Metabolic syndrome and its components in Polish women of childbearing age: a nationwide study.

BACKGROUND: Abnormal body mass and related metabolic disorders may affect female reproductive health. The purpose of the study was to determine the prevalence of underweight, overweight, obesity, lipid and glucose metabolism disorders, hypertension, and metabolic syndrome, among Polish women of childbearing age. METHODS: One thousand five hundred eighty-eight non-pregnant Polish women of childbearing age (20-49 years) who participated in the Multi-Centre National Population Health Examination Survey (WOBASZ II study) in 2013-2014, were assigned to 3 age groups: 20-29 years (n = 403), 30-39 years (n = 600) and 40-49 years (n = 585). Measurements of weight, height, waist circumference, blood pressure, blood lipids, and blood glucose were taken. For statistical analysis, the Kruskal-Wallis, Chi-Square, and Cohran-Armitage tests were used. RESULTS: Of the participants, 4.3% were determined to be underweight, 25.2% were overweight, 15% were obese, and 53.1% had abdominal obesity. With age, the prevalence of both excessive body mass and abdominal obesity tended to increase, and that of underweight to decrease. Frequency of hypercholesterolemia and hypertriglyceridemia found in the whole group were 50% and 12.6% respectively, and also tended to rise with age. Low serum HDL-cholesterol (high density lipoprotein cholesterol) levels were found in 15.1% of the participants. Prevalence of impaired fasting glucose in the whole group was 8.2% and tended to increase with age. Diabetes was found in 1.2% of the participants and its prevalence also tended to rise with age, at the borderline of significance. Frequency of arterial hypertension and metabolic syndrome in the whole group was 15.7% and 14.1% respectively and both tended to increase with age. CONCLUSIONS: Overweight and obesity, especially of abdominal type, and the related metabolic abnormalities are common in Polish women of childbearing age. Their prevalence tends to increase with age. Underweight is relatively common in the youngest age group.

[Effects of hybrid comprehensive cardiac telerehabilitation conducted under the pension prevention program of the Social Insurance Institution]. / Efekty hybrydowej kompleksowej telerehabilitacji kardiologicznej realizowanej w ramach prewencji rentowej Zakladu Ubezpieczen Spolecznych.

BACKGROUND: The Polish Social Insurance Institution (SII), under its pension prevention initiative, has taken measures to support the patients return to work and thus developed a new model of hybrid, comprehensive, cardiac telerehabilitation (HCCT). The aim of the study was to analyze the effects of HCCT in terms of its acceptance, adherence to and influence on patients' physical capacity and ability to return to work. MATERIAL AND METHODS: The study included 99 patients, aged 54.6±6.3 years, who suffered from cardiovascular diseases. They participated in a 24-day HCCT consisting of preliminary and final examinations, 10 days of out-patients rehabilitation based on cycloergometer training (5 sessions) and Nordic walking training (10 sessions), and 12 days of home telerehabilitation based on Nordic walking training. The effectiveness of HCCT was assessed by comparing changes in functional capacity expressed by metabolic equivalent of task (MET) and a 6-min walking test (6-MWT) distance from the beginning and the end of HCCT. Acceptance of HCCT was evaluated using a questionnaire. Adherence to HCCT was assessed by the patients' participation in the training sessions. Effectiveness of HCCT in terms of return to work was assessed according to SII definition. RESULTS: Hybrid, comprehensive, cardiac telerehabilitation resulted in significant improvement of functional capacity 7.6±2.0 vs. 8.1±2.4 MET (p < 0.0001) and distance in 6-MWT 448.5±79.2 m vs. 480.5±84.1 m (p < 0.0001). There were 82.8% of adherent, 16.2% of partially adherent and 1% of non-adherent patients. After HCCT 48 patients were able to return to work. CONCLUSIONS: Hybrid, comprehensive, cardiac telerehabilitation was well accepted and led to the improvement of the patients' physical capacity. Adherence to HCCT was high and allowed 48.48% of patients return to work. Med Pr 2017;68(1):61-74.

Positive Effects of the Reversion of Depression on the Sympathovagal Balance after Telerehabilitation in Heart Failure Patients.

