Cardiovascular diseases prevention in Poland: results of WOBASZ and WOBASZ II studies.

BACKGROUND: Cardiovascular diseases are the main cause of morbidity and an important cause of disability and premature death in European countries. Current guidelines recommend prevention delivery by physicians during medical consultations. AIM: We sought to evaluate the prevention support offered by Polish physicians in 2013-2014 compared to 2003-2005, and its determinants. METHODS: The data from two population surveys were analysed: WOBASZ (6392 men and 7153 women, aged 20-74 years, screened in 2003-2005) and WOBASZ II (2751 men and 3418 women, aged ≥ 20 years, screened in 2013-2014). For comparison analysis, the population of WOBASZ II was restricted to persons aged 20-74 years. Prevention delivery was assessed using a questionnaire. RESULTS: Overall, 64% of men and 75% of women screened in 2003-2005 consulted their physicians at least once in the preceding year; 10 years later these rates were 70% and 82%, respectively. In both studies, 70% of respondents recalled having received one piece of prevention advice during a medical consultation. One-third of participants neither received any prevention advice nor had their blood pressure or cholesterol level measured. In WOBASZ II we observed a significant increase in the frequency of counselling regarding smoking cessation, nutrition, and increased physical activity, as well as in the frequency of cholesterol measurements, compared to WOBASZ. The prevention support was related to the health status. CONCLUSIONS: The prevention support in the years 2013-2014 was better than in 2003-2005, but was still insufficient. About one-third of participants did not receive any preventive advice. The prevention support was offered more often to patients with worse health status.

Dietary acid load and cardiometabolic risk in the Polish adult population.

BACKGROUND: The potential influence of disorders of acid/base homeostasis on cardiovascular risk factors has been suggested. OBJECTIVES: The aim of the study was to estimate the relationship between dietary acid load and the prevalence of cardiovascular disease and the prevalence and intensity of cardiovascular risk factors (i.e., hypertension, diabetes, overweight and obesity, dyslipidemia) in the Polish adult population. MATERIAL AND METHODS: Data was derived from a cross-sectional survey of a random sample of 6,170 Polish residents aged 20+ (Multi-Center National Population Health Examination Survey, WOBASZ II study), including anthropometric and laboratory measurements, and estimates of nutrient intakes by 24-h recall. Dietary acid/ base load was assessed as potential renal acid load (PRAL) and net endogenous acid production (NEAP). RESULTS: The median PRAL and NEAP values for the whole study population were: PRAL -3.85 mEq/day and NEAP 39.79 mEq/day. The prevalence of overweight and obesity, both in males and females, tended to decrease across tertiles of PRAL and to increase across tertiles of NEAP. In females, the values of several metabolic characteristics differed across tertiles of NEAP. After adjustment for age and waist circumference, these relationships did not persist, but the prevalence of diabetes was found to increase across tertiles of PRAL (p for trend <0.05) in females. CONCLUSIONS: The dietary acid load in the Polish adult population was relatively low. There was no independent relationship between dietary acid load and cardiovascular disease and its risk factors in the population under study, except for the positive association between the PRAL value and diabetes prevalence in females.

Prevalence, awareness, treatment and control of hypertension in the adult Polish population - Multi-center National Population Health Examination Surveys - WOBASZ studies.

INTRODUCTION: Hypertension is one of the main risk factors of cardiovascular diseases. The first aim of the study was to evaluate the prevalence, awareness and treatment of hypertension as well as treatment effectiveness (blood pressure < 140/90 mm Hg) in a representative sample of the Polish population over the age of 19, examined in the WOBASZ II program. The second aim was to assess the changes in these parameters between 2003-2005 (WOBASZ study) and 2013-2014 in adults aged 20-74. MATERIAL AND METHODS: Sampling was performed in three stages, stratified according to voivodeship (province), type of commune, and gender. Finally, the study included 6163 persons (3406 women and 2757 men) examined in the years 2013-2014 (aged ≥ 19 years). For comparison the data from 14 755 persons (7783 women and 6452 men aged 20-74 years) examined in the years 2003-2005 were used. RESULTS: In the years 2013-2014, the age-standardized prevalence of hypertension, awareness, treatment and control was 42.7%, 59.3%, 46.1%, and 23% respectively. In the last decade an increase in the prevalence of hypertension (relative ratio (RR) 1.12; 95% confidence interval (CI): 1.07-1.18), treatment (RR = 1.26; 95% CI: 1.17-1.36) and control (RR = 2.16; 95% CI: 1.9-12.45) was found. In contrast, the awareness decreased nonsignificantly (RR = 0.98; 95% CI: 0.92-1.05). CONCLUSIONS: The prevalence of hypertension in Poland is high, and increased by about 12% in 10 years. Although the number of treated patients and blood pressure control improved nearly twofold over the last decade, this is still below expectations. Efforts to improve the diagnosis and effective treatment of hypertension in Poland should still be intensified.

