Lack of an association between apolipoprotein B XbaI polymorphism and blood lipid parameters in childhood.

The frequencies of the alleles of XbaI polymorphism in the apolipoprotein B gene were determined in two groups of children, 82 with high (HCG) and 86 with low (LCG) cholesterol levels. A slightly higher incidence of the X2X2 genotype in HCG was found, but the differences were not statistically significant. No relations were found between the XbaI polymorphic site and the levels of serum lipids and lipoproteins. Common XbaI polymorphism in the apolipoprotein B gene does not determine significantly the plasma cholesterol levels in childhood.

[Decrease in cardiovascular disease mortality in the Czech Republic from 1984 to 1993 and its possible causes]. / Pokles úmrtnosti na kardiovaskulární onemocnení v Ceské republice v období 1984-1993 a jeho mozné príciny.

BACKGROUND: The objective of the investigation was to evaluate the ten-year development of the cardiovascular mortality rate in two population groups in the age bracket from 25 to 64 years, i.e. in subjects living in six districts which participated in the international WHO project MONICA and in the population of the whole Czech Republic. METHODS AND RESULTS: Data on the mortality rate in 1984-1993 for the age group from 25-64 years were provided by the Institute of Health Information and Statistics, information on the prevalence of risk factors was obtained in three cross-sectional studies implemented in six districts as part of the MONICA project in 1985, 1988 and 1992. In the mortality rate per 100,000 population in the six districts the following changes were revealed (in parentheses the values for 1984 and 1993 are given): men - a statistically significant declining trend in the from all caused mortality (849.3-742.5; p < 0.001) and cardiovascular mortality (367.2-280.4; p < 0.001) and cerebrovascular mortality (69.7-44.8; p < 0.001). In the mortality from ischaemic heart disease (215.7-170.6; ns) a declining trend was not recorded. In women aged 25-64 years in the six districts there was a statistically significant decline of the mortality from all caused (359.5-322.1; p < 0.001), the cardiovascular mortality (115.6-100.6; p < 0.001) and cerebrovascular mortality (31.1-23.6; p < 0.001). The mortality from ischaemic heart disease did not change (49.2-48.8; ns). In the population of the Czech Republic in men the following were detected: a drop of the from all caused mortality (907.1-784.8; P < 0.001), the cardiovascular mortality (383.5-308.4; p < 0.001) and cerebrovascular mortality (76.5-55.3; p < 0.001). Also in women of the Czech Republic a decline of the mortality from all caused was recorded (390.1-328.5; p < 0.001), the cardiovascular mortality (135.3-103.8; p < 0.001), ischaemic heart disease (58.0-48.6; p < 0.001) and cerebrovascular mortality (43.5-27.4; p < 0.001). In 1990 an increased cardiovascular mortality was recorded in men different from the trend during 1984-1993, statistically significant in the Czech Republic (p < 0.05) and in the six districts (p < 0.05). The reasons of this trend are not clear. The role of health services in the mortality drop is not clear, although available data indicate their improvement. Favourable changes were found in risk factors: during the period from 1985-1992 the prevalence of hypercholesterolaemia declined significantly in men and women, the prevalence of hypertension in women and the prevalence of smoking in men declined in the six districts. From nationwide data ensues that after 1989 significant changes occurred in the diet of the Czech population. The meat consumption declined by 1993 by 13%, the milk and dairy product consumption by 26.8% the butter consumption by 43.6% the consumption of vegetable fats increased by 16%, of vegetables by 8%, tropical fruit by 43.2%. These changes probably had an impact on the cholesterol level and BMI of the Czech population. CONCLUSIONS: In the declining cardiovascular mortality trend during 1984-1993 the following may have participated: improved medical care, dietary changes, improvement of the risk profile and other, in particular socioeconomic factors. With regard to the close temporal association of the investigated changes it may be assumed that this development is at least partly associated with changes of the political and economic position in the Czech Republic after 1989.

Political changes and trends in cardiovascular risk factors in the Czech Republic, 1985-92.

