The Southern European Atlantic diet and all-cause and cause-specific mortality: a European multicohort study.

AIMS: The Southern European Atlantic diet (SEAD) is the traditional dietary pattern of northwestern Spain and northern Portugal, but it may resemble that of central, eastern, and western European countries. The SEAD has been found associated with lower risk of myocardial infarction and mortality in older adults, but it is uncertain whether this association also exists in other European populations and if it is similar as that found in its countries of origin. METHODS AND RESULTS: We conducted a prospective analysis of four cohorts with 35 917 subjects aged 18-96 years: ENRICA (Spain), HAPIEE (Czechia and Poland), and Whitehall II (United Kingdom). The SEAD comprised fresh fish, cod, red meat and pork products, dairy, legumes and vegetables, vegetable soup, potatoes, whole-grain bread, and moderate wine consumption. Associations were adjusted for sociodemographic variables, energy intake, lifestyle, and morbidity. After a median follow-up of 13.6 years (range = 0-15), we recorded 4 973 all-cause, 1 581 cardiovascular, and 1 814 cancer deaths. Higher adherence to the SEAD was associated with lower mortality in the pooled sample. Fully adjusted hazard ratios and 95% confidence interval per 1-standard deviation increment in the SEAD were 0.92 (0.89, 0.95), 0.91 (0.86, 0.96), and 0.94 (0.89, 0.99) for all-cause, cardiovascular, and cancer mortality, respectively. The association of the SEAD with all-cause mortality was not significantly different between countries [Spain = 0.93 (0.88, 0.99), Czechia = 0.94 (0.89,0.99), Poland = 0.89 (0.85, 0.93), United Kingdom = 0.98 (0.89, 1.07); P for interaction = 0.16]. CONCLUSION: The SEAD was associated with lower all-cause, cardiovascular, and cancer mortality in southern, central, eastern, and western European populations. Associations were of similar magnitude as those found for existing healthy dietary patterns.

In this study of 35 917 subjects from southern, central, eastern, and western European countries, the Southern European Atlantic diet (traditional dietary pattern of northwestern Spain and northern Portugal) was associated with lower 13.6-year mortality from any cause, cardiovascular disease, and cancer. The associations of the Southern European Atlantic diet with lower mortality were not significantly different between countries (Spain, Czechia, Poland, and the United Kingdom). Study associations were similar as those found for existing healthy dietary patterns, suggesting that rather different diets could confer comparable benefits on health.

Identifying associations between the social network index, its components, and the prevalence of cardiovascular diseases in Polish adults. Results of the cross-sectional WOBASZ II study.

BACKGROUND: Psychosocial risk factors are important determinants of cardiovascular diseases (CVDs): people involved in positive relationships live longer than those with low social support (SS). AIMS: Our study aimed to evaluate the association between SS, components of the social network, and CVDs. METHODS: A cross-sectional population-based survey WOBASZ II conducted in the years 2013-2014 included a sample of 6043 individuals, aged 20 and over, who completed the Berkman-Syme questionnaire to assess SS using the social network index (SNI). RESULTS: Higher percentage of low SS was observed in women (52.15%) compared to men (45.4%) (P <0.001). People with a low SNI had a worse CVD risk factor profile. None of the analyzed social contacts (with children, relatives, or friends), regardless of how satisfactory they were, was associated with CVDs in men. In women, satisfying contact with children or relatives appeared to be associated with better cardiovascular health. Furthermore, active participation in organized social activity increased the chance of arrhythmia in both sexes: 1.50 (1.04-2.15); P = 0.029 in men; 1.47 (1.11-1.95); P = 0.007 in women. Although a low SNI was associated with analyzed CVDs in the univariate analysis, it was not confirmed in the fully adjusted model. CONCLUSIONS: More women had low SS compared to men. People with low SS had a worse CVD risk factor profile. There was a significant independent relationship between different components of the SNI, such as social contacts and CVDs in women and active participation in organized social activity and arrhythmia in both sexes.

Trajectories in physical functioning at older age in relation to childhood and adulthood SES and social mobility: a population-based cohort study.

Introduction: Older age is associated with the deterioration of physical functioning (PF), and low PF is strongly related to poor quality of life among older people. We conducted a study to examine the trajectories of PF between middle and old age, considering sex differences as well as the association between socioeconomic status (SES) at different life stages and changes in PF. Methods: We analyzed data from the Polish arm of the HAPIEE (Health, Alcohol and Psychosocial factors In Eastern Europe) study, including 1,116 men and 1,178 women aged 45-64 years at baseline. Adult and childhood SES and social mobility were assessed using a retrospectively focused questionnaire. PF was assessed using the 10-question SF-36 scale at baseline examination, face-to-face re-examination, and three postal surveys, covering up to 20 years (on average, 18 years). We employed Generalized Estimating Equations models to assess changes in PF scores over time and compare PF trajectories across different SES categories. Results: After adjusting for age and other covariates, we found that, in both sexes, participants with always middle or high SES, as well as those who reported upward mobility, had higher PF scores at baseline compared to those with always low SES. A decline in PF between middle and old age was observed in all SES groups; however, the decline was slower in participants with always middle or high SES compared to those with always low SES. Conclusion: This cohort study revealed that lower SES and downward social mobility were cross-sectionally associated with poorer PF, while upward social mobility seemed to largely reverse the effect of low childhood SES. In addition to the cross-sectional associations observed at baseline, advantaged SES was also significantly associated with a slower decline in PF over an 18-year follow-up period.

Can spirometry improve the performance of cardiovascular risk model in high-risk Eastern European countries?