BACKGROUND: Autonomic nervous system (ANS) dysfunction appears in the course of both chronic heart failure (CHF) and depression. Comprehensive cardiac rehabilitation (CCR), apart from improving physical capacity, can reduce depressive symptoms and leads to the restoration of ANS function among CHF patients. The purpose was to evaluate the influence of the reversion of depression (measured by Beck Depression Inventory [BDI] score, cut point <10) and the physical capacity improvement (measured by peak oxygen consumption [peak VO2 ; ml/kg per minute]) on the sympathovagal balance (measured by low/high frequency ratio [LF/HF]) after CCR in CHF patients. METHODS: The study group comprised 111 CHF patients (New York Heart Association II-III; left ventricular ejection fraction ≤ 40%). Patients were randomized (2:1) to 8-week CCR based on Nordic walking training (five times weekly) at 40-70% of maximal heart rate, training group (TG) n = 77, or to control group (CG) n = 34. The effectiveness of CCR was assessed by changes-delta (Δ) in LF/HF, BDI score, and peak VO2 , as a result of comparing these parameters from the beginning and the end of the program. RESULTS: Eventually, 46 patients in TG and 23 patients in CG were eligible for simultaneous ANS and psychological status analysis. Only in TG the LF/HF decreased 2.06 ± 1.14 versus 1.19 ± 0.80 (P < 0.0001) and peak VO2 increased 16.83 ± 3.72 versus 19.14 ± 4.20 ml/kg per minute (P < 0.0001). Favorable results in CG were not observed. The differences between TG and CG were significant: Δpeak VO2 (P < 0.0001); ΔLF/HF (P = 0.0001). Depressive symptoms were substantially reduced in both groups (TG, P = 0.0006; CG, P = 0.0490). Nevertheless, the greatest improvement of sympathovagal balance was observed in patients whose depression was reversed, thanks to the CCR in comparison to other patients from TG and the entire CG. CONCLUSION: Positive effect of the sympatho-parasympathetic balance obtained during the home CCR based on Nordic walking training results from the additive effects of the reversion of depression and physical capacity improvement in CHF patients.

Dietary antioxidant capacity of the patients with cardiovascular disease in a cross-sectional study.

BACKGROUND: The purpose of this study was to establish sources and patterns of antioxidant, polyphenol and flavonoid intakes in men and women with cardiovascular disease (CVD). METHODS: The subjects with CVD and healthy controls (HC) were participants of the Polish National Multicenter Health Survey (WOBASZ). Food intakes were measured with the 1-day 24-hour recall method. A self-developed database was used to calculate dietary total antioxidant capacity (DTAC), dietary total polyphenol content (DTPC) and dietary total flavonoid content (DTFC). RESULTS: DTAC did not differ between the men with CVD and HC men (6442 vs. 6066 µmol trolox equivalents - TE), but in the women with CVD it was significantly higher than in the HC women (6182 vs. 5500 µmol TE). The main sources of antioxidants in the males with CVD were: tea, coffee, apples, and nuts and seeds, and tea, coffee and apples in HC. In the females they were: tea, coffee, apples and strawberries, both in the women with CVD and HC. DTPC in the men with CVD did not differ from HC (1198 vs. 1114 mg gallic acid equivalents, GAE). In the females, DTPC was significantly higher in the subjects with CVD as compared to HC (1075 vs. 981 mg GAE). Predominant sources of polyphenols were: tea, coffee, cabbage, potatoes, apples and white bread in the men with CVD, and tea, coffee, potatoes, white bread and apples in HC, while in the women (both with CVD and HC): tea, coffee, apples, potatoes and cabbage. No differences in DTFC have been found between the males with CVD and HC (212 vs. 202 mg quercetine equivalents, QE). In the women with CVD, DTFC was significantly higher than in HC (200 vs. 177 mg QE). Main sources of flavonoids in all participants (men and women, CVD and HC) were tea, apples, cabbage and coffee. CONCLUSIONS: Polish men and women faced with CVD beneficially modify their dietary practices by enhancing intakes of foods that are sources of antioxidants, polyphenols and flavonoids. Different sources and patterns of antioxidant, polyphenol and flavonoid intakes, however, between male and female patients with CVD were observed.

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

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

Electrocardiographic characteristics of the right ventricle following hemodynamic improvement after percutaneous pulmonary valve implantation, one year follow-up.

