The Prevalence of Cardiovascular Risk Factors among Polish Soldiers: The Results from the MIL-SCORE Program.

The MIL-SCORE (Equalization of Accessibility to Cardiology Prophylaxis and Care for Professional Soldiers) program was designed to assess the prevalence and management of cardiovascular risk factors in a population of Polish soldiers. We aimed to describe the prevalence of cardiovascular risk factors in the MIL-SCORE population with respect to age. This observational cross-sectional study enrolled 6440 soldiers (97% male) who underwent a medical history, physical examination, and laboratory tests to assess cardiovascular risk. Almost half of the recruited soldiers were past or current smokers (46%). A sedentary lifestyle was reported in almost one-third of those over 40 years of age. The prevalence of hypertension in a subgroup over 50 years of age was almost 45%. However, the percentage of unsatisfactory blood pressure control was higher among soldiers below 40 years of age. The prevalence of overweight and obese soldiers increased with age and reached 58% and 27%, respectively, in those over 50 years of age. Total cholesterol was increased in over one-half of subjects, and the prevalence of abnormal low-density lipoprotein cholesterol was even higher (60%). Triglycerides were increased in 36% of soldiers, and low high-density lipoprotein cholesterol and hyperglycemia were reported in 13% and 16% of soldiers, respectively. In the >50 years of age subgroup, high and very high cardiovascular risk scores were observed in almost one-third of soldiers. The relative risk assessed in younger subgroups was moderate or high. The results from the MIL-SCORE program suggest that Polish soldiers have multiple cardiovascular risk factors and mirror trends seen in the general population. Preventive programs aimed at early cardiovascular risk assessment and modification are strongly needed in this population.

Left ventricular end-diastole hemodynamics is strongly associated with spontaneous cardiac baroreflex in humans.

BACKGROUND: In animals, hemodynamic conditions during left ventricular (LV) end-diastole are crucial for the excitation of autonomic afferents distributed throughout cardiac chambers and large thoracic vessels. The objective of the study was to select the echocardiographic indices of LV diastolic function that are the most potent predictors of the heart's spontaneous baroreflex in humans. METHODS: In 47 untreated hypertensive patients (26 with normal and 21 with increased left atrium diameter) and 24 healthy controls, baroreflex sensitivity (BRS) was assessed in the low (αLF; 0.04-0.15 Hz) and high frequency (αHF; 0.15-0.4 Hz) components in the supine and during tilting. The [Formula: see text] normalized to LV end-diastolic diameter (the [Formula: see text] index) is a marker of the septum late diastolic distension rate ([Formula: see text] denotes peak late diastolic velocity at the septal mitral annulus) under the corresponding transmitral pressure gradient that determines the peak velocity of blood flow (A) into the LV chamber. RESULTS: The [Formula: see text] markedly stronger than [Formula: see text] ratio correlated with the BRS. In the best-fit models of multivariable linear regression, the [Formula: see text] index was the independent predictor of the αLF BRS at tilting (ß = -0.3; p = 0.01). Independent of clinical and echocardiographic parameters, the [Formula: see text] index predicted also both the αHF BRS in the supine position (ß = -0.23; p = 0.01) and the αHF BRS reinforcement due to increased preload (ß = -0.28; p = 0.001). CONCLUSIONS: The [Formula: see text] index is a reliable marker of diastolic dysfunction that evokes significant heart's baroreflex impairment and is markedly stronger than [Formula: see text] ratio associated with these systemic consequences of altered LV diastole hemodynamics.

The effects of cardiac rehabilitation on haemodynamic parameters measured by impedance cardiography in patients with heart failure.

BACKGROUND: Cardiac rehabilitation (CR) is an important element of heart failure (HF) treatment although the mechanisms of its beneficial effects remain debatable. AIM: To evaluate the haemodynamic effects of CR measured by impedance cardiography in patients with HF. METHODS: Study group included 50 HF patients (aged 56.2 ± 8.8 years, NYHA class II and III, left ventricular ejection fraction ≤ 40%) who underwent 8-week CR. Clinical and haemodynamic assessment was performed before and after CR. RESULTS: As a result of CR, exercise tolerance improved significantly as measured by peak VO(2) (18.7 ± 4.4 vs 20.8 ± 4.7 mL/kg/min; p = 0.025), six-minute walking test distance (6-MWT; 417.8 ± 103.6 vs 467.7 ± 98.4 m, p = 0.016) and NYHA class (change to the lower NYHA class in 30% of subjects). A significant reduction of the left atrial diameter was observed in echocardiography (4.55 ± 0.63 vs 4.43 ± 0.59 cm, p = 0.017). Impedance cardiography revealed a significant change in diastolic to systolic wave ratio (O/C ratio; 54.8 ± 24.0 vs 47.9 ± 20.8%, p = 0.021). A significant change in the haemodynamic profile of the left ventricular blood ejection was also observed. Before CR, transthoracic fluid content (TFC) correlated with stroke index (SI; R = 0.37, p < 0.01), compared to no correlation after CR (R = 0.00, NS). Reduction in TFC correlated with prolongation of the 6-MWT (R = -0.32, p = 0.06), and increase in systolic time ratio (STR) correlated with increase in peak VO(2)(R = 0.40, p = 0.006). Subjects who benefited from CR tended to have lower heart rate (61.4 ± 9.0 vs 67.7 ± 10.7 1/min, p = 0.07), longer pre-ejection period (PEP; 12.2 ± 11.6 ms vs -2.6 ± 23.1 ms, p = 0.018) and non-significantly higher STR (0.423 ± 0.123 vs 0.377 ± 0.102, p = 0.37). CONCLUSIONS: Impedance cardiography revealed beneficial effects of CR, manifested by reduced fluid retention and a reduced effect of preload on left ventricular relaxation and ejection.