The role of platelet reactivity assessment in dual antiplatelet prophylaxis after transcatheter aortic valve implantation.

BACKGROUND: Dual antiplatelet therapy (DAPT) is recommended prophylaxis after transcatheter aortic valve implantation (TAVI). The usefulness of platelet reactivity (PLTR) tests in predicting the safety of periprocedural DAPT in the TAVI population is unknown. AIM: To analyze the value of aspirin/clopidogrel PLTR testing in predicting the risk of in-hospital TAVI-related bleeding. METHODS: PLTR, expressed as P2Y12/aspirin reaction units (PRU/ARU), was performed using optical aggregometry with the VerifyNow® device, in the 24h before and on the sixth day after TAVI. Follow-up was by telephone. Bleeding was defined according to VARC-2, and comprised in-hospital, major and life-threatening events. RESULTS: Overall, 100 patients undergoing TAVI were included; 30 (30%) had bleeding. Clopidogrel PLTR before TAVI (area under the curve [AUC] 0.686, 95% confidence interval [CI] 0.542-0.808; P=0.02) and after TAVI (AUC 0.970, 95% CI 0.904-0.995; P<0.001) correlated with bleeding, with PRU cut-off values of ≤204 and ≤124 as bleeding predictors, respectively. A significant periprocedural decrease in clopidogrel PLTR was noted, with a PRU drop of >78 as bleeding predictor (AUC 0.851, 95% CI 0.725-0.935; P<0.001). Only postprocedural aspirin PLTR was associated with bleeding (AUC 0.697, 95% CI 0.585-0.794; P=0.008). Follow-up (359±73 days after TAVI) included 85 patients (85%) (after exclusion for in-hospital death [n=4] and lack of contact [n=11]). Major bleeding was noted in four patients (4.7%), all on combined prophylaxis. CONCLUSIONS: TAVI-related bleeding occurs mainly during the procedure or in the early postprocedural period. Testing of periprocedural clopidogrel PLTR, but not aspirin PLTR, seems useful because of its predictive value for TAVI-related bleeding. PLTR testing suggests that premedication with clopidogrel, enhanced response to clopidogrel early after TAVI and significant periprocedural drop in clopidogrel PLTR might increase the risk of TAVI-related bleeding.

Menopause improves the predictive value of common cardiovascular risk scores in women with premature coronary artery disease.

OBJECTIVE: Menopause, particularly its early stage (≤3 years from onset), may be an important risk factor for premature coronary artery disease. The objective of the study was to assess whether the addition of the presence of menopause in women with premature coronary artery disease could improve the predictive value of the Atherosclerotic Cardiovascular Disease risk estimator and the Systematic COronary Risk Evaluation model. METHODS: The case-control study included 307 women with coronary artery disease aged 55 or less, and 347 age-matched controls without coronary artery disease. Diagnostic accuracy parameters were evaluated for traditional risk models versus those enriched with menopausal status. Early and late postmenopausal periods were defined as ≤3 and >3 years from the onset of menopause, respectively. RESULTS: Only the addition of the presence of the early postmenopausal stage to the 10-year Atherosclerotic Cardiovascular Disease risk classes resulted in significantly increased c-statistics from 0.66 (95% confidence interval [CI] 0.62-0.7) to 0.705 (95%CI 0.66-0.75) (P = 0.0003) and an increase of accuracy from 61.3% to 63.8% (P = 0.0025).Adding the presence of early postmenopause to the Systematic COronary Risk Evaluation risk classes also resulted in significantly increased c-statistics from 0.59 (95% CI 0.55-0.63) to 0.641 (95%CI 0.6-0.68) (P = 0.0024) and an increase of accuracy from 64.1% versus 57.5% (P = 0.001). CONCLUSION: Adding the early menopausal period may significantly improve the predictive value of the 10-year Atherosclerotic Cardiovascular Disease risk score and the Systematic COronary Risk Evaluation model in women with premature coronary artery disease.