Percutaneous pulmonary valve implantation (PPVI) is an alternative to open-heart surgery in patients with congenital heart defect. The purpose of the study is to evaluate right ventricle (RV) electrocardiographic characteristics in relation with hemodynamic changes after PPVI. In 30 patients (16 males, aged 24±7years), ECG RV characteristics changes (R amplitude in V1 and aVR, Sokolow-Lyon index (SL) for RV hypertrophy, QRS duration) from before and 1year after PPVI were correlated with changes in RV end-diastolic volume (RVEDV), RV end-systolic volume (RVESV), RV ejection fraction (RVEF), RV mass in cardiac magnetic resonance (cMRI) and within pulmonary gradient in echocardiography. Significant correlations were observed: decrease R amplitude in aVR correlated to decrease RVESV and RV mass; decrease RVESV and pulmonary gradient to reduction in SL-V5; increase RVEF to reduction R aVR and SL-V5. Improvement of hemodynamic parameters in cMRI and echocardiography is parallel to that of electrocardiographic criteria of RV hypertrophy.

Method of variability optimization in pharmacokinetic data analysis.

For many drugs administered per os, high variability in the concentration-time (C-T) values from first sampling to the phase of distribution may cause difficulty in pharmacokinetic analysis. Therefore, the aim of this study was to propose a method of transformation of C-T data, which would allow significantly reducing the standard deviation (SD) value of observed concentrations, without a statistically significant influence on the value of the mean for each sampling point in group. In the presented study, the lowest value of relative standard deviation of concentrations observed in the elimination phase and the value of precision of the used analytical method, were used to optimize the arithmetic, geometric means, median, and the value of SD obtained after single oral administration of itraconazole in human subjects. Non-compartmental modeling was used to estimate pharmacokinetic parameters. The analysis of SD pharmacokinetic parameters after C-T value optimization indicated more than twice the lower value of SD. After transforming the itraconazole data, lower variability of concentration data gives more selective pharmacokinetics profile in absorption and early distribution phase.

Concentration of vascular endothelial growth factor in patients with acute coronary syndrome.

UNLABELLED: Vascular endothelial growth factor (VEGF) is a regulator of vascular formation in physiological and pathological conditions. The aim of our study was to evaluate the value of VEGF as a surrogate marker of myocardial injury in acute ischemic conditions. MATERIALS AND METHODS: In 104 consecutive patients with acute coronary syndrome (ACS) with and without ST segment elevation (STEMI and NSTEMI) the plasma and serum human VEGF (hVEGF) concentration was measured two times i.e. immediately after admission due to ACS and 24h later. According to ECG findings and coronary angiography results, patients were divided into three groups. Group A represented major myocardial injury due to ST-segment elevation in precordial leads and/or in I and aVL leads and with left anterior descending (LAD) artery responsible for STEMI symptoms or additionally with significant atherosclerotic lesions (lumen vessel narrowed>50%) in other than LAD coronary arteries. Group B (medium myocardial injury) consisted of patients with ST-segment elevation in II, III and aVF leads and/or ST-segment depression in V2-V3 leads with one-vessel disease and the culprit artery was not LAD. Group C included patients with changes in ECG other than ST-segment elevation independently of the site of atherosclerotic lesions in coronary arteries. RESULTS: In all 104 patients with ACS the highest values of serum hVEGF were observed in second measurement (357.9 ± 346 pg/ml, p<0.01). Although in the first measurement, plasma and serum hVEGF concentration did not differentiate groups, the difference between deltas for serum hVEGF was observed (p<0.05). Increased number of neutrophils in the first measurement increased the OR of the high serum hVEGF concentration in the first measurement (OR=1.155; 95%CI: 1.011; 1.32) (p<0.05). The number of neutrophils in the second measurement also revealed significant relationship with high serum hVEGF in the first assessment (OR=1.318, 95%CI: 1.097; 1.583) (p<0.01). Increased values of triglycerides (exceeding the upper limit) were connected with decreased OR of high serum hVEGF concentrations in the first measurement (OR=0.152, 95%CI: 0.033; 0.695, p<0.05). CONCLUSIONS: In acute coronary syndrome, serum VEGF concentrations are elevated and can serve as a surrogate marker of myocardial injury. The elevated number of neutrophils increases odds ratio of high VEGF concentrations in ACS. In patients with high concentrations of triglycerides, odds ratio of low level of hVEGF is expected.

Sudden death in hypertrophic cardiomyopathy: old risk factors re-assessed in a new model of maximalized follow-up.