BACKGROUND: Mortality from cardiovascular diseases is substantially higher in central and eastern Europe than in the west. After the fall of communism, these countries have undergone radical changes in their political, social, and economic environments but little is known about the impact of these changes on health behaviours or risk factors. Data from the Czech Republic, a country whose mortality rates from cardiovascular diseases are among the highest, were analysed in this report. OBJECTIVES: To examine the trends in cardiovascular risk factors in Czech population over the last decade during which a major and sudden change of the political and social system occurred in 1989, and whether the trends differed in relation to age and educational group. DESIGN AND SETTING: Data from three cross sectional surveys conducted in 1985, 1988, and 1992 as a part of the MONICA project were analysed. The surveys examined random samples of men and women aged 25-64 in six Czech districts and measured the following risk factors: smoking, blood pressure, body mass index (BMI), and total and high density lipoprotein (HDL) cholesterol. RESULTS: The numbers of subjects (response rate) examined were 2573 (84%) in 1985, 2769 (87%) in 1988, and 2353 (73%) in 1992. Total cholesterol and body mass index increased between 1985 and 1988 and decreased between 1988 and 1992. The prevalence of smoking was declining slightly in men between 1985 and 1992 but remained stable in women. There were only small changes in blood pressure. The decline in cholesterol and BMI in 1988-92 may be related to changes in foods consumption after the price deregulation in 1991. An improvement in risk profile was more pronounced in younger age groups, and the declines in cholesterol and obesity were substantially larger in men and women with higher education. By contrast, there was an increase in smoking in women educated only to primary level. CONCLUSION: Substantial changes in cholesterol, obesity, and women's smoking occurred in the Czech population after the political changes in 1989. Although a causal association cannot be claimed, national trends in foods consumption are consistent with changes in blood lipids and obesity. Further monitoring of trends is required to confirm these trends.

[Is the recent decrease in cholesterolemia in the Czech Republic convincing evidence?]. / Je nedávný pokles cholesterolémie v Ceské republice prukazný?

BACKGROUND: The objective of the study was to evaluate the 8-year trend of serum cholesterol levels in six districts of the Czech Republic, to assess whether the reduction of mean values of total cholesterol recorded during the period between 1985 and 1992 was convincing and to discuss possible causes and consequences of this development. METHODS AND RESULTS: Three cross-sectional surveys of risk factors were implemented in independent random 1% samples of the population aged 25-64 years. In 1985 1256 men (respondence rate 81.5%) and 1317 women (85%) were examined, In 1988 1357 men (85.2%) and 1412 women (88.4%), in 1992 1142 men (73.2%) and 1211 women (76.7%). A detailed check of the deviations in estimations during different time intervals from reference values provided evidence that the analytical method did not have an impact on the revealed changes. In men the mean total cholesterol level was 6.21 (95% confidence limit 6.14-6.28 mmol/l in 1985; 6.29 (6.23-6.35) mmol/l in 1988; 5.99 (5.91-6.06) mmol/l in 1992. In women the mean value of the total cholesterol level was 6.19 (6.12-6.25) mmol/l in 1985; 6.23 (6.17-6.30) mmol/l in 1988; 5.95 (5.88-6.02) mmol/l in 1992. According to variance analysis (ANOVA) the serum cholesterol in 1992 was lower by 0.22 mmol/l (p < 0.0001) than in 1985 and by 0.28 mmol/l (p < 0.0001) lower than in 1988. The drop of cholesterol between 1988-1992 may have been caused by dietary changes recorded in the population. According to nationwide data after 1990 there was a marked drop of the consumption of meat and meat products, milk and dairy products and animal fats, while the consumption of vegetable fats increased. Despite these dietary improvements, in six districts in 1992 fats accounted for 37% of the energy intake, the P/S ratio was only 0.41 in men and 0.46 in women. In these districts in 1992 and 1993 a decline of the standardized mortality rate from IHD in men was recorded. CONCLUSIONS: During an eight-year period the mean serum cholesterol level of men and women decreased significantly in six districts of the Czech Republic. This change was probably associated with a restricted intake of foods which have an impact on the serum cholesterol level.

