Cardiovascular Risk Factors Drive Impaired Fasting Glucose to Type 2 Diabetes: Findings After a 9-Year Follow-Up in the PURE Study in Poland.

This study aimed to evaluate the role of risk factors included in the Framingham Risk Score for hard coronary heart disease (CHD) in the development of type 2 diabetes (DM) in patients with impaired fasting glycemia (IFG) after a 9-year follow-up. The research was part of the Polish insight into the international Prospective Urban and Rural Epidemiology (PURE) study. The cohort consisted of 283 subjects aged 54.3 ± 8.9 years who were diagnosed with IFG at baseline and then completed after a 9-year follow-up. The main risk factors for both CHD and DM evaluated were smoking, arterial hypertension, abnormal lipid profile, and family medical history. Most participants had both untreated or poorly controlled hypertension and dyslipidemia. Those who developed full-fledged DM over time were older and had significantly higher levels of fasting plasma glucose, lipid parameters, and mean blood pressure records. In conclusion, we confirmed that early diagnosis of dyslipidemia and hypertension, along with the treatment optimization of these conditions, could prevent or reduce the risk of DM and adverse cardiovascular outcomes. The study highlighted a large-scale problem of the modifiable risk factors that could jeopardize the health status in patients with IFG in the long range and pointed to targeted preventive measures.

Sociodemographic characteristic of changes in smoking patterns in rural and urban population of PURE Poland study: findings from 6-year follow up.

BACKGROUND: Tobacco smoking is one of the most serious modern civilization threats. According to WHO identifying patterns of tobacco use is essential for implementing effective preventive policies. The aim of the paper was to assess changes in smoking patterns among the PURE study population over 6 years. METHODS: The study sample comprised of 1784 adult participants from PURE Poland study, who were assessed at baseline (2007-2010) and then at 6-year follow-up. Participants were classified into current smokers, ex-smokers and never smokers. Smoking patterns were analyzed according to sex, age/birth cohort, place of residence (urban vs rural setting), and education level. RESULTS: Overall, a significant decrease of 3.1% in current smokers was observed (from 20.0% in baseline to 16.9 at follow-up). However, 0.8% of never smokers and 6.2% of ex-smokers at baseline were classified as current smokers at 6-year follow-up. Despite overall decrease in percentage of current smokers in both rural and urban area, in fact significantly more ex-smokers from rural area became current smokers after 6 years. Living in the rural area was associated with nearly two-fold increase in current smoking, and almost two-fold decline in chances to quit smoking. The highest percentage of current smokers was observed in birth year cohort 1961-1979. CONCLUSION: Despite a small but significant decline in overall smoking rates, important differences in smoking and quitting patterns emerged between rural and urban areas, as well as sexes. A less favorable smoking patterns were observed among women, and rural populations, suggesting that these are important targets of future tobacco control interventions in Poland.

Serum Lipid Transfer Proteins in Hypothyreotic Patients Are Inversely Correlated with Thyroid-Stimulating Hormone (TSH) Levels.

BACKGROUND Plasma cholesteryl ester transfer protein (CETP) activity is often decreased in patients with hypothyroidism, whereas less is known about the phospholipid transfer protein (PLTP). We aimed to evaluate simultaneously serum CETP and PLTP activity in patients diagnosed with hypothyroidism. MATERIAL AND METHODS The selection criteria for control group members (without thyroid dysfunction) in this case to case study were levels of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol (HDL-C), and triglycerides similar to those in study group patients (101 patients diagnosed with hypothyroidism). Serum CETP and PLTP activities were measured by homogenous fluorometric assays using synthetic donor particle substrates. RESULTS Serum CETP and PLTP activities in hypothyreotic patients were lower (p<0.001) compared with those in healthy subjects. This lowering was associated with significant changes in HDL-C subclasses: decrease in HDL2- and increase in HDL3 cholesterol levels. Multiple linear regression analyses adjusted for age, sex, body mass index, smoking habits, and alcohol drinking showed a strong association between hypothyroidism and activity of lipid transfer proteins. A linear inverse relationship between thyroid-stimulating hormone (TSH) and CETP (r=-0.21; p<0.01) and between TSH and PLTP (r=-0.24; p<0.001) was shown. There also was a positive correlation (p<0.001) between CETP and HDL2 cholesterol (r=0.27) and between PLTP and HDL2 cholesterol (r=0.37). A negative correlation between CETP and HDL3 cholesterol (r=-0.22: p<0.01) and between PLTP and HDL3 cholesterol (r=-0.24; p<0.001) has been demonstrated as well. CONCLUSIONS The decreased HDL2 and increased HDL3 cholesterol levels in subjects with hypothyroidism are consequences of decreased activity of lipid transfer proteins. These changes are early symptoms of lipid disturbances in hypothyroidism.