AIMS: in hypertrophic cardiomyopathy (HCM), the following five risk factors have a major role in the primary prevention of sudden death (SD): family history of SD (FHSD), syncope, massive wall thickness (MWTh) >30 mm, non-sustained ventricular tachycardia (nsVT) in Holter monitoring of electrocardiography, and abnormal blood pressure response to exercise (aBPRE). In HCM, as a genetic cardiac disease, the risk for SD may also exist from birth. The aim of the study was to compare the survival curves constructed for each of the five risk factors in a traditional follow-up model (started at the first presentation of a patient at the institution) and in a novel follow-up model (started at the date of birth). In an additional analysis, we compared the survival rate in three subgroups (without FHSD, with one SD, and with two or more SDs in a family). METHODS AND RESULTS: a total of 1306 consecutive HCM patients (705 males, 601 females, mean age of 47 years, and 193 patients were <18 years) evaluated at 15 referral centres in Poland were enrolled in the study. In a novel method of follow-up, all the five risk factors confirmed its prognostic power (FHSD: P = 0.0007; nsVT: P < 0.0001; aBPRE: P = 0.0081; syncope: P < 0.0001; MWTh P> 0.0001), whereas in a traditional method, only four factors predicted SD (except aBPRE). In a novel model of follow-up, FHSD in a single episode starts to influence the prognosis with a delay to the fifth decade of life (P = 0.0007). Multiple FHSD appears to be a very powerful risk factor (P < 0.0001), predicting frequent SDs in childhood and adolescence. CONCLUSION: the proposed concept of a lifelong calculated follow-up is a useful strategy in the risk stratification of SD. Multiple FHSD is a very ominous risk factor with strong impact, predicting frequent SD episodes in the early period of life.

Hepatocyte growth factor--a new marker for prognosis in acute coronary syndrome.

UNLABELLED: This study was designed to check the properties of hepatocyte growth factor (HGF) as a new marker of myocardial necrosis. MATERIALS AND METHOD: In one hundred and four patients with acute coronary syndrome (ACS), plasma human HGF (hHGF) concentrations were assessed twice, i.e. just after admission to hospital and 24 h afterwards. The primary composite endpoint was assessed at three-month follow-up. RESULTS: The maximal concentration of hHGF (1902 pg/ml) was reached at the time of admission to hospital due to ACS with significant decrease 24 h after the first measurement (705 pg/ml p < 0.0001). hHGF levels in ST segment elevation myocardial infarction (STEMI) were higher than in non-ST segment elevation myocardial infarction (NSTEMI) and in patients who reached composite primary endpoint (33 patients-4211 pg/ml) vs. event-free 71 patients (1013 pg/ml p < 0.01). The correlation between values of hHGF and N-terminal prohormone B-type natriuretic peptide and cardiac troponin I was revealed. CONCLUSION: HGF is a very early, good marker of myocardial necrosis and a sensitive short- and long-term prognostic factor in ACS.

Influence of dynamic training on hemodynamic, neurohormonal responses to static exercise and on inflammatory markers in patients after coronary artery bypass grafting.

BACKGROUND: Little is known about the influence of dynamic training on the hemodynamic and neurohormonal responses to static exercise and on inflammatory markers in optimally treated post-coronary artery bypass grafting (CABG) patients. METHODS AND RESULTS: One hundred and twenty male patients, aged 55±6 years, 3 months after receiving CABG, were randomized to either 6 weeks of aerobic training on a cycloergometer, 3 times a week, at a 70-80% of the maximum tolerated heart rate (HR) (training group, n=60) or to a control group (n=60). At baseline and at the end of the study, all patients underwent: (1) a cardiopulmonary test; (2) handgrip at 30% of maximal voluntary contraction for 3min in a sitting position during in which HR, blood pressure (BP), stroke volume (SV, by impedance cardiography), cardiac output (CO) and total peripheral resistance (TPR) were monitored; and (3) plasma level assessment of catecholamines, nitric oxide and inflammatory markers. During the final tests, handgrip-induced increases in HR, BP, and TPR (14% vs 27%, P<0.01) were lower, whereas SV and CO were higher (by 13% and 15%, respectively, P<0.05) in trained patients compared with controls. Moreover, a higher increase in nitric oxide level (46% vs 14%, P<0.01) and a lower increase in noradrenaline (11% vs 20%, P<0.05) were observed in trained patients compared with controls. Accordingly, training caused significant improvement in peak oxygen uptake per kilogram body weight (peak VO(2)) and inflammatory markers. CONCLUSIONS: Short-term dynamic training caused significant improvement of hemodynamic and neurohormonal responses to handgrip, cardiovascular fitness and inflammatory state.