[Changes in the cardiovascular risk profile of the population of the Czech Republic--MONICA 1992]. / Zmeny v kardiovaskulárním rizikovém profilu obyvatelstva Ceské republiky--MONIKA 1992.

BACKGROUND: The cardiovascular risk profile of the population in the Czech Republic is unfavourable, the mortality of the population from cardiovascular diseases is among the highest in the world. The objective of the present work was to compare the prevalence of the most serious risk factors in 1988 and 1992 and to find out whether the change of the political and economic system in 1989 had an impact on the risk profile of the population. Within the framework of the international WHO project MONICA independent 1% random population samples, age bracket 25-64 years, were examined in six districts of the Czech Republic. METHODS AND RESULTS: In 1988 1,357 men (response rate 85.5%) and 1,412 women (88.4%) were examined; in 1992 1,139 men (71.2%) and 1,214 women (75.0%) attended the examination. The prevalence of smokers (regular consumption of more than 1 cigarette per day) did not differ significantly in men: 41.8% in 1988, 40.3% in 1992 nor in women: 25.3%-24.1%. Also the prevalence of elevated blood pressure levels (BPs > 21.3 and/or BPd > 12.7 kPa) did not reveal a significant difference neither in men: 19.1%-20.4% nor in women 14.0%-15.0%. The prevalence of hypercholesterolaemia (total cholesterol > 6.5 mmol/l) was in 1992 significantly lower than in 1988--in men by 9% (39.6%-30.6%, p < 0.001) and in women by 6.3% (36.3%-30.0%, p < 0.001). Also in the prevalence of obesity (BMI men > 30, women > 29) a significant drop was recorded in men by 5.2% (23.8%-18.6%, p < 0.01) in women by 5.1% (33.3%-28.2%, p < 0.01). CONCLUSIONS: The probable reason for this partial improvement of the risk profile in 1992, as compared with data in 1988, are dietary changes which may be the result of the introduced market economy and global transformation of society after the political change in 1989.

[Relation between educational level and prevalence of cardiovascular risk factors]. / Vztah mezi vzdeláním a prevalencí kardiovaskulárních rizikových faktoru.

BACKGROUND: Although socioeconomic factors are significant predictors of cardiovascular disease risk, their role has not yet been fully elucidated in our country. The objective of the present work was to find out whether they participate, and to what extent, in cardiovascular diseases. METHODS AND RESULTS: We re-analyzed data assembled during the second cross-sectional survey of the MONICA project in 1988: the investigated population, comprising 1349 men and 1407 women, was divided into four age groups (25-34, 35-44, 45-54 and 55-64 years) and into three groups by the highest achieved education (elementary, secondary and university). The age specific prevalence of cigarette smoking, obesity (expressed as BMI), serum cholesterol and blood pressure reading by level of education was investigated. While in the younger age groups--consistent with observations in western countries--an inverse correlation between education and risk factors predominates, in the older age groups this relationship is reversed. The contrast between groups by attained education is manifested most markedly in smoking (men, trend p < 0.001), obesity (women, trend p < 0.001), total cholesterol (men, women, the difference is, however, not statistically significant), and systolic blood pressure in men (trend p < 0.001). In all these risk factors the profile is more favourable in subjects with a higher (university) education. An exception is the lower HDL cholesterol level (p < 0.001) in women with elementary education (in men a reversed relationship, but not statistically significant). The contrast between younger and older age groups was manifested most markedly in smoking and obesity. CONCLUSIONS: The observation supports the hypothesis that gradually a change of the socioeconomic gradient of cardiovascular diseases is taking place. The results indicate that subjects with lower education in the younger age groups and subjects with higher education in the older age groups are a population with an unfavourable risk profile on which preventive programmes should be focused in the first place.

Genetic markers in hypercholesterolemic and normocholesterolemic Czech children.

The genetic background of polygenic hypercholesterolemia was studied in hypercholesterolemic children consuming a diet identical to control individuals with low cholesterol concentrations. Significantly higher frequencies of "disadvantage" alleles, usually combined with a higher LDL cholesterol, were found in hypercholesterolemic individuals when polymorphisms in apolipoprotein E, apolipoprotein B--XbaI and LDL receptor--PvuII were studied.

