: estimates from a nationally representative study--HORTPOL 2002.

OBJECTIVES: To evaluate the knowledge about hormone replacement therapy (HRT) and the prevalence of its current use in Polish female population. METHODS: Cross-sectional survey on a representative sample of 1544 women between 18 and 87 years of age. RESULTS: Almost half of the Polish women have heard of HRT. Depending on the education level, 26-38% of women knew that HRT alleviates the physical and psychological symptoms of menopause and 18-32% knew that HRT reduces the risk of developing osteoporosis. Forty-three percent of all the women with a higher level of education were aware that HRT increases the risk of breast and uterine cancer. The prevalence of current HRT use among women aged 45-64 was 12%. Women who had only basic education were less likely to use HRT than those with a medium and higher education level. Lack of information about HRT was the main cause of not using it. Forty-four percent of the perimenopausal women (age range 45-54 years) have never heard of HRT and 36% were never told by their healthcare providers that they could use it. Nineteen percent of perimenopausal women were not using HRT because they were afraid of the HRT related risks. Sixty-four percent of women who were using HRT were prescribed oral HRT preparations. CONCLUSIONS: A fairly small proportion of Polish women currently uses HRT, largely because most remain poorly informed about the therapy.

Effects of social intervention on detection and efficacy of treatment for arterial hypertension. Main results of the Polish Four Cities Programme.

BACKGROUND: Cardiovascular diseases are the main cause of death in the adult Polish population. Beside lipid disorders and cigarette smoking, hypertension represents the most important risk factor leading to cardiovascular complications. Representative studies conducted in Poland in 1994-2002 showed that in 2002 the number of respondents in the survey who stated they knew their own blood pressure values dropped by 3.5 million, compared with 1994. This decrease was predominantly seen in small towns and in the countryside. Preventive programmes should therefore be addressed mainly to the most vulnerable communities. Modern methods of social marketing may play a substantial role in the creation of a healthy lifestyle. AIM: The aim of the Polish Four Cities Programme (PP4M), conducted in 2000-2001, was to develop the most effective methods of detection of and improvement in treatment for hypertension among the residents of small towns and rural areas. One of the programme tasks was to compare the effectiveness of a standard medical screening intervention with a similar approach combined with the use of social marketing methods.Methods. The programme was conducted by an interdisciplinary team in three small Polish towns -- Kartuzy, Oborniki Wlkp. and Braniewo, as well as in one of the districts of a large city Lódz -- Olechów. Medical intervention combined with social marketing (community intervention) took place in Oborniki Wlkp. whereas the residents of Kartuzy and Lódz were subjected only to the traditional medical intervention. Braniewo served as a control location -- neither medical nor community intervention was implemented. Community intervention with elements of social marketing consisted of a three-month, intensive education and information campaign, initiated four weeks prior to the start of medical intervention. Epidemiological situation was assessed in all the four cities before and after the completion of the preventive interventions (screening), using representative surveys, with the objective to assess the changes in the awareness of one's own blood pressure values, detection of hypertension and knowledge concerning cardiovascular risk factors.Results. In two survey locations -- Kartuzy and Lódz - awareness of one's own blood pressure values after the medical intervention did not significantly change (61% and 67.6% at baseline versus 62.1% and 71.6% after the intervention, respectively). In contrast, social marketing activities conducted in Oborniki significantly increased this parameter from 61.5% to 79.8% (p<0.01). While medical intervention did not change the proportion of non-diagnosed hypertension in a small town (a non-significant decrease from 49% to 45% in Kartuzy), its effect in a large city was clearly visible (a decrease from 46% to 28% in Lódz). In Oborniki Wlkp. (medical intervention combined with social marketing) the effects were the most noticeable -- a reduction from 50% to 27% was achieved. The efficacy of hypertension treatment at baseline was low (4.7% in Kartuzy, 6.6% in Oborniki, and 6.5% in Lódz), but it then improved significantly (a twofold increase in Kartuzy and Oborniki, and more than twofold increase in Lódz). When the target value of blood pressure was set at 160/95 mmHg, the highest efficacy of hypotensive therapy was observed directly after the completion of medical and community intervention in Oborniki (an almost twofold increase in treatment efficacy). CONCLUSIONS: 1. Medical intervention combined with a community intervention and marketing campaign leads to a statistically significant improvement in self-awareness of blood pressure values among residents of small towns. 2. Medical intervention combined with community intervention brings the detection rate of hypertension in small towns up to the level observed in large cities. 3. Medical intervention, especially when combined with community intervention, improves the efficacy of the treatment of hypertension, regardless of the size of agglomeration.

Theophylline therapy for Cheyne-Stokes respiration during sleep in a 41-year-old man with refractory arterial hypertension.

We report a case of a 41-year-old man who was noted to have position-dependent Cheyne-Stokes respiration with central sleep apnea (CSA) during sleep. The patient had multiple cardiovascular risk factors and target organ damages, including a history of two myocardial infarctions, transient ischemic attack, and chronic kidney disease. His hypertension was refractory to a number of antihypertensive medicines, however, a complete elimination of sleep-disordered breathing with oral theophylline treatment was paralleled by a significant BP fall with a subsequent need for reduction of antihypertensive drugs. Following these surprising observations we decided to withdraw theophylline from treatment (in-clinic). Theophylline discontinuation resulted in a gradual increase in BP and an urgent call for antihypertensive treatment modification. These observations suggest a potent hypotensive action of oral theophylline via Cheyne-Stokes respiration with CSA elimination. Our data suggest that CSA may be a mechanism that raises BP even during the daytime.

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.

Decline in mortality from coronary heart disease in Poland after socioeconomic transformation: modelling study.

OBJECTIVES: To examine how much of the observed rapid decrease in mortality from coronary heart disease in Poland after the political, social, and economic transformation in the early 1990s could be explained by the use of medical and surgical treatments and how much by changes in cardiovascular risk factors. DESIGN: A modelling study. SETTING: Sources of data included controlled trials and meta-analyses, national surveys, and official statistics. PARTICIPANTS: Population of adults aged 25-74 in Poland in 1991-2005. MAIN OUTCOME MEASURES: Number of deaths prevented or postponed in 2005 attributable to specific treatments for coronary heart disease and changes in risk factors. A previously validated epidemiological model for coronary heart disease was used to combine and analyse data on the uptake and effectiveness of specific cardiac treatments and changes in risk factors. The observed fall in deaths from coronary heart disease from 1991 to 2005 was then partitioned among specific treatments and risk factor changes. RESULTS: From 1991 to 2005, the death rate from coronary heart disease in Poland halved, resulting in 26,200 fewer coronary deaths in 2005 in people aged 25-74. About 37% (minimum estimate 13%, maximum estimate 77%) of this decrease was attributable to treatments, including treatments for heart failure (12%), initial treatments for acute coronary syndrome (9%), secondary prevention treatments after myocardial infarction or revascularisation (7%), chronic angina treatments (3%), and other treatments (6%). About 54% of the fall was attributed to changes in risk factors (minimum estimate 41%, maximum estimate 65%), mainly reductions in total cholesterol concentration (39%) and an increase in leisuretime physical activity (10%); however, these were partially offset by increases in body mass index (-4%) and prevalence of diabetes (-2%). Blood pressure fell in women, explaining about 29% of their decrease in mortality, but rose in men generating a negative influence (-8%). About 15% of the observed decrease in mortality was attributable to reduced smoking in men but was negligible in women. CONCLUSIONS: Over half of the recent fall in mortality from coronary heart disease in Poland can be attributed to reductions in major risk factors and about one third to evidence based medical treatments.