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BACKGROUND: Ageing populations experience greater risks associated with health and survival. It increases the relevance of identifying variables associated with mortality. Grip strength (GS) has been identified as an important biomarker for all cause and cardiovascular mortality, however, its prognostic value has not been studied in Lithuania. The aim of the present study is to evaluate the relationship of GS to vital status in a representative sample of the Lithuanian 45-72-year-old urban population during the period of 12 years of follow-up and to explore associations of GS with all-cause mortality and mortality from cardiovascular diseases (CVD). METHODS: Within the framework of the international study Health, Alcohol and Psychosocial Factors in Eastern Europe (HAPIEE) 7,115 men and women 45-72 years of age were examined in the baseline survey (2006 to 2008). Data from the Official Lithuanian Mortality Register were used to evaluate CVD and all-cause mortality from follow-up till 2020. Cox proportional hazards regression was used, and four models for all-cause and CVD mortality were assessed. RESULTS: The mean GS was significantly higher among survivors' men and women as compared to individuals deceased from CVD and other causes of death. In survivor men and women groups, minimal values of GS in all terciles were higher as compared to all three deceased groups. In both men and women groups, the lowest GS (1st tercile) was associated with a significantly higher risk of all-cause and CVD mortality as compared to the highest levels of GS (3rd tercile) in three Cox regression models. In both men and women were found to have a 1.34- and 1.35-fold higher risk of all-cause mortality, respectively, at lower GS, but no significant difference in the risk of CVD mortality. When GS was treated in all models as decrement per 1 kg and decrement per 1 SD, in both men and women, the risk of all-cause mortality significantly increased with decreasing of GS. CONCLUSIONS: The mean GS was significantly higher among survivors' men and women as compared to deceased from CVD and other causes of death. Risk of all-cause mortality significantly increased with decreasing of GS.
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Enfermedades Cardiovasculares , Sistema Cardiovascular , Masculino , Humanos , Femenino , Anciano , Persona de Mediana Edad , Lituania/epidemiología , Factores de Riesgo , Fuerza de la ManoRESUMEN
BACKGROUND: The impact of weather on morbidity from stroke has been analysed in previous studies. As the risk of stroke was mostly associated with changing weather, the changes in the daily stroke occurrence may be associated with changes in atmospheric circulation. The aim of our study was to detect and evaluate the association between daily numbers of ischaemic strokes (ISs) and haemorrhagic strokes (HSs) and the teleconnection pattern. METHODS: The study was performed in Kaunas, Lithuania, from 2000 to 2010. The daily numbers of ISs, subarachnoid haemorrhages (SAHs), and intracerebral haemorrhages (ICHs) were obtained from the Kaunas Stroke Register. We evaluated the association between these types of stroke and the teleconnection pattern by applying Poisson regression and adjusting for the linear trend, month, and other weather variables. RESULTS: During the study period, we analysed 4038 cases (2226 men and 1812 women) of stroke. Of these, 3245 (80.4%) cases were ISs, 533 (13.2%) cases were ICHs, and 260 (6.4%) cases were SAHs. An increased risk of SAH was associated with a change in mean daily atmospheric pressure over 3.9 hPa (RR = 1.49, 95% CI 1.14-1.96), and a stronger El Niño event had a protective effect against SAHs (RR = 0.34, 95% CI 0.16-0.69). The risk of HS was positively associated with East Atlantic/West Russia indices (RR = 1.13, 95% CI 1.04-1.23). The risk of IS was negatively associated with the Arctic Oscillation index on the same day and on the previous day (RR = 0.97, p < 0.033). During November-March, the risk of HS was associated with a positive North Atlantic Oscillation (NAO) (RR = 1.29, 95% CI 1.03-1.62), and the risk of IS was negatively associated with the NAO index (RR = 0.92, 95% CI 0.85-0.99). CONCLUSIONS: The results of our study provide new evidence that the North Atlantic Oscillation, Arctic Oscillation, East Atlantic/West Russia, and El Niño-Southern Oscillation pattern may affect the risk of stroke. The impact of these teleconnections is not identical for various types of stroke. Emergency services should be aware that specific weather conditions are more likely to prompt calls for more severe strokes.