Serum selenium in adult Czechoslovak (central Bohemia) population.

The serum selenium levels in 367 healthy adult (25-64 yr) Central Bohemia residents, 176 men and 191 women, were determined using atomic absorption spectrometry. An extremely wide range of values was found in the whole population sample (< 20-296 micrograms/L) as well as in each sex or age category studied. The mean selenium concentration and 95% confidence interval calculated after logarithmic transformation of the data were 74 micrograms/L (71-77) for the whole population sample, 72 micrograms/L (67-76) for men, and 76 micrograms/L (72-81) for women. About 10% of the residents exhibited serum selenium level below 45 micrograms/L. There was no significant correlation between serum selenium and sex, age, or smoking status of participants. However, the lowest average level was found in the group of heavy smoking women: 66 micrograms/L. The selenium status of the Central Bohemia population seems to be below European average. Groups of residents having a very low nutritional selenium intake may be expected to occur in this population.

Normal genetic variation at the low density lipoprotein receptor (LDLR) locus influences cholesterol levels in children.

The population of Czechoslovakia is at high risk of premature atherosclerosis. Normal DNA polymorphism at the low density lipoprotein receptor (LDLR) locus detectable with the restriction enzyme PvuII was analyzed in Czech children with a high or a low concentration of total serum cholesterol. The PvuII restriction site was found significantly more often in the low cholesterol group than in the high cholesterol group. Thus, normal genetic variation at the LDLR locus contributes to the population variation in cholesterol in children in the population studied.

Development of the cardiovascular risk in the population of the Czech Republic.

Population surveys of the major cardiovascular risk factors were conducted in six districts of the Czech Republic in 1988 and 1992 as part of the WHO MONICA Project. One-percent independent random samples of the population aged 25-64 years were examined and investigated; in 1988, the survey included 1357 men and 1412 women (response rates of 85.5% and 88.4%, respectively); 1139 men and 1214 women with the response rate 71.2% and 75.0%, respectively, were enrolled in 1992. Over the four years, the mean levels of diastolic blood pressure rose from 83.8 mmHg to 85.5 mmHg (p < 0.001) in men; the rise in women from 80.7 mmHg to 81.6 mmHg was non-significant. Systolic blood pressure between the two surveys did not differ significantly. Mean total cholesterol levels declined from 6.24 mmol/l to 5.91 mmol/l (p < 0.001) in men and from 6.16 mmol/l to 5.87 mmol/l (p < 0.001) in women. Mean BMI decreased from 27.5 to 26.9 (p < 0.001) in men and from 27.4 to 26.5 (p < 0.001) in women. The authors assume that the significant decreases in cholesterolaemia and BMI may be caused by changes in the dietary pattern resulting from the market economy principles setting in after the 1989 revolution, and by an increased attention of the population to their health in the new socioeconomic conditions. If the trend continues, one might expect a decrease in mortality from IHD. On the other hand, the rise in diastolic blood pressure may be due to deteriorated control of hypertension.

The effect of body fat distribution on cardiovascular risk factors in the population of the Czech Republic.

