[Incidence of ischemic heart disease among men aged 40-49 years not participating in the population study]. / Rasprostranennost' ishemicheskoi bolezni serdtsa u muzhchin 40-49 let, ne uchastvovavshikh v populiatsionnom issledovanii.

This investigation was carried out in the framework of a collaborative study on the multifactorial prophylaxis of coronary heart disease (CHD) among men aged 40-59 years living in Kaunas. The authors compared the findings from the medical examination of the group of subjects involved in this study (5943 males) and of 200 randomly selected men who were not involved in this study. It was elicited that those not involved in the study showed a greater predominance of CHD risk factors (arterial hypertension, smoking, underexercise and personality psychological type A) and a greater proportion of myocardial infarction survivers (3.87% and 1.49%, respectively).

[Chief risk factors of ischemic heart disease and mortality of the middle-aged male population of Kaunas]. / Osnovnye faktory riska ishemicheskoi bolezni serdtsa i smertnost' muzhskogo naseleniia srednego vozrasta Kaunasa.

A prospective study, averaging 11 years, of a representative sample of 2455 male residents of Kaunas between 45 and 59 years of age has explored relationships between coronary risk factors and mortality due to coronary heart disease (CHD), cancer, injuries, as well as total mortality rates. An original analytical approach has been developed for the analysis of associations between individual risk factors and mortality that allows to exclude the effects of age and other examined factors. A marked relationship has been demonstrated between: coronary mortality and age, arterial blood pressure, cholesterol, glucose tolerance, smoking, body weight, the presence and clinical form of CHD; cancer-related mortality, and age or smoking; traumatic mortality and smoking; total mortality and age, arterial blood pressure, glucose tolerance, body weight, smoking, and the presence and type of CHD.

[Prevalence of risk factors and indicators of mortality among males 40-59 years of age with various forms of ischemic heart disease (data of a 5-year prospective study)]. / Rasprostranennos't faktorov riska i pokazateli smertnosti u muzhchin 40-59 let s razlichnymi formami ishemicheskoi bolezni serdtsa po dannym prospektivnogo nabliudeniia).

A collaborative study was undertaken to assess the efficacy of multifactor prevention of myocardial infarction and cerebral stroke. A representative group of 5951 males aged 40-50 years was examined in Kaunas. Coronary heart disease (CHD) was detected in 11.1%, including 2.7% who had a history of myocardial infarction, 2.5% had exertional angina, its painless type was found in 5.9%. In males with CHD, arterial hypertension, hypercholesterolemia, obesity were more common and smoking was more infrequent than in those without the disease. The results of the 5-year follow-up showed that CHD males had higher total and cardiovascular mortality and myocardial infarction morbidity rates than males without CHD. Males with prior MI and pain-free CHD significantly differed from those from the control group in total and cardiovascular mortality rates. No statistically significant difference was found in MI mortality and morbidity rates between male patients with exertional angina and controls.

[Various characteristics of persons with behavior-related risk of ischemic heart disease]. / Nekotorye osobennosti lits s povedencheskim riskom ishemicheskoi bolezni serdtsa.

In the framework of the programme on the multi-factorial prophylaxis of myocardial infarction and cerebral stroke in males aged 40-59 years, the authors studied the relationship between type A behaviour pattern as a risk factor for coronary heart disease and somatic and history indices. A study of 5698 men showed that group A was characterized by a greater percentage of subjects with elevated cholesterol and triglyceride levels and with hypercoagulatory changes in the hemostatic system. Group A subjects more frequently complained of chest pain and had a larger proportion of relatives with cardiovascular disease.

[Attitude to health matters among middle-aged men in a program to prevent ischemic heart disease]. / Otnoshenie k voprosam zdorov'ia u muzhchin srednego vozrasta v programme po profilaktike ishemicheskoi bolezni serdtsa.

The authors studied the health-related attitudes (to prophylaxis, one's own health, physicians, bad habits) in men aged 40-59 years invited to participate in the programme of the multifactorial prophylaxis of myocardial infarction and cerebral stroke among the population. A total of 6803 men filled in a questionnaire consisting of 47 points mailed to them together with an invitation to take part in a screening examination. The results obtained showed that the elderly men responded favourably to the conduction of preventive procedures and to advice to change the smoking habits but less favourably toward recommendations to increase physical activity and change the diet.

[Participation of the population in mass screening and the role of complete population surveillance for detection of the disease studied (from the experience of the methodical measures for the prevention of ischemic heart disease in Kaunas)]. / Ob uchasti naseleniia v massovykh profilakticheskikh osmotrakh i roli polnoty okhvata naseleniia obsledovaniem dlia vyiavleniia izuchaemogo zabolevaniia (iz opyta kaunasskogo metodicheskogo issledovaniia po profilaktike ishemicheskoi bolezni serdtsa.