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Accidente Cerebrovascular , Tiempo (Meteorología) , Femenino , Humanos , Lituania , Masculino , Federación de Rusia , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiologíaRESUMEN
An increase in the daily rate of acute myocardial infarction (AMI) has been observed during days of geomagnetic storm (GS). However, the analysis of associations between the daily number of AMI and geomagnetic activity (GMA) over longer periods sometimes yields controversial results. The study aimed to detect the complex association between the daily numbers of AMI and weather, the Quasi-biennial Oscillation (QBO) phase, GMA, and solar wind variables. We used data of Kaunas population-based Ischemic Heart Disease Register of residents of Kaunas city (Lithuania) for 2000-2012. The associations between weather and space weather variables and the daily number of AMI were evaluated by applying the multivariate Poisson regression. A higher risk of AMI was positively associated with active-stormy local GMA (rate ratio (RR) = 1.06 (95% CI 1.01-1.10)), solar wind dynamic pressure with a lag of 4 days (RR = 1.02 (1.01-1.04) per 1 nPa increase), and solar wind speed with a lag of 3-7 days (RR = 1.03 (1.01-1.05) per 100 km/s increase). A positive association was found between the west QBO phase and the risk of AMI during winter (RR = 1.08 (1.01-1.16)), and a negative association was observed between them during March-November (RR = 0.93 (0.90-0.97)). The risk of AMI positively associated with the GS due to stream interaction regions with a lag of 0-2 days during the east QBO phase (RR = 1.10, p = 0.046) and was negatively associated with them during the west QBO phase (RR = 0.82, p = 0.024). These results may help understand the population's sensitivity under different weather and space weather conditions. The QBO phase may modify the effect of GS.
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Infarto del Miocardio , Actividad Solar , Humanos , Incidencia , Lituania , Tiempo (Meteorología) , VientoRESUMEN
OBJECTIVE: The aim of this study was to assess the trends of myocardial infarction (MI) morbidity and evaluate the associations with some meteorological factors. MATERIALS AND METHODS: Data on MI morbidity were collected from Kaunas ischemic heart disease registry and information about meteorological factors from Kaunas meteorological station was collected. RESULTS: The overall morbidity rates of acute MI among men aged 25-64 increased by 2.0%/yr. (P=0.02), whereas among women did not change significantly (+1.2%/yr., P=0.2) during 1995-2007. Among men aged 65-84 the overall morbidity rates of MI were without significant changes (-1.0%/yr., P=0.3) and among women decreased significantly by -1.7%/yr. (P=0.03). During 1995-2000, a weak inverse significant correlation between atmospheric air temperature and morbidity of MI (r=-0.05, P=0.019) was documented (in women and the elderly r=-0.045 and -0.048, respectively, P<0.05). Weak correlation between atmospheric air wind speed and MI morbidity in women (r=-0.042, P=0.05) and in population of older age (r=-0.056, P=0.099) was determined. In men and in elderly population a direct weak correlation between atmospheric pressure and MI morbidity was found (r=0.114 and 0.166, respectively, P<0.01). In this study monthly and seasonal variation of MI rates were observed. In winter period MI rates were higher to compare with other seasons (χ(2)=18.682, df=3, P<0.0001). CONCLUSIONS: The overall morbidity rates of MI increased among Kaunas men aged 25-64 and tended to increase among women, whereas among men aged 65-84 MI morbidity trends were without statistically significant changes and significantly decreased among women during 1995-2007. Weak inverse correlations between atmospheric air temperatures, rainfall level and direct correlation between air wind speed, atmospheric pressure and MI morbidity were established. Months/seasonal variations during analyzed period were observed.