A study of cardiovascular risk factors including anthropometry was performed as part of the MONICA project in 1988 in the population of six districts of the Czech Republic. In addition to probands' weight and height, the circumferences of waist and hips were measured to calculate the index of body fat distribution given as WHR (wast/hip ratio). In the age group of 25-64 years, WHR was significantly higher in men (0.936) than in women (0.836 - p < 0.001); in either sex, its value rose with increasing age. WHR values were statistically significantly higher in this group than those found in a Finnish population where males aged 25-64 years had a mean WHR value of 0.90 (p < 0.001), and women of the same age group had a mean WHR of 0.78 (p < 0.001). An analysis of the relationship between abdominal obesity and some cardiovascular risk factors revealed significant correlations between WHR and total cholesterol (men: r = 0.112, p < 0.001; women: r = 0.122, p < 0.001), HDL cholesterol (men: r = -0.184, p < 0.001; women = -0.23, p < 0.001); atherogenic index, i.e., total cholesterol/HDL cholesterol (men: r = 0.183, p < 0.001; women: r = 0.345, p < 0.001), systolic blood pressure (men: r = 0.295, p < 0.001; women: r = 0.263, p < 0.001), diastolic blood pressure (men: r = 0.32, p < 0.001; women: r = 0.237, p < 0.001). The closest correlation was demonstrated between WHR and BMI (men: r = 0.525, p < 0.001; women r = 0.345, p < 0.001). The authors believe WHR is an important parameter for cardiovascular risk assessment and should be determined on a routine basis. The frequent prevalence of abdominal obesity, as suggested by the high values of WHR, contributes to the high cardiovascular risk of the population of the Czech Republic.

[Serum lipid and lipoprotein levels in children in relation to their dietary habits and parental blood cholesterol]. / Hladiny sérových lipidu a lipoproteinu u detí ve vztahu k jejich nutricním návykum a k cholesterolémii rodicu.

In a group of 2000 Prague children aged 11-12 years the distribution of serum cholesterol levels was assessed. For further investigations 100 children with cholesterol levels above the 95th percentile (HYPER) were selected and 100 children with values between the 5th and 10th percentile (HYPO). Children and parents were subjected to detailed clinical and laboratory examination, in children the three-day dietary intake was assessed. Boys of the HYPER group had significantly higher LDL, HDL and VLDL cholesterol levels as well as levels of apolipoprotein B and less favourable values of the atherogenic index (AI). Girls of the HYPER group had significantly higher mean values of LDL-cholesterol and apolipoprotein B and also less favourable values of the AI. In the group HYPER children no abnormalities were detected in the carbohydrate metabolism nor a higher incidence of obesity although they differed significantly from children in the HYPO group as regards parameters of the lipid spectrum. The energy value of the consumed diet of children in the HYPER and HYPO group does not differ significantly. Although in boys of the HYPER group there was a higher ratio of total fat and animal fat (p less than 0.05), neither the percentage ratio of fatty acids nor the P:S ratio differed significantly in children of the HYPER and HYPO group. Parents of children of the HYPER group had significantly higher mean cholesterol, apolipoprotein B, LDL cholesterol values and less favourable values of the atherogenic index than parents of children of the HYPO group. The incidence of hypercholesterolaemia in the families of these children was also significantly higher.

Cardiovascular risk factors in the Czech population.

In 1985 and 1988 as part of the WHO's MONICA project two surveys of cardiovascular risk factors were conducted in the population aged 25 to 64 years and resident in the six districts of the Czech Republic collaborating in MONICA. Over a period of three years, the prevalence of smoking decreased from 46% to 41.8% (p less than 0.05) in men. Daily cigarette consumption declined from 17.9 to 15.1 (p less than 0.001) in men and from 11.1 to 10.1 (p less than 0.05) in women. Despite the unchanged prevalence of hypertension during the three years' period the proportion of population with elevated BP levels declined from 22.25% to 19.1% in men (p less than 0.05), and from 16.8% to 14.0% (p less than 0.05) in women as a result of better hypertension control. The prevalence of obesity in men rose from 18.5% to 23.9% (p less than 0.001). The proportion of individuals with a total cholesterol level over 5.2 mmol/l rose from 78.0% to 83.1% (p less than 0.001) in men and from 75.9% to 80.6% in women (p less than 0.01). The changes were favourable only in those risk factors that were actively influenced by the preventive programmes "A Chance for Three Million" in smoking habits, and the "National Programme of Hypertension Control". The authors believe that consistent nationwide preventive programmes might exert a beneficial effect on the profile of risk factors of the whole Czech population.

Cholesterolaemia in school-age children and hypercholesterolaemia aggregation in the family.