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.

Significance of the age of transfused blood for prognosis after transcatheter aortic valve implantation.

INTRODUCTION    Blood transfusion after transcatheter aortic valve implantation (TAVI) is frequently required owing to the high vulnerability of this patient group and procedure-related bleeding. OBJECTIVES    We assessed the impact of postprocedural blood transfusion and the age of transfused red blood cell (RBC) units on prognosis after TAVI. PATIENTS AND METHODS    This was a single-center, observational analysis conducted between the years 2009 and 2014. The adopted endpoints were early and long-term mortality after TAVI. The risk factors for mortality included in-hospital bleeding and vascular complications, the number of transfused RBC units, transfusion of at least 2 RBC units, the age of transfused RBCs, and standard deviation of the age of RBCs. RESULTS    The study included 178 patients (mean [SD] age, 80.07 [7.47] years; range, 55-91 years). The follow-up ranged between 1 month and 5.8 years (mean [SD], 20.1 [15.2] months) after discharge; 14 early deaths (7.8%) and 27 late deaths (16.5%) were noted. In-hospital bleeding and vascular complications increased the risk of early deaths (hazard ratio [HR], 2.113; 95% CI, 1.011-4.418; P = 0.046 and HR, 2.265; 95% CI, 1.270-4.039; P = 0.005). Transfusion of younger RBCs (HR, 1.044; 95% CI, 1.004-1.085; P = 0.028) and a greater discrepancy in the age of transfused RBCs (HR, 1.153; 95% CI, 1.042-1.275; P = 0.006) were positively correlated with the risk of late deaths only in a univariate analysis. A higher number of transfused RBC units was the only independent predictor of long-term mortality (HR, 1.149; 95% CI, 1.024-1.291; P = 0.018). CONCLUSIONS    The higher number of RBC units transfused early after TAVI worsens long-term prognosis. Shorter-storage RBCs and a greater discrepancy in RBC age in multitransfused elderly patients after TAVI might have a deleterious effect on life expectancy.

Cardiovascular health knowledge of the Polish population. Comparison of two national multi-centre health surveys: WOBASZ and WOBASZ II.

BACKGROUND AND AIM: To compare the cardiovascular health knowledge (CHK) of the adult Polish population in the years 2003-2005 and 2013-2014, and to evaluate the CHK determinants in the Polish adult population. METHODS: Data came from the two random samples of the Polish population, screened in 2003-2005 in the WOBASZ health survey (6392 men and 7153 women, aged 20-74 years) and in 2013-2014 in the WOBASZ II health survey (2751 men and 3418 women, aged 20+ years). For the present analysis, the population of WOBASZ II was limited to persons aged 20-74 years. A CHK score (CHKs) was constructed based on questionnaire answers of responders, and the results of physical examination and ranged from -1 (lowest knowledge) to +6 (highest knowledge). RESULTS: Women had greater CHK than men. In both studies, about 30% of women and 40% of men did not know their blood pressure (BP). About 20% of men and women that declared their BP awareness was not able to classify it correctly to the normal or high category. Most persons that declared body weight awareness could give their body weight to within 2 kg and could correctly classify it as normal or overweight/obesity. The mean CHKs raised in men from 1.74 in WOBASZ to 1.93 in WOBASZ II (in women, respectively, from 2.10 to 2.23). The chance of having CHK greater than mean value of CHKs increased in men by 31% and in women by 27% in WOBASZ II compared to WOBASZ (ORCHK = 1.31, p < 0.0001 in men; ORCHK = 1.27, p < 0.0001 in women). Younger, better educated persons and men with coronary artery disease history and persons with familial history of death from myocardial infarction or stroke had greater health knowledge. CONCLUSIONS: Since 2003 Polish adults significantly advanced their knowledge and awareness of cardiovascular risk factors. Gender, age, education level, coronary artery disease history, and family history of cardiovascular disease death are significant determinants of CHK. From 20% to 30% of studied persons who declared their awareness, were shown to be unaware of their own cardiovascular disease risk factors.

[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.

Tobacco smoking in Poland in the years from 2003 to 2014. Multi­centre National Population Health Examination Survey (WOBASZ).