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Infarto del Miocardio/epidemiología , Tiempo (Meteorología) , Adulto , Anciano , Anciano de 80 o más Años , Presión Atmosférica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sistema de Registros , Estaciones del AñoRESUMEN
Background: Two indices: visceral adiposity index (VAI) and atherogenic index of plasma (AIP) during several recent years were implemented into epidemiological studies for predicting of cardiovascular diseases (CVD) and mortality risk. Our study aimed to evaluate the association of VAI and AIP with the risk of all-cause and CVD mortality among the Lithuanian urban population aged 45-72 years. Methods: In the baseline survey (2006-2008), 7,115 men and women 45-72 years of age were examined within the framework of the international study Health, Alcohol and Psychosocial Factors in Eastern Europe (HAPIEE). Six thousand six hundred and seventy-one participants (3,663 women and 3,008 men) were available for statistical analysis (after excluding 429 respondents with the missed information on study variables) and for them, VAI and AIP were calculated. The questionnaire evaluated lifestyle behaviors, including smoking and physical activity. All participants in the baseline survey were followed up for all-cause and CVD mortality events until December 31st, 2020. Multivariable Cox regression models were applied for statistical data analysis. Results: After accounting for several potential confounders, higher levels of VAI (compared 5th quintile to 1st quintile) were associated with significantly higher CVD mortality in men [Hazards ratio (HR) = 1.38] and all-cause mortality in women (HR = 1.54) after 10-year follow-up. CVD mortality significantly increased in men with 0 the highest AIP quintile compared with that for the lowest quintile (HR = 1.40). In women, all-cause mortality was significantly higher for the 4th quintile of AIP as compared with the 1st quintile (HR = 1.36). Conclusions: High-risk VAI levels were statistically significantly associated with all-cause mortality risk in men and women groups. The higher AIP level (5th quintile vs. 1st quintile-in men and 4th quintile vs. 1st quintile-in women) was significantly associated with increased mortality from CVD in the men group and increased all-cause mortality in the women group.
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Enfermedades Cardiovasculares , Masculino , Persona de Mediana Edad , Anciano , Humanos , Femenino , Enfermedades Cardiovasculares/epidemiología , Adiposidad , Lituania/epidemiología , Modelos de Riesgos Proporcionales , Población UrbanaRESUMEN
INTRODUCTION: The role of COVID-19 regarding in-hospital complications and poor outcomes for patients with ischaemic stroke (IS) is still important to explore. The aim of this study was to evaluate the risk of in-hospital lethality for IS patients respectively to their comorbidities and in-hospital complications in the context of the COVID-19 pandemic. METHODS: We identified 1898 acute IS patients (749 men and 1149 women) admitted to the Lithuanian University of Health Sciences Kaunas Hospital, Lithuania, from December 2020 to February 2022. The sociodemographic, clinical, and outcome features of the patients were evaluated deploying appropriate statistical tests. Hazard ratios and 95% confidence intervals were estimated by the Cox proportional hazards regression for hospital lethality. RESULTS: The risk of in-hospital lethality was 2.22 times higher in men suffering from IS and chronic ischaemic heart disease (cIHD) compared to those with IS and isolated arterial hypertension (iAH) (p < 0.05). COVID-19 elevated the risk of in-hospital lethality in men by 3.16 times (p < 0.05). In comorbid women with type two diabetes mellitus (DM) or cIHD, the risk of in-hospital lethality was two times higher compared to those with iAH (p < 0.05). The risk of in-hospital lethality increased significantly in both men and women, with the total number of in-hospital complications increasing per one unit. CONCLUSIONS: Of the comorbidities studied, DM and cIHD together with COVID-19 elevated the risk of in-hospital lethality significantly. Within the acute in-hospital complications, pneumonia with respiratory failure and acute renal failure showed the most significant prognostic value anticipating lethal outcomes for IS patients.
