The Severity of Changes in Cardiovascular Risk Factors in Adults Over a Five-Year Interval.

PURPOSE: The aim of this study was to analyze the severity of changes in cardiovascular risk factors (hypertension, overweight and obesity, carbohydrate metabolism disorders, burdened family history) and to assess the risk of a cardiovascular incident according to the Systematic Coronary Risk Evaluation (SCORE) algorithm in the same group of patients over a five-year interval. PATIENTS AND METHODS: The research method was analysis of medical records of patients from the area of West Pomeranian Province, Poland, included in the Cardiovascular Disease Prevention Program of the National Health Fund five years after the first examination (2012/2013 vs 2017/2018). We collected data on changes in the levels of selected cardiovascular risk factors over five years and calculated the SCORE values. RESULTS: In the second measurement (after five years), the odds of obesity were about 2.5 times higher. The repeated BMI measurement showed that after five years more respondents were classified as overweight and obese compared with the first measurement (p = 0.000; η2 = 0.056). The repeated SCORE measurement indicated that after five years the SCORE values significantly increased compared with the first measurement (p = 0.000; η2 = 0.588). Statistically significant differences (p < 0.05) were also found between the first and the second measurements of arm circumference, waist circumference, BMI, diastolic blood pressure, heart rate, and triglycerides. The risk of visceral obesity was statistically significantly higher for men than for women (RHM = 1.47). CONCLUSION: In the group of patients examined twice over five years, the incidence of obesity, including abdominal obesity, significantly increased. Furthermore, five years after the last examination, the risk of a cardiovascular incident significantly increased. The participants had higher values of such parameters as: arm circumference, waist circumference, BMI, diastolic blood pressure, heart rate, and triglycerides.

Cardiovascular Risk Distribution in a Contemporary Polish Collective.

The aim of this study was to assess the prevalence of selected risk factors for cardiovascular disease (hypertension, overweight, obesity, carbohydrate metabolism disorders, a positive family history, a lack of physical activity), and to estimate the risk of a cardiovascular incident according to the Systematic Coronary Risk Evaluation (SCORE) algorithm for patients aged 35, 40, 45, 50, and 55 years, included in a primary-care prevention program, with regard to selected variables (sex and age brackets). The study sample consisted of 2009 subjects, 63% of whom were women. The largest group was the group of 35-year-olds (27%). The research method was the analysis of medical documentation of primary-care patients living in West Pomerania included in the Program of Prevention and Early Detection of Cardiovascular Disease of the National Health Fund. We collected data concerning risk factors for cardiovascular disease, blood pressure, anthropometric measurements (arm circumference, waist circumference, height, weight), body mass index (BMI), and the levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), and fasting glucose, as well as the SCORE results. Men more often than women were overweight and obese, had hyperglycemia, and had elevated levels of total cholesterol, LDL cholesterol, and triglycerides (p < 0.001). There was also a statistically significant difference in the odds of a cardiovascular incident (p < 0.001)-the SCORE results obtained by men were higher. Men require special preventive measures in order to reduce their risk factors for cardiovascular disease, especially hypertension, dyslipidemia, diabetes, overweight, obesity, smoking, and a positive family history.

[Program of early detection of pulmonary neoplasms by the computed tomography - preliminary Szczecin experience]. / Program wczesnego wykrywania nowotworów pluc za pomoca tomografii komputerowej-- wstepne doswiadczenia Szczecina.

INTRODUCTION: Lung cancer (LC) remains one of the most serious epidemiological and clinical challenges both in the world and Poland. Results of LC therapy are far from satisfaction. One of the reasons of high LC mortality is its late detection. Currently, few centers in the world conduct LC screening programs based on low-dose spiral computed tomography (CT) of the chest. There have been no such programs in Poland up to date. MATERIAL AND METHODS: The program of LC early detection based on CT for citizens of Szczecin aged 55-65, who smoked at least 20 pack/years, was introduced on May 1st 2008 and was planned for 3 years. There were 3647 subjects examined till December 31st 2008. Algorithm of further action for detected lesions was based on the IELCAP and NELSON trial protocols. RESULTS: There were 25 malignancies detected, including 21 LC (17 females and 4 males) up to date (70% were in stage I TNM). In contrast - there was only 16.8% stage IA LC detected in the comparable group diagnosed on the symptoms basis. Fifty seven patients were treated surgically, of whom 16 underwent lobectomy or pneumonectomy coupled with radical mediastinal lymphadenectomy. There were 3 wedge resections and 2 segmentectomies performed, too. Perioperative mortality was 0%. There were 32 benign lesions of different clinical importance resected as well (tuberculoma, hamartoma, inflammatory, mycotic and sarcoidal lesions). In our group 1365 lesions were detected in 996 persons - they are followed up in accordance with the IELCAP algorithm. CONCLUSIONS: Early LC detection program initiated in Szczecin resulted in significant increase of stage IA TNM detected patients subsequently treated radically. There was also a large number of small non malignant lesions detected.