INTRODUCTION    The reduction of tobacco smoking is a challenging problem of public health. OBJECTIVES    The main purpose of this work was to evaluate the prevalence and tobacco use patterns in the adult population of Poles and its changes in a period between year 2003 and 2014. Furthermore, changes in the smoking addiction, the declared reasons for smoking as well as readiness and motivation to stop smoking has been assessed.  PATIENTS AND METHODS    Based on data from the Polish studies - WOBASZ and WOBASZ II, the analysis covered a population of 14576 persons from the 1st study (6906 men and 7670 women) and 5696 persons from the 2nd study (2578 men and 3118 women), aged 20 - 74. RESULTS    According to the WOBASZ II study, in Poland 30% of men and 21% of women smoked,  the shares being 9 and 4 % lower for men and women respectively in comparison with the WOBASZ (p<0.001). The average number of cigarettes smoked daily per smoker significantly decreased in the period of observation among men (from 17.9 to 15.8 cigarettes/day) and women (from 13.7 to 12.1). The percentage of never smoking men rose from 29.8% to 36.1% (p<0.0001). The proportion of never smoking women no changed. However, the percentage of those expressing unwillingness to quit tobacco smoking nearly doubled in WOBASZ II vs WOBASZ. CONCLUSIONS    Although we found smoking rates in Poland have declined over the past decade, smoking remains prevalent among men and women. Therefore it is necessary to optimize the tobacco control in Poland including fiscal policy, counseling and tobacco addiction treatment, promotional and educational activities, with a special emphasis on the female population.

Chronic kidney disease in Polish elderly population aged 75+: results of the WOBASZ Senior Survey.

PURPOSE: Kidney filtration decreases with age, which results in an increased frequency of chronic kidney disease (CKD) in the elderly population. The purpose of the study was to assess the prevalence and epidemiology of CKD in the Polish elderly population. METHODS: A representative sample of the Polish elderly population, composed of 918 people (F 452, M 466) in the age of ≥75 years, was chosen. All participants had their history, anthropometric measures and biochemical parameters (creatinine, fasting glucose, complete cholesterol) evaluated. CKD was diagnosed when eGFR was <60 ml/min/1.73 m2. The comorbidities, anthropometric and social factors connected with the onset of CKD were also analyzed. RESULTS: The prevalence of CKD in the analyzed population was 26.9% (F 32.0%, M 15.8%), which gives an estimated number of 495,590 (95% CI 396,363-594,817) patients in the study subpopulation. The majority of these people were in the G3A category-70.1%, while the remaining fell under the G3B-25.7%, G4-3.1% and G5-1.1% categories. Disease awareness among the participants was found to be at 17%. Arterial hypertension (AH) was more frequent in people with CKD (91.0 vs. 80.3%, P < 0.001), whereas diabetes mellitus (DM) prevalence was comparable in both CKD and non-CKD groups (11.7 vs. 11.4%, ns). In the examined group, DM had no influence on the frequency of CKD. In contrast, the presence of cardiovascular diseases substantially increased the chances of developing CKD (OR 1.87, P < 0.05). CONCLUSION: 1. The prevalence of CKD in the Polish elderly population was 26.9%. 2. Awareness of CKD is low. 3. DM, increasing age and AH did not increase the risk of CKD. 4. Coexistence of cardiovascular diseases increased the risk of having CKD.

Prevalence of familial hypercholesterolemia: a meta-analysis of six large, observational, population-based studies in Poland.

INTRODUCTION: Familial hypercholesterolemia (FH) is a severely underdiagnosed and undertreated genetic disorder. Little is known about regional variation in the prevalence of FH, and information for Central and Eastern Europe (CEE) is scarce. This paper assesses the prevalence of FH and related cardiovascular disease (CVD) risk factors in Poland. MATERIAL AND METHODS: We performed a meta-analysis of six population-based studies in Poland. The FH was assessed using the Dutch Lipids Clinics Network (DLCN) criteria. The categories "definite" (> 8 points) and "probable" (6-8 points) were combined into "potential FH". Combined estimates of proportions across studies were pooled by meta-analysis with a random effects model. RESULTS: A total of 37,889 persons aged 20-79 years were included in the analysis. The distribution of DLCN scores was skewed, and there were only 7 cases of definite FH. Prevalence of potential FH was 404/100,000 people (95% CI = 277-531/100,000). Familial hypercholesterolemia was more prevalent in women than in men, and the prevalence was the highest in the age group 45-54 years in men and 55-64 years in women. After adjustment for age and sex, compared to participants with normal cholesterol, persons with potential FH had twice the prevalence of hypertension (p < 0.01); smoking was more prevalent by about 80% (p < 0.01) and hypertriglyceridemia was nine times more frequent (p < 0.001). There was no difference in the prevalence of low high-density lipoprotein (HDL)-cholesterol or diabetes. CONCLUSIONS: We believe that our study might facilitate the planning of a strategy to manage the disease at a population level, i.e. to develop a national strategy for the detection, diagnosis, and treatment of FH.