A comparison of the results of examination of 100 individuals, some of whom had taken part in the survey while the others had refused it and information about them was specially obtained by other means (in some cases by collecting the medical documentation), is presented. Factors conducive to the development of ischemic heart disease predominated among individuals who refused to take part in the survey. The incidence of ischemic heart disease and arterial hypertension was also higher among them. It is concluded that individuals who refuse examination during preventive survey form a group with a high risk of the development of ischemic heart disease; this group should be taken into account when therapeutic and preventive measures are conducted among the population.

[Approaches to the secondary prevention of arterial hypertension among the population (data from a cooperative study on the multifactorial prevention of ischemic heart disease)]. / Podkhody k vtorichnoi profilaktike arterial'noi gipertonii sredi naseleniia (dannye kooperativnogo issledovaniia po mnogofaktornoi profilaktike ishemicheskoi bolezni serdtsa).

A cooperative study has reviewed the prevalence of arterial hypertension (AH) among 40- to 59-year-old male residents of three cities (Moscow, Minsk and Kaunas) and the possibility of organizing a long-term outpatient treatment of newly-detected AH cases as well as the efficiency of the latter. Of 16,703 individuals screened, AH was detected in 27.9%. Evidence is obtained that preventive and therapeutic procedures for hypertensive patients are in need of an improvement. In a middle-aged population, moderate AH is prevalent (nearly 67.7%). Coronary risk factors, such as hyperlipoproteinemia and excessive body weight, were more frequent in AH patients, as compared to the general population, an argument in favor of the need for an improved combined approach to AM control in the population. Active combined treatment of the recognized cases over 5 years proved effective as it brought arterial blood pressure back to normal. Patient participation in the treatment and its contribution to treatment efficiency are reviewed.

[Psychological aspects of the measures for lowering the cholesterol level in a population study]. / Psikhologicheskie aspekty meropriiatii po snizheniiu urovnia kholesterina v populiatsionnom issledovanii.

Psychologic personality features influenced the participation of male subjects, aged 40-59, from Kaunas, in preventive procedures aiming to control hypercholesterolemia within a many-factor prophylactic program against coronary heart disease (CHD). A negative attitude to the recommendation to give up smoking and change dietary habits and physical behavior, demonstrated prior to the first medical examination, was indicative of a tendency to abstain from preventive procedures. According to the first medical check-up data, the abstaining individuals showed signs of somatic discomfort and psychologic stress more frequently. Unlike the voluntary participants, they had more marked difficulties in psychologic adaptation as assessed by the MMPI scale. The effectiveness of cholesterol-controlling measures also depended on the psychological makeup of the personality. A lower MMPI profile prevailed in those men whose increased cholesterol levels were eventually controlled.

[Comparative evaluation of mortality and incidence of ischemic heart disease among participants and non-participants in a population study]. / Sravnitel'naia otsenka smertnosti i zabolevaemosti ishemicheskoi bolezn'iu serdtsa sredi uchastnikov i neuchastnikov populiatsionnogo issledovaniia.

The groups of participants (5946 males) and nonparticipants (2626 males) in a population study, carried out in Kaunas, were compared on the basis of a 4.5-year follow-up, making use of the acute myocardial infarction register and the mortality register. The total mortality rate, as well as the rates of mortality due to cardiovascular diseases, traumas and accidents were higher in nonparticipants, as compared to the participants. The detectability of recent coronary disease was also higher among those who refused to participate in the study: 5.46 vs. 4.41, respectively, per 1000 people per year (p less than 0.05). It is demonstrated that particular attention must be paid to individuals avoiding preventive screening programs.

[Division of the 45- to 59-year-old male population into groups depending on the risk factors in a prophylactic study of ischemic heart disease]. / Delenie 45--59-letnego muzhskogo naseleniia na gruppy v zavisimosti ot faktorov riska v profilakticheskom issledovanii ishemicheskoi bolezni serdtse.

A prospective study was conducted from March 1972 to November 1976 in a group of Kaunas male population ranging in age from 45 to 59 years. At the beginning of the study it consisted of 3,553 individuals. They were divided into groups of low, moderate, and high risk according to the presence of a risk factor (hypertension, hypercholesteremia, impaired glucose tolerance test) and a pathologic condition. The ratio of the total mortality rate per 1,000 of the population during the observation period in these groups was 1 : 2 : 3, while that of the mortality of ischemic heart disease was 1 : 3 : 5. The rate of out-patient coronary mortality and the occurrence of new cases with myocardial infraction according to their number registered in the groups of low, moderate, and high risk was 1 : 2 : 5. All the indices in the group of individuals who refused to take part in the study were close to those in the high risk group. The data obtained point to the possibility of defecting by means of preventive study individuals exposed to a greater or lesser risk of the development of ischemic heart disease and death, which makes it possible for the Public Health Service to concentrate attention of definite groups of the population so as to apply differentiated preventive measures.