The distribution of cholesterol values was established in a group of 2,000 Prague children aged 11-12 years. Of these, 100 children with cholesterol values exceeding the 95th percentile (HYPER), and 100 children with values between the 5th and the 10th percentiles (HYPO) were selected for follow-up. In addition to a thorough clinical and laboratory examination in children and parents, three-day food consumption was registered in children. Even though differing significantly from those assigned to the HYPO group in lipid spectrum parameters, HYPER group children did not show any abnormalities in carbohydrate metabolism or increased incidence of obesity. There is no significant difference in the energy values of food consumed by HYPER and HYPO children. Although a significantly higher proportion (in per cent) of total lipids and animal fat consumption was found in HYPER boys (p less than 0.05), the proportions (in per cent) of fatty acids, and the unsaturated/saturated fatty acid ratio in HYPER and HYPO children did no differ significantly. Parents of HYPER children showed significantly higher mean values of cholesterol, apolipoprotein B, LDL cholesterol and more unfavourable atherogenic index values. Hypercholesterolaemia aggregation in both parents was likewise significantly higher in children assigned to the HYPER group.

[Trends in body weight in the population of the Czech Republic]. / Vývoj telesné hmotnosti v populaci Ceské republiky.

The authors investigated the development of body weight of the population from six districts in the Czech Republic participating in the international WHO project MONICA. The examinations were made within the framework of epidemiological studies of risk factors of IHD in 1985 and 1988 in 1% independent population samples (range 25-64 years). The mean values of body mass index, BMI, increased in the above three-year period in men from 26.9 to 27.5 (p less than 0.001) in women from 26.9 to 27.4 (n. s.). The prevalence of obesity increased during the same period from 19.9% to 25.4% (p less than 0.001) in men and from 33.8% to 35.7% (n. s.) in women. In all decades of men and women there was a rising trend of body weight and increasing prevalence of obesity. With regard to the adverse effects of overweight on health and life span, the authors consider prevention of obesity as one of the foremost tasks of preventive medicine.

[The development of cholesterolemia in the Czech population 1985-1988]. / Vývoj cholesterolémie v populaci CR v období let 1985-1988.

The authors followed up the development of serum cholesterol levels in the population aged 25-64 years in six districts of the CR. These districts collaborate since 1984 in the international WHO programme, MONICA. The mean total cholesterol levels increased during 1985-1988 in men from 6.21 mmol/l to 6.28 mmol/l (ns), in women from 6.18 mmol/l to 6.22 mmol/l (ns). During the same period in the population of the six districts the number of subjects with total cholesterol values of 5.2 mmol/l or less declined from 21.9% to 16.8% (p less than 0.001) in men and from 24.0% to 19.4% in women (p less than 0.01). It is important that the greatest change was recorded in the age group of 25-34 years--in men from 38.7% to 27.7% (p less than 0.01) and in women from 46.6% to 36.7% (p less than 0.05). In the investigated population in 1988 cholesterol levels of 6.5 mmol/l and more were recorded in 39.4% of the men and 36.9% of the women, values of 7.8 mmol/l and more in 10% of the men and 9.6% of the women. If in our population, within the framework of prevention of IHD, recommendations of the European Society for Atherosclerosis will be applied, preventive provisions will be necessary in more than 80% of the adult population.

International differences in developing improvements in cardiovascular health.

The mortality rates for the years 1975-1985 for all causes, cardiovascular disease, coronary heart disease and cerebrovascular diseases obtained from the WHO Data Bank in Geneva were analysed separately for men and women in the age group 30-69 years. Data from 30 industrialised countries were available for the analysis. In most of the countries cardiovascular diseases are still responsible for nearly half the deaths in men. The highest mortality rates, except for coronary heart disease, in the age groups studied are in Eastern Europe. Most countries in this region have also registered an increase in the mortality rates during the last decade. This increase is more pronounced in men than in women. The importance of the WHO MONICA Project (Multinational Monitoring of Cardiovascular Disease and Their Determinants) for interpreting these trends is discussed. Information is provided about another WHO project "The Intensified Programme in Coronary Heart Disease Prevention" in which 27 countries are participating. The aim of this project is to facilitate the national action plans for preventing coronary heart disease and exchanging information on their implementation in different countries.