Changes in the prevalence, treatment, and control of hypercholesterolemia and other dyslipidemias over 10 years in Poland: the WOBASZ study.

INTRODUCTION Lowering exposure to dyslipidemias is one of the biggest challenges in cardiovascular disease prevention.  OBJECTIVES The aim of the study was to describe the prevalence of dyslipidemias and treatment of hypercholesterolemia in Poland, and to assess changes since the period of 2003-2005. PATIENTS AND METHODS Two cross-sectional surveys of the random samples of the Polish population were performed in the years 2003-2005 (WOBASZ) and 2013-2014 (WOBASZ II). Interviews were carried out according to a standard questionnaire. Blood lipid levels were determined in a single laboratory in frozen samples using the enzymatic colorimetric method. RESULTS The analysis included 14151 participants aged 20-74 years (WOBASZ) and 5947 participants aged 20-99 years (WOBASZ II). In the 2013-2014 survey, hypercholesterolemia was found in 70.3% of men and 64.3% of women. Isolated hypertriglyceridemia was found in 5.6% of men and 2.4% of women. Isolated low levels of high-density lipoprotein cholesterol (HDL-C) were found in 5.1% of men and in 7.3% of women. The prevalence of hypercholesterolemia did not change significantly with regards to the 2003-2005 survey. An increase in the prevalence of hypertriglyceridemia was found in men (relative ratio [RR], 1.26; 95% confidence interval [CI], 1.03-1.55), and an increase in the prevalence of low HDL-C levels was observed in both sexes (men: RR, 2.26; 95% CI, 1.77-2.88; women: RR, 1.94; 95% CI, 1.61-2.33). There was an increase in the proportion of persons receiving high- or moderate-intensity statin therapy. However, 60,6% of persons with hypercholesterolemia were not aware of their condition, and only 6% were treated and achieved the treatment target.  CONCLUSIONS There is an urgent need for more effective strategies for the prevention and management of dyslipidemias.

The relationship between physical activity level and selected cardiovascular risk factors and mortality of males ≤ 50 years in Poland - the results of follow-up of participants of National Multicenter Health Survey WOBASZ.

OBJECTIVES: The role of leisure-time physical activity in reducing all-cause and cardiovascular mortality is well explored. The knowledge on occupational and commuting physical activity continues to be ambiguous and misleading. The aim of the study is to assess the influence of different kinds of physical activity on cardiovascular mortality risk in men. MATERIAL AND METHODS: Data analysis on physical activity level and other selected cardiovascular risk factors acquired from 3577 men in the age between 50-80 years who participated in the National Multicenter Health Survey WOBASZ (Wieloosrodkowe Ogólnopolskie Badanie Stanu Zdrowia), Poland (2003-2005) was linked with male mortality in 2004-2009. Data about causes of deaths were obtained from the Central Statistical Office and the Population Electronic Register. RESULTS: Among males aged 50-59 years, the strongest risk factor was living in large settlements and provincial capitals as a place of residence and the most protective factor was occupational physical activity. In the age group 60-69 years and 70-80 years, the strongest protective effect was observed for leisure-time physical activity. In men aged between 70-80 years (unlike in the 50-59 years age group), the protective effect of large settlements and provincial capitals as a place of residence was noted. CONCLUSIONS: Occupational physical activity significantly reduced cardiovascular mortality in men aged 50-69 years, while for leisure-time activity the positive effect was observed in age group 60-69 years and 70-80 years. On the other hand, for the inhabitants of large settlements and provincial capitals, significantly higher risk of cardiovascular mortality in the age group 50-69 years and lower risk in the age group ≥ 70 years was noted, both in comparison with smaller places of residence.

Prognostic significance of reactive pulmonary hypertension in patients with chronic heart failure listed for elective heart transplantation.