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UNLABELLED: The aim of the study was to evaluate patients' satisfaction with the quality of provided services in private primary health care institutions in Kaunas. MATERIAL AND METHODS: A questionnaire-based inquiry of 280 persons registered to family physicians at primary health care settings was performed. The study was carried out using 20-item anonymous questionnaires with questions about the quality of services provided in primary health care settings. RESULTS: More than 50.0% of the respondents stated that they waited for more than 15 minutes at the physician's office, while 17.0% of the respondents stated that the waiting time exceeded 30 minutes. More than 25.0% of the respondents positively evaluated the possibility to consult their family physician by phone. In 67.0% of patients, the family physician determined the cause of the disorder and administered treatment; in 32.0% of patients, the family physician referred them to a specialist, and 1.0% of patients were urgently sent to hospital. More than 90.0% of the respondents were satisfied with the services provided by their family physicians. Those who were dissatisfied with these services indicated that the provided treatment failed to eliminate the disorder, that they wanted to be referred to a specialist, and that they expected more diagnostic tests to be performed for more effective treatment. CONCLUSIONS: A greater part of the patients indicated that the main reason for long waiting at the physician's office was physicians' wish to serve too many patients. More than two-thirds (67.0%) of the patients stated that their family physicians determined the cause of the disorder and prescribed treatment. The overwhelming majority (more than 90.0%) of the patients were satisfied with the services provided by their family physicians.
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Encuestas de Atención de la Salud , Satisfacción del Paciente , Calidad de la Atención de Salud , Adolescente , Adulto , Anciano , Femenino , Humanos , Lituania/epidemiología , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Adulto JovenRESUMEN
UNLABELLED: The aim of the study was to determine the associations between the quality of life and social and demographic factors in stroke survivors and control group. MATERIAL AND METHODS: The case group consisted of 508 inhabitants of Kaunas city who were aged 25-84 years and had survived a stroke. The control group included 508 age- and sex-matched inhabitants of Kaunas city randomly selected from the stroke-free population. The SF-12 questionnaire was used in the study. Quality of life in the physical and mental health domains with respect to social and demographic factors was analyzed. RESULTS: A significant inverse correlation was found between the evaluation of physical health and age in both the stroke survivors and controls (r=-0.34, P<0.05, and r=-0.64, P<0.05, respectively). The comparison of the evaluation of physical health between men and women showed that only in the control group, men demonstrated significantly better physical health than women (P=0.0005), while no statistically significant difference in this respect was found comparing male and female stroke survivors. Stroke survivors of Lithuanian nationality reported better physical health as compared to individuals of other nationalities (P=0.008). Both the controls (P=0.01) and stroke survivors (P=0.008) who were not living alone scored higher on the physical health domain than their counterparts living alone. Employed subjects - both the controls and stroke survivors - presented better evaluations of their physical health (P=0.005 in both the groups). CONCLUSIONS: Quality of life in the physical health domain worsened with age both in the stroke survivors and controls. Both in the stroke survivors and controls, males and females with higher education levels, not living alone, and having employment demonstrated better evaluations of their quality of life in the physical health domain compared to those with poorer education, living alone, or unemployed.
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Calidad de Vida , Accidente Cerebrovascular , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Demografía , Femenino , Estado de Salud , Humanos , Lituania , Masculino , Persona de Mediana Edad , Factores Sexuales , Accidente Cerebrovascular/psicología , Sobrevivientes/psicologíaRESUMEN
UNLABELLED: The aim of the study was to compare the quality of life between stroke survivors and controls with respect to their health, daily activities, and emotional status. CONTINGENT AND METHODS OF THE STUDY: The studied group consisted of 508 25-84-year-old inhabitants of Kaunas city who have survived first-onset stroke. The control group consisted of 508 age- and sex-matched randomly selected inhabitants of Kaunas city who had not experienced stroke. The SF-12 Quality of Life Questionnaire was used for the study. Logistic regression was used to compare quality of life with respect to health, daily activities, and emotional status. RESULTS: Only 1.0% of stroke survivors evaluated their health as excellent or very good, compared to 24.4% of the controls (P=0.0005); the respective percentages of those who evaluated their health as poor or fair were 78.9% and 26.4% (P=0.0005). Health significantly limited moderate activities in 35.2% of stroke survivors and 3.5% of controls (P=0.0005). During the last 4 weeks, health status or emotional problems most of the time or a little of the time impeded social activities in 19.3% of stroke survivors and 1.6% of controls (P<0.05). When comparing with respect to age, sex, and diseases (arterial hypertension, myocardial infarction, atrial fibrillation, diabetes mellitus, transient ischemic attack), stroke had the greatest negative effect on social activities (odds ratio, 36.7), caused sadness (odds ratio, 16.0), and significantly limited home activities (odds ratio, 15.5). CONCLUSIONS: Less that one-third (28.2%) of stroke survivors evaluated their health as poor, and 50.7% as fair as compared to 1.8% and 24.6% of controls, respectively. Stroke significantly impaired the subjects' emotional status and limited their daily activities.