[Diabetes control in type 2 diabetic subjects treated in primary health care--how far is from life to standards?]. / Wyrównanie cukrzycy typu 2 u chorych pozostajacych pod wylaczna opieka lekarzy rodzinnych--jak daleko od zycia do standardów?

UNLABELLED: In Poland, as in many other countries, majority of type 2 diabetics subjects (80%) is treated by general practitioners (GPs). Aim of the study was to assess control of type 2 diabetic subjects treated by GPs in one of the big cities in Poland. Achievement of treatment goals was assessed according to recommendations of European Diabetes Policy Group (EDPG) published in 1998-1999 and used in Poland till 2004 and according to more rigorous criteria recommended in 2005 by Polish Diabetological Association (PDA). Study was conducted in 2004 year in 355 consecutive type 2 diabetic subjects coming for a visit to GPs in one of the primary health care centries. Group consisted of 205 women and 150 men, mean age 65.7 +/- 10.3 years, mean diabetes duration 9.2 +/- 7.3 years, mean BMI 29.9 +/- 4.9 kg/m2. In all patients blood pressure measurements were performed in sitting position and blood samples for HbA1c, fasting glycaemia, total cholesterol, LDL, HDL and triglicerides were taken. Mean HbA1c was 7.2 +/- 1.3%; HbA1c < or = 6.5% recommended by EDPG was found in 34,6% of patients, HbA1c < or = 6.1% recommended by PDA was achieved in 19.7% of subjects. Mean fasting glycaemia was 144 +/- 48 mg/dl; glycaemia < or = 110 mg/dl recommended by EDPG and PDA was present in 24% of patients. Dyslipidaemia was present in 62% of diabetics. Mean total cholesterol was 203.7 +/- 45 mg/dl, LDL 118 +/- 33 mg/dl, HDL 51 +/- 13 mg/dl. LDL cholesterol < 100 mg/dl recommended by EDPG and PDA was observed in 28.7% of subjects. HDL cholesterol > 46 mg/dl (EDPG criteria) was found in 61% of patients. HDL cholesterol > 40 mg/dl in men and > 50 mg/dl in women ( PDA criteria) was present 64.5% of subjects. Mean triglycerides level was 182 +/- 108 mg/dl; concentrations < 150 mg/dl (EDPG and PTD criteria) were observed in 46.2% of subjects. Hypertension was present in 81.4% of patients. Mean systolic blood pressure (SPB) was 146.1 +/- 20.4 mmHg, diastolic (DBP) 83.0 +/- 11.1 mmHg. Recommended by EDPG, SPB < 140 mmHg was observed in 47,9%, DBP < 85 mmHg--in 69.9%. Recommended by PTD, SBP < 130 mmHg was found in 16.1%, DBP < 80 mmHg--in 24.5%, and both values only in 8.2% of diabetics. All treatment goals recommended by EDPG-1998-1999 were achieved only in 2 patients. No one person achieved all goals of treatment recommended by PDA-2005. CONCLUSIONS: Great majority of type 2 diabetic subjects treated in primary health care failed to attain treatment goals recommended by EDPG 1998-1999 and by PDA 2005.

[Diabetes control in type 2 diabetic subjects treated in primary health care]. / Wyrównanie cukrzycy typu 2 u chorych leczonych przez lekarzy podstawowej opieki zdrowotnej.

Aim of the study was to assess control of type 2 diabetes in subjects treated by general practitioners. Study was conducted in one of the primary health care centers in a big city, in which health care was provided for 27 900 inhabitants. Control of diabetes was assessed in 355 of all 936 type 2 diabetic subjects registered in the center. None of them was seen by diabetologist in the preceeding year. Mean age was 65,7 +/- 10,3 lat, diabetes duration 9,2 +/- 7,3 lat, BMI 29,9 +/- 4,9 kg/m2. Normal body weight was found in 15%, overweight in 39%, obesity in 46% of subjects. Hypertension was present in 81%, dyslipidaemia in 62% of patients. Mean HbAlc was 7,2 +/- 1,3%, fasting serum glycaemia 144 +/- 48 mg/dl, total cholesterol 204 +/- 45 mg/dL, LDL - 119 +/- 33 mg/dL, HDL - 51 +/- 13 mg/dl, triglicerides 182 +/- 108 mg/dL. Mean systolic blood pressure was 146 +/- 20 mmHg, diastolic 83 +/- 11 mmHg. Treatment goals recommended by Polish Diabetological Association in 2005 were attained as follows: HbAlc < or = 6,1% - 19,7% of subjects, fasting glycaemia < or =110 mg/dl - 24%, total cholesterol < 175 mg/dl - 26%, LDL < 100 mg/dl - 29%, triglicerides < 150 mg/dl - 46%, cholesterol HDL > 40 mg/dl in men and > 50 mg/dl in women - 65% of subjects. Recommended systolic blood pressure < 130 mmHg was found in 16 %, diastolic blood pressure < 80 mmHg - in 24%, and both values - in 8% of diabetics. In no one subject all recommended treatment goals were met. Conclusions 1. Recommended treatment goals are perceived in unacceptably low number of type 2 diabetic subjects treated by general practitioners. 2. Medical care of type 2 diabetic subjects performed in primary health care is unsatisfactory and should be essentially improved or changed.