Usefulness of 6-minute walk test, plasma neurohumoral and cytokine activation in the assessment of symptomatic patients with left ventricle dysfunction caused by chronic severe mitral valve regurgitation.

OBJECTIVE: The aim of our study was to select the most relevant markers of impaired left ventricle (LV) function in patients with heart failure (HF) symptoms due to severe chronic mitral regurgitation (MR). METHODS AND RESULTS: Thirty-six patients with decompensated HF due to severe MR underwent echocardiography, 6-minute walk test (6MWT) and measurements of plasma renin activity, angiotensin II, aldosterone, noradrenaline (NA), brain natriuretic peptide (BNP), tumour necrosis factor alpha (TNFalpha) with its receptors, and interleukine-6. Patients presented with significant neurohumoral/cytokine activation. By stepwise multiple regression analysis the strongest prediction model for 6MWT included LVEDVI (R2 = 0.95, P = 0.024), BNP (R2 = 0.67, P = 0.0006), IL-6 (R2 = 0.90, P = 0.044); for BNP: 6MWT (R2 = 0.36, P = 0.003), LA (R2 = 0.56, P = 0.0077), LVESVI (R2 = 0.83, P = 0.0072); for NA: EF (R2 = 0.4 1, P = 0.036), and for TNFalpha: LVESVI (R2 = 0.65, P = 0.003). CONCLUSIONS: 6MWT and neurohumoral markers (mainly BNP, but also NA and TNFalpha) are good predictors of the degree of LV remodelling, showing an independent correlation with the level of LV dilatation/dysfunction in chronic severe MR.These assessments may supplement standard echocardiography in LV decompensation due to severe MR.

Ten-year risk of fatal cardiovascular disease in the Polish population and medical care. Results of the WOBASZ study.

BACKGROUND: An individual assessment of global risk of death from cardiovascular diseases (CVD) should guide management, both life style changes and medical therapy, in order to decrease risk factors and improve prognosis. AIM: We assessed global risk in the Polish population and its relation to medical care, including blood pressure and cholesterol measurements, smoking cessation and dietary advice, and recommendations regarding increased physical activity. METHODS: A sample of the Polish population including 6392 men and 7153 women aged 20-74 years was screened in 2003-2005. We calculated global risk for subjects aged 40-70 years using the SCORE function for high-risk regions of Europe. RESULTS: We found high global risk (> or = 5%) in 46% of men and 21% of women. Compared to low risk subjects, high risk subjects more often had hypercholesterolaemia, hypertension or were obese, and they more often visited their primary care physicians. Dietary advice was given to 36% of high global risk men compared to only 20% of low global risk men with hypercholesterolaemia (47% vs 23% among women, respectively p < 0.0001), and cholesterol measurement was made in 31% of high global risk men and 19% of low global risk men with hypercholesterolaemia (38% vs 27% among women, respectively p < 0.0001). Smokers with high global risk received smoking cessation advice significantly more often than low global risk smokers (men: 72% vs 55%; women: 63% vs 52%). Subjects with hypertension and high global risk had their blood pressure measured significantly more often than those with hypertension and low global risk (men: 83% vs 68%; women: 87% vs 79%). High-risk obese persons significantly more often received both dietary advice (men: 55% vs 36%; women: 60% vs 34%) and recommendations regarding higher physical activity (men: 43% vs 32%; women: 40% vs 27%). In the logistic regression analysis, the quality of medical care was significantly associated with the global risk. CONCLUSIONS: The Polish population is characterised by a high proportion of subjects with high global risk especially among men. The quality of medical care was found to be associated with the global risk level: the higher was the global risk, the better was the medical care, although it is still insufficient compared to current standards.

Mortality from ischaemic heart disease in Poland in 1991-1996 estimated by the coding system used since 1997.