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Calidad de Vida , Accidente Cerebrovascular , Sobrevivientes , Actividades Cotidianas , Adulto , Anciano , Anciano de 80 o más Años , Actitud Frente a la Salud , Femenino , Estado de Salud , Humanos , Modelos Logísticos , Masculino , Salud Mental , Persona de Mediana Edad , Calidad de Vida/psicología , Accidente Cerebrovascular/psicología , Encuestas y Cuestionarios , Sobrevivientes/psicologíaRESUMEN
BACKGROUND: There is a lack of reliable epidemiological data on long-term survival trends of first-ever stroke patients in Lithuanian population. AIMS: To evaluate trends in long-term survival after stroke and to determine the influence of some sociodemographic and lifestyle factors, time and subtype of stroke, and stroke care on survival. METHODS: All stroke events included in Kaunas stroke register database were ascertained and validated according to the standardized criteria outlined by the WHO MONICA Project. The study included all patients in Kaunas (Lithuania) city aged 25 to 64 years who experienced a stroke between 1986 and 2011. Death time was confirmed by the Office for National Death Statistics. Estimates of stroke long-term survival data and factors influencing survival changes were made by applying the Kaplan-Meier and Cox regression analysis. RESULTS: During the study period, 4,129 persons aged 25-64 years suffered from a first-ever stroke: 2,215 (53.6%) of them were men and 1,914 (46.4%)-women. Ischemic stroke was significantly more frequent in males than in females (80.6% and 78.6%, respectively, p<0.05) and subarachnoid hemorrhage was more common in women than in men (9.0% and 7.0% respectively, p <0.05). Of all first-ever stroke patients, 3,272 (79.2%) survived 1 year and 2,905 (70.4%) survived 5 years after stroke onset. The 1- and 5-years survival rate after a first-ever stroke in women was significantly higher as compared with that in men (Log-rank test p = 0.0001). The older (55-64 year) persons had poorer 1-year and 5-years survival rate as compared with persons in the younger (25-54 years) age group (Log-rank test p = 0.0001). Among persons with a first-ever stroke who had their stroke in 2007-2011, 1- and 5-year survival rate was higher compared with that in persons who had had a stroke in 1986-1990 and in 1997-2001 (Log-rank test p = 0.0001). The persons with a first-ever ischemic stroke had a better chance to survive first 1- and 5-years after stroke compared with persons who had intracerebral or subarachnoid haemorrhage. Only female gender was associated with higher 1- and 5-year survival rate after first-ever stroke. The older age, previous myocardial infarction and diabetes mellitus were associated with lower 1- and 5-year survival rate after first-ever stroke. CONCLUSIONS: This population-based study of patients with first-ever stroke demonstrated that the long-term survival was better in women than men, and improved significantly in both men and women during the past decade. Long-term survival was better of those with first-ever ischemic stroke and of younger age- 25 to 54 years.