BACKGROUND: Pulmonary hypertension (PH) is recognised in about 60% of patients referred for heart transplantation (HTx), and it influences the patient's prognosis. AIM: To assess the prognostic value of reactive PH in patients listed for elective HTx. METHODS: A total of 522 patients were enlisted from the Polish National Registry (POLKARD), listed for HTx, in whom complete haemodynamic data were reported. The endpoint was all-cause death before HTx. Heart transplantation, elective or urgent, was considered as an end of the follow-up (mean follow-up 1.47 ± 1.26 years). Patients were divided into three subgroups: no PH, passive PH, reactive PH taking into account mean pulmonary artery pressure (PAP) of 25 mm Hg, pulmonary capillary wedge pressure (PCWP) 15 mm Hg, and pulmonary vascular resistance (PVR) 3.0 Wood units. Haemodynamic, clinical, echocardiographic, and biochemical assessments (including NT-proBNP, hs-CRP) were performed. The Heart Failure Survival Score (HFSS) was calculated. RESULTS: Estimated death rate was comparable between patients with no PH, passive PH, and reactive PH, despite the fact that the patients with reactive PH had the worst pulmonary haemodynamic scores (mean PAP 38.4 ± 7.8, PCWP 27 ± 7.4 mm Hg and PVR 4.8 ± 1.7 Wood units). In patients with reactive PH, in multifactor Cox analysis only the serum Na level influenced survival. According to the Kaplan-Meier method, patients with reactive PH, with mean PAP ≥ 41.4 mm Hg had the worst prognosis, estimated survival was: one year - 83%, two years - 65%. CONCLUSIONS: Reactive PH is common among patients with chronic HF listed to HTx (28%). It has no further influence on short-term prognosis as compared with patients with no PH and passive PH. Serum Na concentration and mean PAP ≥ 41.4 mm Hg influence the prognosis of patients with reactive PH.

Global cardiovascular mortality risk in the adult Polish population: prospective assessment of the cohorts studied in multicentre national WOBASZ and WOBASZ Senior studies.

BACKGROUND AND AIM: To develop a global cardiovascular disease (CVD) mortality risk model for the Polish population and to verify these data in the context of the SCORE risk algorithm. METHODS: We analysed data obtained in two multicentre national population studies, the WOBASZ study which was conducted in 2003-2005 and included 14,769 subjects aged 20-74 years, and the WOBASZ Senior study which was conducted in 2007 and included 1096 subjects above 74 years of age. All these subjects were followed for survival status until 2012 and the cause of death was determined. The mean duration of follow-up was 8.2 years for WOBASZ study participants and about 5 years for WOBASZ Senior study participants. Overall, 1436 subjects died, including 568 due to CVD. For the purpose of our analysis of overall and CVD mortality, 15 established risk factors were selected. Survival was analysed separately in WOBASZ and WOBASZ Senior study participants. Statistical methods included descriptive statistics, Kaplan-Meier curves, Cox proportional hazard models, and the SCORE risk algorithm. Measure of incompatibility of the SCORE risk model to the Polish population was determined as the difference between mortality rates by the SCORE risk quartiles and the Cox approach. RESULTS: During the 8-year follow-up of the WOBASZ study population, mortality due to CVD was 38% among men and 31% among women. The most common causes of CVD mortality were ischaemic heart disease (IHD, 33%) followed by cerebro-vascular disease (17%) in men, and cerebrovascular disease (31%) followed by IHD (23%) in women. We found significant differences between men and women in regard to survival curves for both overall mortality and CVD mortality (p < 0.0001). For overall mortality among men and women, nearly all selected risk factors were shown to be significant in univariate analyses, except for high density lipoprotein cholesterol (HDL-C) level and the total cholesterol/HDL-C ratio in men, and smoking status in women. In multivariate analysis, independent predictors in men included age, glucose level, systolic blood pressure, and smoking status. In women, independent predictors were age, smoking status, and diabetes. During the 5-year follow-up of the WOBASZ Senior study population, mortality due to CVD was 48% among men and 58% among women. The most common cause of CVD mortality in both men and women was IHD (29% and 24%, respectively), followed by cerebrovascular disease (16% and 21%, respectively). We found significant differences between men and women in regard to survival curves for overall mortality (p < 0.0001) but not for CVD mortality (p = 0.0755). Due to the fact that survival curves for CVD mortality did not differ between men and women, we estimated the cut-off age for no survival difference in the WOBASZ study. By selecting the oldest patients and adding them to the WOBASZ Senior cohort, we obtained the cut-off age of 70 years above which the survival curves were not significantly different between men and women. In univariate analyses, independent predictors in men were age and creatinine level. These factors remained significant in multivariate analysis. In women above 74 years of age, independent predictors in univariate analyses included age, HDL-C level, creatinine level, total cholesterol/HDL-C ratio, and smoking status. Age, HDL-C level, creatinine level, and smoking status remained independent predictors of overall mortality in multivariate analysis. For CVD mortality, significant predictors were the same as for overall mortality. In women, significant predictors in uni- and multivariate analyses were age and smoking status. Overall disagreement between CVD mortality rates by the SCORE risk model and the Cox model was 5.7% in men and 2% in women. CONCLUSIONS: 1. Long-term follow-up of WOBASZ and WOBASZ Senior study participants allowed assessment of the inde-pendent association of the evaluated cardiovascular risk factors with CVD mortality in the Polish population. 2. Validation of the SCORE risk algorithm to estimate individual global CVD risk in the Polish population showed a high predictive value of this algorithm.