[Prevalence of diabetes, antidiabetic treatment and chronic diabetic complications reported by general practitioners]. / Ocena czestosci wystepowania cukrzycy, sposobu jej leczenia oraz czestosci powiklan o typie mikroangiopatii u osób pozostajacych pod opieka lekarzy podstawowej opieki zdrowotnej.

INTRODUCTION: Prevalence of type 2 diabetes has increased greatly over the past decade and focus of care for people with diabetes has shifted from specialists to general practitioners (GPs). Because of lack of the central registry, a real number of diagnosed diabetes in Poland is unknown, as unknown is the prevalence of diabetes in patients attending primary health care, provided treatment and a prevalence of chronic diabetic complications registered by GPs. AIM OF STUDY: Assessment of the prevalence of diabetes registered in primary health care, recommended antidiabetic treatment and prevalence of microangiopathic diabetic complications diagnosed by GPs. MATERIAL AND METHODS: Study was performed in Szczecin, a city of 450 000 inhabitants, located in North-West part of Poland. Data were obtained in year 2002 from one of the primary health care centers, in which health care was provided by 12 GPs for 27 932 inhabitants (15655 females and 12277 males), aged 0-98 years (average 38.3 +/- 23.2 years). Data were extracted from medical records and provided by GP doctors. RESULTS: Number of diagnosed and registered diabetics was 993 (prevalence--3.56%), age 3-95 years (mean 65.4 +/- 13.6 years). The diabetic group consisted of 611 females (mean age 67.5 +/- 12.4)--prevalence--3.90% and 382 males (mean age 62.0 +/- 14.7)--prevalence--3.11% (p = 0.003). Mean duration of diabetes was 7.4 +/- 6.9 years and it was similar for males and females. Type 2 diabetes was diagnosed in 94.4%, type 1 diabetes in 4.5%, other types of diabetes in 1.1% of all patients. Prevalence of registered diabetes in the group of 0-10 years old was 0.08%, in the group 11-20 years--0.33%, 21-30 years--0.25%, 31-40 years--0.44%, 41-50 years--1.93%, 51-60 years--5.03%, 61-70 years--9.88% and in the group over 70 years old--14.37%. Prevalence of diabetes in the group over 14 years old was 4.38%, in the group over 20 years--4.86%, and in subjects older than 35 years--6.84%. Elderly patients, over 60 years account for 74% of all diabetic subjects and subjects over 70 years--for 45% of them. Reported treatment of type 2 diabetes: diet alone--9%, oral agents--68%, oral agents combined with insulin--10.5%, insulin alone--12.5%. Mean HbA1c value measured in 307 type 2 diabetic subjects was 7.25 +/- 1.28%. According to GPs' opinion chronic microangiopathic diabetes complications were present in 36.6% of type 2 diabetic subjects. Retinopathy was reported in 24.8% of patients, polyneuropathy in 2.4%, nephropathy in 1.5%, diabetic foot in 0.5%, and combination of different complications in 7.4% of them. In type 1 diabetes chronic diabetic complications were stated in 42.2% of subjects--retinopathy--in 15.6%, polyneuropathy--in 2.2%, nephropathy--in 2.2%, diabetic foot--in 2.2%, and combination of them--in 20.0%. Average number of registered diabetics was 83 per physician, however 6 doctors took care of 107-158 diabetic subjects. In the past year diabetologist consultation or hospitalisation in internal medicine unit was provided for 47% of type 2 diabetics and for 98% of type 1 diabetics. CONCLUSIONS: 1. The prevalence of diabetes registered in primary health care in Szczecin is higher than expected on the basis of European data. 2. Low number of type 2 diabetics is treated with diet alone and quite high number is treated with insulin. 3. Low number of chronic diabetic complications reported by GPs, despite long duration of disease, indicates the necessity of special training in delivering care for diabetic people, diagnosis of diabetic complications, increased access to secondary care and better cooperation between primary and secondary care.