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Infarto del Miocardio/epidemiología , Accidente Cerebrovascular/epidemiología , Sobrevivientes , Adulto , Factores de Edad , Femenino , Humanos , Estimación de Kaplan-Meier , Lituania/epidemiología , Masculino , Persona de Mediana Edad , Infarto del Miocardio/fisiopatología , Modelos de Riesgos Proporcionales , Sistema de Registros/estadística & datos numéricos , Factores Sexuales , Accidente Cerebrovascular/fisiopatologíaRESUMEN
Background/Objective: The purpose of this study is to evaluate changes of psychological well-being (PWB) in older Lithuanian city dwellers during ten years of follow-up, and to establish factors associated with it. Method: 7,115 men and women of age 45-72 years participated in the initial survey in 2006-2008. In 2016 the follow-up survey was performed among all 6,210 participants who survived. 4,266 individuals responded to postal questionnaires. PWB was evaluated by using CASP-12 questionnaire. Depressive symptoms were evaluated by CES-D-10 scale. Quality of life, self-rated health, and social activity were evaluated.Socio-demographic, socio-economic factors were included into standard questionnaire. Results: PWB deteriorated in all age groups during 10-years follow-up. Poor quality of life, poor self-rated health, having depressive symptoms, and not being member of social organization are associated with lower PWB after 10 years in men and women. Employed-retired, retired, and not socially active women have higher possibility to have lower PWB over 10 years. Conclusions: PWB in older Lithuanian city dwellers deteriorates as many other socio-economic and psychosocial indicators during ten-year follow-up. Mostly psychosocial factors, but not the socio-demographic, and socio-economic ones predict PWB over 10 years. It is crucial to understand and promote predictors of PWB in older age.
Antecedentes/Objetivo: Evaluar los cambios en el bienestar psicológico (BP) de los habitantes de las ciudades lituanas más antiguas en un seguimiento de diez años e identificar factores asociados. Método: Inicialmente participaron 7.115 hombres y mujeres de 45-72 años de edad durante los años 2006-2008. En 2016, la encuesta de seguimiento se realizó entre 6.210 participantes. De ellos, 4.266 personas respondieron a los cuestionarios. El BP fue evaluado mediante el cuestionario CASP-12. Los síntomas depresivos mediante la escala CES-D-10. Se evaluó la calidad de vida, la salud y la actividad social. Resultados: El BP se deterioró en todos los grupos de edad a los 10 años de seguimiento. Mala calidad de vida, mala autoevaluación de la salud, síntomas depresivos y la no pertenencia a una organización social se asocian con BP más bajo. Mujeres jubiladas y socialmente inactivas tienen mayor probabilidad de peor BP. Conclusiones: El BP de los habitantes de las ciudades lituanas más antiguas se deteriora, al igual que otros muchos indicadores socioeconómicos y psicosociales a los diez años de seguimiento. La mayoría de los factores psicosociales, aunque no los sociodemográficos y socioeconómicos, predicen el BP. Es crucial promover predictores de bienestar psicológico en la vejez.
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Some researchers have hypothesised that meteorological factors may have an impact on acute cerebrovascular diseases. The aim of this study was to determine an impact of some meteorological factors on occurrence of acute cerebrovascular events in the middle-aged Kaunas population. Kaunas stroke register data were used. Data on meteorological factors for the time period from 2000 to 2010 were obtained from the Lithuanian Hydrometeorological Service Kaunas Meteorological Station. We analysed 4038 cases with stroke. Ischemic strokes composed 80.4% and haemorrhagic strokes-19.6%. According to Poisson regression analysis, significant negative correlation between ischemic, haemorrhagic and all types of stroke and ambient air temperature was found (ß coefficient - 0.007, -0.016, -0.009, p < 0.001, respectively). Results of ARIMA showed that ambient temperature of the day of stroke onset was associated with the occurrence of ischemic, haemorrhagic and all types of stroke: when temperature was lower, the risk of stroke was higher (-0.006, -0.003, -0.009, p < 0.001, respectively). Low temperature on the event day and 1 and 2 days before the event was associated with higher incidence of haemorrhagic stroke in women. Low ambient temperature on the event day increased incidence of haemorrhagic stroke in subjects 55-64 years. High wind speed on the event day was associated with higher incidence of ischemic stroke in older subjects. Meteorological factors may have some impact on the risk of acute cerebrovascular events. Health care providers should focus on preventive measures, which can reduce these risks.