[Disorders of glucose tolerance and ischemic heart disease]. / Narushenie tolerantnosti k gliukoze i ishemicheskaia bolezn' serdtsa.

The incidence of impaired glucose tolerance, the relation of blood glucose levels to the prevalence of risk factors for coronary heart disease (CHD) and to myocardial infarction morbidity and mortality were studied over 15 years among males aged 45-59 years, excluding patients with diabetes mellitus. The data analysis was made in quintils of glucose levels. Impaired glucose tolerance was detected in 20.6% of the males. In the fifth versus the first quintil, there was an increase in the prevalence of systolic and diastolic arterial hypertension (p less than 0.001), obesity (p less than 0.001), low physical activity and hypercholesterolemia (p less than 0.05). As compared with the first, the fifth quintil showed higher total mortality rates and higher myocardial infarction morbidity and cardiovascular disease and CHD morbidity rates. But for age, and major risk factors, the risk for CHD, total and cardiovascular mortality increase at low and high blood glucose concentrations.

[Detection of ischemic heart disease in a survey of a male population 40-59 years of age (data of cooperative studies performed in Moscow, Kaunas, Kiev and Kharkov)]. / Vyiavlenie ishemicheskoi bolezni serdtsa pri obsledovanii muzhskogo naseleniia 40-59 let (dannye kooperativnogo issledovaniia v Moskve, Kaunase, Kieve, Khar'kove).

The authors analyzed the prevalence of coronary heart disease (CHD) and its various types detected by routine epidemiological methods among the examinees in four cities (Moscow, Kaunas, Kiev, and Kharkov). The results were obtained in the collaboration study, adhering to the rigid standardization of all the procedures applied. Examination of 17, 168 males aged 40-59 years revealed signs of CHD in 13.8%; 3.3% had a history of myocardial infarction; 5.3% suffered from exertional angina without prior myocardial infarction; 5.2% showed a painless course of CHD. The analysis demonstrated that simultaneous use of the standard epidemiological methods is the only way of ensuring a more complete detection of CHD. In different cities, from 36.4 to 60.8% were not aware of the presence of the disease. Secondary preventive measures should involve methods for identifying the major risk factors and eliminating the latter.

[Effectiveness of the cooperative program of multifactorial prevention of ischemic heart disease (results of the 3-year study)]. / Effektivnost' kooperativnoi programmy mnogofaktornoi profilaktiki ishemicheskoi bolezni serdtsa (rezul'taty 3-letnego nabliudeniia).

The paper provides the results obtained in the course of the cooperative All-Union programme on multifactor prevention of coronary heart disease (CHD), which has been implemented over 3 years to examine the efficiency of preventive actions aimed at correcting the levels of CHD risk factors. The study was conducted in 6 centers of the country among a non-organized male population aged 40-59 years. The outcome of the preventive measures, largely nonpharmacological ones, made during 3 years suggests that the prevalence of the major CHD risk factors may be reduced in the population. The preventive actions are the most beneficial in arterial hypertension and smoking.

[Significance of risk factors in the prevalence of ischemic heart disease in men living in different climatic-geographic areas of Russia, the CIS countries and the Baltic states (a cooperative study)]. / Znachenie faktorov riska v rasprostranennosti ishemicheskoi bolezni serdtsa u muzhchin, prozhivaiushchikh v razlichnykh klimato-geograficheskikh zonakh Rossii, stran SNG i Pribaltiiskikh gosudarstv (kooperativnoe issledovanie).

The paper deals with the contribution of risk factors to the spread of coronary heart disease (CHD) among males living in various cities and towns of Russia, CIS countries and Baltic states. The examination of random representative samples of male populations established that risk factors, such as age, arterial hypertension, obesity, hypercholesterolemia, dyslipoproteinemia, and smoking (p < 0.05), make a significant contribution to the spread of CHD, including acute CHD. Age, arterial hypertension, and body weight (p < 0.01) also make a substantial contribution to the development of CHD. The risk factors play a greater role in the spread of CHD in Tallinn, Alma-Ata, St. Petersburg, and Novosibirsk than in Moscow and Ufa, but in the spread of acute CHD in Tallinn, Kaunas, Ufa, and Alma-Ata than in Moscow and St. Petersburg.

[Intermittent claudication and risk factors among men 40 to 59 years of age based on the data of a prospective population study]. / Peremezhaiushchaiasia khromota i faktory riska sredi muzhchin 40--59-letnego vozrasta po dannym prospektivnogo populiatsionnogo issledovaniia.