BACKGROUND: Official statistical data on deaths due to heart disease and cerebrovascular disease in Poland in 1991-2005 are not consistent because of the changes in the coding system introduced after 1996. Between 1996 and 1999, the number of deaths due to ischaemic heart disease (IHD) increased considerably, while the number of deaths due to atherosclerosis decreased. Considering the magnitude of these changes, any analyses of mortality trends in these periods treating these data as consistent are practically impossible. This also applies to international comparisons of IHD mortality data. AIM: To develop a method of estimating the number of deaths that would approximate the real numbers of deaths due to IHD in Poland in 1991-2005. METHODS: Sets of individual death records from the Central Statistical Office (CSO) and data from the WHO Mortality Database were used. The IHD mortality data documented officially in Poland were obtained using two different coding systems used consistently before and since 1997. IHD mortality was highly consistent in each of these periods. The applied version of the regression model makes use of both these properties. RESULTS: The system of certifying death causes which was used in Poland before 1997 resulted in underestimating the real number of IHD deaths in Poland in 1991 by around 35% compared to the numbers estimated using a more correct system of certifying death causes used after 1997. Approximate relative error of the official number of deaths due to IHD in 1991 in age groups of 45-54, 65-74, 75-84, and > or = 85 years was 30%, 24%, 49% and 67%, respectively, in men, and 27%, 25%, 52% and 72%, respectively, in women. CONCLUSIONS: An increase in the IHD mortality rate in Poland in 1996-1999 noted by CSO was an apparent phenomenon resulting from inaccuracies in coding death causes before 1997. These inaccuracies were mainly related to IHD, atherosclerosis and cerebrovascular disease. Our method enabled correction of the number of deaths between 1991 and 1996, yielding figures much closer to the real ones. Using this method, it is also possible to assess long-term mortality trends, including evaluation of the effectiveness of different methods of treatment and prevention. In particular, it also refers to the use of the IMPACT model to analyse reasons of changes in IHD mortality in Poland.

Influenza vaccination in secondary prevention from coronary ischaemic events in coronary artery disease: FLUCAD study.

AIMS: To evaluate the effect of influenza vaccination on the coronary events in patients with confirmed coronary artery disease (CAD). METHODS AND RESULTS: Randomized, double-blind, placebo controlled study. We included 658 optimally treated CAD patients; 477 men, mean age 59.9+/-10.3 years. Three hundred and twenty-five patients received the influenza vaccine, and 333 patients placebo. Median follow-up was 298 (interquartile range 263-317) days. Primary endpoint was the cardiovascular death. Its estimated 12-month cumulative event rate was 0.63% in the vaccine vs. 0.76% in controls (HR 1.06 95% CI: 0.15-7.56, P = 0.95). There were two secondary composite endpoints: (i) the MACE (cardiovascular death, myocardial infarction, coronary revascularization) tended to occur less frequently in the vaccine group vs. placebo with the event rate 3.00 and 5.87%, respectively (HR 0.54;95% CI: 0.24-1.21, P = 0.13). (ii) Coronary ischaemic event (MACE or hospitalization for myocardial ischaemia) estimated 12-month event rate was significantly lower in the vaccine group 6.02 vs. 9.97% in controls (HR 0.54; 95% CI: 0.29-0.99, P = 0.047). CONCLUSION: In optimally treated CAD patients influenza vaccination improves the clinical course of CAD and reduces the frequency of coronary ischaemic events. Large-scale studies are warranted to evaluate the effect of influenza vaccination on cardiovascular mortality. (ClinicalTrials.gov: NCT 00371098).

Effect of protein convertase subtilisin/kexin type 9 (PCSK9) 46L gene polymorphism on LDL cholesterol concentration in a Polish adult population.

The purpose was to study the effect of PCSK9 46L on cholesterol concentration and cardiovascular morbidity. By comparing 176 carriers with 6618 non-carriers identified through a cross-sectional population study (WOBASZ) we confirmed the LDL lowering effect of PCSK9 46L and demonstrated that it increases with the concentration of LDL. We noted that PCSK9 46L was associated with tendency for protection from myocardial infarction but not stroke suggesting a difference in the effect on susceptibility to these disorders.

Alterations in calcium regulatory protein expression in patients with preserved left ventricle systolic function and mitral valve stenosis.

BACKGROUND: In heart failure, alterations in the expression of proteins relevant to calcium homeostasis are involved in depressed contractility and diminished relaxation. However the regulation of genes expression is only partially known. The aim was to assess expression of calcium regulatory proteins in left ventricle (LV) myocardium characterised by a preserved global function in mitral valve stenosis (MVS) model but increased neurohumoral/cytokine (N/C) activation. METHODS AND RESULTS: Plasma N/C activation was evaluated in MVS-patients (n = 27), where expression of calcium regulatory proteins (L-type channel, sarcoplasmic reticulum Ca2+-ATPase type2 - SERCA2, Na+/Ca2+ exchanger -NCX, calsequestrin, phospholamban) in LV myocardium was assessed (Western Blot) in comparison with non-failing hearts (NFH). Out of all proteins assessed in MVS, only SERCA2 and NCX expression revealed highly variable changes between subjects, with significant reduction of SERCA2 (15%) level compared to NFH. Moreover, SERCA2 was negatively correlated with BNP (univariate/regression analysis r = -0.63, P = 0.005/r2 = 0.74, P <0.001, respectively), whereas NCX was positively correlated only with noradrenaline (univariate/stepwise analysis r = 0.59 P = 0.002/r2 = 0.59; P = 0.003). CONCLUSIONS: In MVS-patients LV becomes remodelled, although its global function is preserved. It seems that apart from alterations in LV load and wall stress, also such neurohumoral factors as BNP/noradrenaline may influence the Ca2+ handling proteins expression.