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Conceptos Meteorológicos , Accidente Cerebrovascular/epidemiología , Femenino , Humanos , Incidencia , Lituania/epidemiología , Factores de Riesgo , TemperaturaRESUMEN
BACKGROUND: There is a lack of reliable epidemiological data on longitudinal trends in stroke attack rates, incidence, and mortality in the countries of the Baltic region. AIMS: The aim of the present study was to explore the longitudinal trends of stroke in middle-aged urban population of Lithuania during the period of 1986 through 2012. METHODS: All stroke events in the studied population were ascertained and validated according to the standardized criteria outlined by the WHO MONICA Project. The study included all patients in Kaunas (Lithuania) city aged 25 to 64 years who experienced a stroke between 1986 and 2012. Estimates of time-trends of the annual percentage change in stroke attack rates, incidence of stroke, and mortality from this condition were made by applying the Joinpoint regression analysis. RESULTS: During the study period, 9,992 stroke events were registered. The overall proportion of recurrent events was 25.7%. Overall, 18.9% of the events (20.0% in men, and 17.4% in women) were fatal within 28 days. During the period of 1986 to 2012, a flat trend in the incidence of stroke was observed among both male and female middle-aged inhabitants of Kaunas city, while attack rates were increasing due to the increase in recurrent strokes. Both mortality and 28-day case fatality of stroke declined significantly over the study period in both sexes. CONCLUSIONS: An increase both in the incidence and recurrence of stroke among middle-aged men residing in Kaunas city and in the recurrence of stroke among women denotes the inefficiency of measures applied both for primary and secondary prevention of stroke in Lithuania. The revision of current prevention strategies and the introduction of new ones are of paramount importance in order to fight the epidemic of stroke.
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Sistema de Registros , Accidente Cerebrovascular/epidemiología , Adulto , Femenino , Humanos , Incidencia , Lituania/epidemiología , Masculino , Persona de Mediana Edad , Accidente Cerebrovascular/mortalidadRESUMEN
AIMS: This study investigated the trends and levels of the prevalence of health factors, and the association of all-cause and cardiovascular (CVD) mortality with healthy levels of combined risk factors among Lithuanian urban population. METHODS: Data from five general population surveys in Kaunas, Lithuania, conducted between 1983 and 2008 were used. Healthy factors measured at baseline include non-smoking, normal weight, normal arterial blood pressure, normal level of total serum cholesterol, normal physical activity and normal level of fasting glucose. Among 9,209 men and women aged 45-64 (7,648 were free from coronary heart disease (CHD) and stroke at baseline), 1,219 death cases from any cause, 589 deaths from CVD, and 342 deaths from CHD occurred during follow up. Cox proportional hazards regression was used to estimate the association between health factors and mortality from all causes, CVD and CHD. RESULTS: Between 1983 and 2008, the proportion of subjects with 6 healthy levels of risk factors was higher in 2006-2008 than in 1983-1984 (0.6% vs. 0.2%; p = 0.09), although there was a significant increase in fasting glucose and a decline in intermediate physical activity. Men and women with normal or intermediate levels of risk factors had significantly lower all-cause, CVD and CHD mortality risk than persons with high levels of risk factors. Subjects with 5-6 healthy factors had hazard ratio (HR) of CVD mortality 0.35 (95% confidence interval (CI) 0.15-0.83) compared to average risk in the whole population. The hazard ratio for CVD mortality risk was significant in men (HR 0.34, 95% CI 0.12-0.97) but not in women (HR 0.38, 95% CI 0.09-1.67). CONCLUSIONS: An inverse association of most healthy levels of cardiovascular risk factors with risk of all-cause and CVD mortality was observed in this urban population-based cohort. A greater number of cardiovascular health factors were related with significantly lower risk of CVD mortality, particularly among men.