A study was made of the prevalence of intermittent claudication (IC) and risk factors among men aged 40 to 59 years and of the acute myocardial infarction lethality and incidence during ten years of the follow up. Using standard techniques a representative group of 6117 men were examined. The prevalence of IC amounted to 0.89% in the group under study (standardized according to age). Analysis of the relationship between the prevalence of IC and risk factors has demonstrated the presence of the significant correlation only among men with hypercholesterolemia and tobacco smokers. In men who suffered myocardial infarction, the rate of IC was higher than in men with angina pectoris of effort, painless coronary disease or without coronary disease. Analysis of the acute myocardial infarction lethality and incidence has shown that they are significantly higher among men with IC than in those without this pathology.

[Role of heredity in the prevalence of ischemic heart disease and its risk factors]. / Rol' nasledstvennosti v rasprostranennosti ishemicheskoi bolezni serdtsa i ee faktorov riska.

The relationship of heredity with CHD prevalence and the main risk factors (RF) was analyzed on the basis of the results of a primary cardiological screening of the male population aged 40 to 59 in Minsk and Kaunas (10012 persons). The results of the analysis were in favor of hereditary predisposition to CHD. The prevalence of CHD and the main RF in probands with aggravated heredity was much higher than that in probands with favorable heredity. CHD prevalence in the compared groups was 12.4 and 10.7%; SK 3.9 and 0.2%; cerebral stroke 1.6 and 0.6%, respectively. Statistically significant changes were also revealed in RF frequency: AH--32.6 and 27.1%; HCS--27.7 and 24.1%; EBM--16.6 and 13.8%; smoking--43.6 and 47.0%. Over 1/3 of all types of CHD and AH were found in the persons with hereditary predisposition to CHD on the maternal side with a tendency to CS.

A survey of the opinions and attitudes of general practitioners in Kaunas to the prevention of ischaemic heart disease.

Fifty-four general practitioners were sent questionnaires inquiring into their attitudes to various aspects of preventive medicine and to primary prevention of ischaemic heart disease (IHD). Besides, their opinions were questioned about three risk factors of IHD (arterial hypertension, hypercholesterolaemia, impaired glucose tolerance), and these factors' values above which drug therapy should be started. It was found that the physicians tended to start drug therapy already at fairly low values of the three risk factors. A survey repeated after extensive preventive study among the population revealed no marked changes in the opinions of the practitioners questioned.

Participation of the male population in primary medical examination in Kaunas and Minsk. Data from the co-operative study of the effectiveness of multifactorial prevention of ischaemic heart disease.

The authors analyse factors complicating the recruitment of men aged 40-59 years for participation in primary medical examination in Kaunas and Minsk. In both cities, invitation for participation was if necessary repeated four times. In Kaunas, 8,590 men were invited and 5,964 (69.4%) of them reported for examination; the respective figures in Minsk were 6,000 and 4,149 (69.2%). The main cause of non-response was substantiated or non-substantiated refusal. It was found that socio-demographic characteristics and the state of health are factors influencing the response to invitation for primary medical examination.

State of health of "non-respondents" in population studies of ischaemic heart disease in Moscow and Kaunas.

The authors analyse the results of medical examination of males aged 40-59 years in Moscow and Kaunas, divided into "respondents" and "non-respondents" in a population study of ischaemic heart disease. Among non-respondents, a higher incidence was found of such risk factors of ischaemic heart disease (IHD) as arterial hypertension, smoking, low physical activity and personality type A. On the other hand, hypercholesterolaemia was more frequent among respondents. Among non-respondents in Moscow as well as in Kaunas, there was a tendency towards a higher incidence of IHD and its clinical forms, and a higher proportion was treated over a longer period of time as out-patients or at hospital. The study proved the need to check the state of health of non-respondents in every mass screening of the population.

[Multifactorial prophylaxis of ischemic heart disease (a cooperative study)]. / Mnogofaktornaia profilaktika ishemicheskoi bolezni serdtsa (kooperativnoe issledovanie).

The examination of 40-59 year-old males in Moscow, Kaunas, Minsk, Tashkent, Frunze in the framework of a cooperative study on multifactorial prophylaxis of coronary heart disease has shown that the disease and its risk factors such as arterial hypertension, smoking, hypercholesterolemia, excessive body weight and low physical activity are wide-spread among the male population of all the five cities, 75-83% of all the subjects examined thus being in need of preventive measures. Preventive measures against risk factors carried out in Moscow, Kaunas and Minsk already in the first 2 years have shown the possibility of reducing the incidence of arterial hypertension in the population (in Moscow by 7.8%, in Kaunas by 6.1%, in Minsk by 9.8%), smoking (in Moscow by 7.9%, in Kaunas by 8.1%, in Minsk by 14.8%), hypercholesterolemia (in Moscow by 4%, in Kaunas by 4.9%, in Minsk by 8.4%).