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.

Multi-centre National Population Health Examination Survey (WOBASZ II study): assumptions, methods, and implementation.

BACKGROUND: Cardiovascular diseases (CVDs) are the main cause of morbidity and mortality in developed countries. Despite the progress in diagnostics and treatment, it is expected that CVD will still be the main cause of death worldwide until at least 2030. From 1991 CVD mortality in Poland systematically decreased, but it is still higher than the average in Western Europe. In 2013 CVDs were the cause of 46% of all deaths in Poland (40.9% in men and 51.1% in women) and 26.9% of deaths among persons under 65 years of age. The epidemiologic assessment of prevalence, control and treatment of CVD risk factors, and monitoring of healthy behaviour and morbidity due to diseases like coronary artery disease, hypertension and diabetes is very important for health policy planning. The WOBASZ II is the newest Polish population based survey, performed in 2013-2014 to evaluate prevalence, control, treatment, and morbidity. The study was the continuation of WOBASZ (2003-2005). AIM: To describe the goals and methods of the WOBASZ II study and to present the results of the recruitment. METHODS: The WOBASZ II study was planned as a cross-sectional survey of a random sample of Polish residents aged over 20 years. The selection, using the National Identity Card Registry of the Ministry of Internal Affairs, was made as a three-stage sampling, stratified according to administrative units (voivodeships), type of urbanisation (commune), and gender. The study protocol consisted of a questionnaire used in face-to-face interviews, physical examination, and blood samples. WOBASZ II was coordinated by the Department of Epidemiology, Cardiovascular Diseases Prevention and Health Promotion of the Institute of Cardiology in Warsaw in cooperation with medical universities in Gdansk, Katowice, Krakow, Lodz, and Poznan. RESULTS: Out of 15,120 persons, 1557 persons were not eligible. Out of eligible persons, 6170 (2760 men and 3410 women) were examined (the response rate 45.5%). The highest response rates were observed in Warminsko-Mazurskie (64.2%), Zachodniopomorskie (58.1%), and Kujawsko-Pomorskie (53.1%). CONCLUSIONS: The importance of the WOBASZ study for the monitoring of the health state of Polish society, and for the as-sessment of prophylaxis efficiency and treatment of CVD and metabolic diseases, as well as for the evaluation of the actions in the field of health promotion, is difficult to overstate.

Comparison of Various Databases for Estimation of Dietary Polyphenol Intake in the Population of Polish Adults.

The primary aim of the study was to estimate the consumption of polyphenols in a population of 6661 subjects aged between 20 and 74 years representing a cross-section of the Polish society, and the second objective was to compare the intakes of flavonoids calculated on the basis of the two commonly used databases. Daily food consumption data were collected in 2003-2005 using a single 24-hour dietary recall. Intake of total polyphenols was estimated using an online Phenol-Explorer database, and flavonoid intake was determined using following data sources: the United States Department of Agriculture (USDA) database combined of flavonoid and isoflavone databases, and the Phenol-Explorer database. Total polyphenol intake, which was calculated with the Phenol-Explorer database, was 989 mg/day with the major contributions of phenolic acids 556 mg/day and flavonoids 403.5 mg/day. The flavonoid intake calculated on the basis of the USDA databases was 525 mg/day. This study found that tea is the primary source of polyphenols and flavonoids for the studied population, including mainly flavanols, while coffee is the most important contributor of phenolic acids, mostly hydroxycinnamic acids. Our study also demonstrated that flavonoid intakes estimated according to various databases may substantially differ. Further work should be undertaken to expand polyphenol databases to better reflect their food contents.