The relationship between resting heart rate and atherosclerosis risk factors.

BACKGROUND AND AIM: The imbalance between sympathetic and parasympathetic activity is one of the important factors in pathogenesis of cardiovascular diseases (CVD). There is a relationship between sympathetic activity and some CVD risk factors. Also heart rate (HR) is related to the autonomic nervous system. We analysed the relation of mean resting HR to hypertension, diabetes, obesity and to some risk factors [body mass index (BMI), hsCRP, systolic blood pressure (SBP), diastolic blood pressure (DBP), LDL cholesterol (LDL), triglycerides (TG) and glucose (G)]. METHODS: 6977 men and 7792 women, aged 20-74, randomly selected from the Polish population, were screened in 2003-2005 within the framework of the National Multicentre Health Survey (WOBASZ). Resting HR and blood pressure were measured 3 times using an automatic device and for analyses only the mean value of the 2nd and 3rd measurement was used. RESULTS: Out of screened subjects, HR <60/min was found in 11% of men and 7% of women, and HR >90/min - in 6% and 5% respectively. Medication that influenced HR was taken by 16% of men and 17% of women. Resting HR was correlated (p <0.0001) with BMI, SBP, DBP, hsCRP, LDL and G in men and with SBP, DBP, hsCRP and G in women. After adjustment for medication significantly higher HR was observed both in men and in women with obesity, diabetes, hypertension, high hsCRP and in smoking persons. The prevalence of obesity, diabetes, hypertension, high hsCRP and smoking habit rose with increasing HR and the highest one was found in persons with HR >90/min. In multivariate logistic regression models resting HR was positively associated with hypertension, obesity and diabetes. In men, with every increase in HR by 10 beats/min, OR for hypertension was 1.28 (95% CI: 1.22-1.35), for obesity 1.24 (95% CI 1.17-1.30) and for diabetes 1.36 (95% CI: 1.26-1.48) after adjustment for age, medication and other factors (in women: 1.42 for hypertension, 1.14 for obesity and 1.47 for diabetes). CONCLUSIONS: Resting heart rate is correlated with cardiovascular risk factors (body mass index, blood pressure, glucose and cholesterol level) and with high hsCRP. Heart rate is positively associated with hypertension, obesity and diabetes which indirectly confirms the autonomic nervous system contribution to the pathogenesis of these diseases.

Quality of nutrition and health knowledge in subjects with diagnosed cardio-vascular diseases in the Polish population--National Multicentre Health Survey (WOBASZ).

BACKGROUND: Dietary treatment plays an important role in prevention of cardiovascular diseases (CVD). A significant factor that influences the fulfilment of dietary recommendations is also the knowledge of non-pharmacological methods of CVD prevention. AIM: To evaluate the health knowledge and the dietary behaviours among subjects with established CVD and to assess how many of them meet recommended dietary allowances (RDA) for secondary prevention. METHODS: Within the framework of the National Multicentre Health Survey (WOBASZ), a representative sample of 7257 persons of the whole Polish population aged 20-74 was screened in years 2003-2005. A subsample of 803 persons (males--430, females--373) with a clinical history of myocardial infarction and/or coronary artery disease and/or heart failure and/or stroke and/or arrhythmia and/or PCI and/or coronary bypass surgery was analysed. Nutrients intake and health knowledge were assessed according to the study protocol. RESULTS: The evaluated group was characterised by a high prevalence of persons with obesity (70%), ex-smokers (49% in males and 22% in females) and smokers (27% and 13%, respectively). The proportion of patients with knowledge of the following CVD prevention methods was very low: weight reduction (33 vs. 35% males vs. females), increase of physical activity (54 vs. 52% respectively), salt reduction (23 vs. 21%), reducing fat intake (37 vs. 36%), and regular consumption of fruits and vegetables (23 vs. 23%). The low level of dietary knowledge was reflected by dietary behaviours. A low fat and low cholesterol diet was reported only by every 5th patient and a low calorie diet by every 100th. Adding salt to previously seasoned dishes was reported by 25% of males and 19% of females. Respectively, 49 and 32% consumed meat products with visible fat. The prevalence of persons whose diet met RDA was unsatisfactory. The degree of fulfilment of recommendations as to anti-oxidant vitamins (A, C and E), proteins, cholesterol and fruits and vegetables was relatively the best; however, also in this case only 40-80% of respondents followed the recommendations. The intake of fats, fatty acids and carbohydrates was less satisfactory. The correct amount of those nutritional components was consumed only by 20-39% of assessed patients. The worst situation was noted as to the intake of B vitamins, calcium and magnesium. The recommendations for those vitamins and minerals was followed only by 11-37% of evaluated persons. CONCLUSIONS: In the Polish population subjects with established CVD are characterised by a low level of knowledge of non-pharmacological methods of preventing heart diseases and low quality of nutrition.