Serum CETP and PLTP activity in middle-aged men living in urban or rural area of the Lower Silesia region. PURE Poland sub-study.

INTRODUCTION: The dependence of lipid transfer proteins on significant pro-atherogenic factors is unclear. The aim of the study was to evaluate serum cholesteryl ester transfer protein (CETP) and phospholipid transfer protein (PLTP) activity in relation to lipid disturbances in men living in an urban or rural area. MATERIAL AND METHODS: A group of 427 men, volunteers for the Prospective Urban Rural Epidemiology (PURE) sub-study - 263 urban inhabitants (aged 51.9 ±6.0) and 164 residents of villages (aged 51.1 ±5.9) - were examined. In the multivariable linear regression model, the following factors were included as potential confounders: age, body mass index (BMI), smoking, alcohol consumption, hs-C-reactive protein reaction (hs-CRP) and co-existence of chronic diseases. RESULTS: In multiple linear regression models, site of residence (urban or rural area) was the most important independent and consistent predictor of CETP and PLTP activity; ß coefficients (95% CI) for CETP (0.18) and PLTP (-0.29) were significant at levels of p < 0.001. Three-way analysis of variance showed no effect of smoking or moderate alcohol consumption on lipid transfer proteins; however, CETP activity showed an interaction effect between these risk factors. In the group of all men, CETP activity was significantly and positively correlated with total cholesterol (r = 0.24), low-density lipoprotein cholesterol (r = 0.18), and non-high density lipoprotein cholesterol (r = 0.21), whereas PLTP activity was correlated with BMI (r = 0.12). Body mass index in rural men was higher than in the urban male population. CONCLUSIONS: Increased PLTP activity, recognized as a pro-atherogenic factor, and decreased CETP activity, known as a protective factor, both observed in men living in rural areas, are probably conditioned by nutritional and/or genetic factors.

Lipid pattern in middle-aged inhabitants of the Lower Silesian region of Poland. The PURE Poland sub-study.

INTRODUCTION: A decreased serum high density lipoprotein-cholesterol (HDL-C) is a strong predictor of cardiovascular risk. However, total HDL is a very dynamic, changeable fraction, and does not perform the function of atherosclerosis markers. In the presented study, the pattern of serum lipids, including HDL-C subclasses (HDL2- and HDL3-cholesterol), in a middle- aged Polish Lower Silesia population was defined. MATERIALS AND METHOD: A group of 746 males and 1,298 females, aged 35-70, were investigated. All subjects were participants in the PURE study. Mean serum lipid levels were determined for groups selected on the basis of gender, age, cigarette smoking, drinking alcohol and place of residence (urban/rural area). The data were analyzed using STATISTICA 6.0 PL. RESULTS: In multiple linear regression models, age was the most important independent and consistent predictor of total cholesterol (TC) and LDL cholesterol (LDL-C). The prevalence of low HDL-C (threshold 40 mg/dL in males, 50 mg/dL in females) was 16.5% for males and 22.6% for females. This gender-conditioned difference in the prevalence of low HDL-C was greater in rural (20.0% vs. 30.9%, respectively, in males and females) in comparison to urban (14.4% vs. 17.1%) areas. The lipid pattern was significantly worse in rural than in urban females. Female rural inhabitants showed higher triglycerides (TG) and lower HDL cholesterol (total and contained in subclasses HDL2 and HDL3). Simultaneously, a higher BMI, higher percent of smokers and drinkers and lower age of smoking female rural inhabitants in comparison to urban females were estimated. In the total population, cigarette smoking or drinking alcohol were associated with significant increases in TC, LDL-C and TG, also with decreased HDL-C (smoking) or HDL2-C (drinking). Two-way analysis of variance showed the existence of interaction between these risk factors in their influence on HDL-C and HDL3-C. CONCLUSION: In the middle-aged population of the Lower Silesian region in Poland the place of residence (urban/rural area) had a significant impact on the lipid pattern. This pattern is more atherogenic in rural women than in urban women.