Significance of dyslipidaemia in patients with heart failure of unexplained aetiology.

BACKGROUND: Dyslipidaemia has been studied in the prognosis of heart failure (HF). Little is known about the role of dyslipidaemia in the aetiopathogenesis of dilated cardiomyopathy (DCM). AIM: To assess (1) serum lipid levels in DCM considering the severity of heart failure; (2) the association between DCM and lipid abnormalities; (3) prognostic significance of lipids in DCM. METHODS: The study group consisted of 100 patients with angiographically proven DCM [mean age 42 years, 80% males, 65% in NYHA class III-IV, mean left ventricular ejection fraction (LVEF) 32%], whose fasting serum lipids had been assessed during diagnosis between 1992 and 2001. Patients' lipid levels were compared with those observed in healthy controls (n=100), age-, gender-, and BMI-matched and related to findings reported in population samples from WHO Pol-MONICA studies from: 1993 (n=526), 1997/1998 (n=526) and 2001 (n=1364). Three (3%) patients received lipid-lowering drugs. Transplant-free survival was assessed in the study group. In the statistical analysis, nonparametric Wilcoxon test and uni- and multivariate logistic and Cox regression analyses were used. RESULTS: Serum total cholesterol (TC), LDL (LDL-C) and HDL cholesterol (HDL-C) tended to be lower (differences NS) in NYHA class III-IV patients vs. class I-II (TC: 196.9+/-45.5 vs. 207.9+/-47.1 mg/dl, LDL-C 126.2+/-37.5 vs. 128.5+/-42.7 mg/dl, HDL-C 44.2+/-11.3 vs. 44.7+/- +/-13.7 mg/dl, respectively), and triglycerides (TG) were lower in advanced HF vs. NYHA class I-II (135.9+/-51 vs. 170.3+/-63.4 mg/dl, p=0.004). In DCM patients HDL-C was lower than in controls (44.1+/-12.1 vs. 54.3+/-17.6 mg/dl, p <0.001), and TG level was higher (147.9+/-58.1 vs. 114.1+/-61.6 mg/dl, p <0.001). HDL-C and TG levels in controls were similar to those observed in population samples. Multivariate analysis with age, low HDL (defined as <40 mg/dl for males, and <50 mg/dl for females), and hyperTG (TG l150 mg/dl) showed that both low HDL-C (OR=2.31; 95% CI 1.2-4.457, p=0.0122), and hyperTG (OR=1.978, 95% CI 1.029-3.799, p=0.0407) were independently associated with DCM. Low HDL-C level occurred more frequently in female DCM patients vs. in males (65 vs. 33.8%, p=0.022). There was a trend towards more frequent occurrence of hyperTG in male patients vs. females (42.5 vs. 20%, p=0.11). The mean follow-up time was 7.32+/-4.7 years. In Cox univariate analysis low TC tended to be a prognostic factor (p=0.067), but in Cox multivariate analysis only NYHA class (HR=1.7, 95% CI 1.136-2.541; p=0.01) and LVEF (HR=0.963, 95% CI 0.932-0.996; p=0.027) turned out to be independent predictors of poor outcome. CONCLUSION: Dyslipidaemia might play a role in the aetiopathogenesis of DCM. Low TC is not an independent prognostic factor in DCM.