Aims: Impaired lung function has been strongly associated with cardiovascular disease (CVD) events. We aimed to assess the additive prognostic value of spirometry indices to the risk estimation of CVD events in Eastern European populations in this study. Methods: We randomly selected 14,061 individuals with a mean age of 59 ± 7.3 years without a previous history of cardiovascular and pulmonary diseases from population registers in the Czechia, Poland, and Lithuania. Predictive values of standardised Z-scores of forced expiratory volume measured in 1 s (FEV1), forced vital capacity (FVC), and FEV1 divided by height cubed (FEV1/ht3) were tested. Cox proportional hazards models were used to estimate hazard ratios (HRs) of CVD events of various spirometry indices over the Framingham Risk Score (FRS) model. The model performance was evaluated using Harrell's C-statistics, likelihood ratio tests, and Bayesian information criterion. Results: All spirometry indices had a strong linear relation with the incidence of CVD events (HR ranged from 1.10 to 1.12 between indices). The model stratified by FEV1/ht3 tertiles had a stronger link with CVD events than FEV1 and FVC. The risk of CVD event for the lowest vs. highest FEV1/ht3 tertile among people with low FRS was higher (HR: 2.35; 95% confidence interval: 1.96-2.81) than among those with high FRS. The addition of spirometry indices showed a small but statistically significant improvement of the FRS model. Conclusions: The addition of spirometry indices might improve the prediction of incident CVD events particularly in the low-risk group. FEV1/ht3 is a more sensitive predictor compared to other spirometry indices.

Prior Diagnosis of Diabetes but Not Its Control is Associated with Higher Depression Score Among Older Individuals.

Purpose: The study assessed the relationship between prior diagnosis of diabetes and its control with depression score, differences in socioeconomic, lifestyle, health characteristics and diabetes control by adherence to treatment in population-based sample of older individuals. Patients and Methods: The analysis of the sub-sample of Polish cohort of the HAPIEE (Health, Alcohol, and Psychosocial Factors in Eastern Europe) study was conducted; 464 participants were interviewed and random first 360 (78%) underwent physical examination and blood sample tests. Depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale. The robust regression method was applied to assess the association between depression score and diabetes diagnosis as well as diabetes control. Results: There were 97 participants (21.0%) at mean age of 73.6 years (SD=6.31 years) with prior diagnosis of diabetes. Mean HbA1c concentration was 6.65% (SD=1.0) The majority of patients (55.7%) used oral medication with diet. Nearly 20% declared the use of oral treatment alone, and 10.3% used combined treatment of oral medications, insulin, and diet. In this study, 86.6% of the participants with diabetes confirmed self-monitoring of blood glucose levels and 58.8% were on high-quality diet. No differences in socioeconomic, lifestyle, health characteristics or control of diabetes by adherence to diabetes treatment were found. After adjustment for age and gender, diagnosis of diabetes was associated with greater depressive score by about 2 points (ß=2.02, 95% CI=0.16;3.88). However, no significant association between depression score and any indicator of diabetes control was found. Conclusion: In older individuals with diabetes, depression score was higher compared to those without diabetes, but it was not related to poorer diabetes control. No differences in socioeconomic, lifestyle, health characteristics and control of diabetes by adherence to diabetes treatment may suggest that in this age group some other, less known factors are substantial for achievement of treatment targets.

The Southern European Atlantic diet and depression risk: a European multicohort study.

The Southern European Atlantic diet (SEAD) is the traditional dietary pattern of north-western Spain and northern Portugal, but it may resemble that of other European countries. The SEAD has been found associated with lower risk for myocardial infarction and mortality. Since dietary patterns may also influence mental health, we examined the association between the SEAD and depression risk in southern, central, eastern, and western European populations. We conducted a prospective analysis of five cohorts (13,297 participants aged 45-92 years, free of depression at baseline): Seniors-ENRICA-1 and Seniors-ENRICA-2 (Spain), HAPIEE (Czechia and Poland), and Whitehall-II (United Kingdom). The SEAD comprised cod, other fresh fish, red meat and pork products, dairy, legumes and vegetables, vegetable soup, potatoes, whole-grain bread, and moderate wine consumption. Depression at follow-up was defined according to presence of depressive symptoms (based on available scales), use of prescribed antidepressants, inpatient admissions, or self-reported diagnosis. Associations were adjusted for sociodemographic, lifestyle, and dietary variables. During a median follow-up of 3.9 years (interquartile range 3.4-4.9), there were 1437 new depression cases. Higher adherence to the SEAD was associated with lower depression risk in the pooled sample. Individual food groups showed a similar tendency, albeit non-significant. The fully adjusted odds ratio (95% confidence interval) per 1-standard deviation increment in the SEAD was 0.91 (0.86, 0.96). This association was rather consistent across countries [Spain = 0.86 (0.75, 0.99), Czechia = 0.86 (0.75, 0.99), Poland = 0.97 (0.89, 1.06), United Kingdom = 0.85 (0.75, 0.97); p for interaction = 0.24], and was of similar magnitude as that found for existing healthy dietary patterns. In conclusion, the SEAD was associated with lower depression risk across European populations. This may support the development of mood disorder guidelines for Southern European Atlantic regions based on their traditional diet, and for central, eastern, and western European populations based on the SEAD food groups that are culturally rooted in these places.

Determinants of body weight changes during COVID-19 pandemic in older urban residents.

INTRODUCTION: COVID­19 pandemic is associated with unfavorable body weight changes. However, little is known about these changes in older individuals, a particularly vulnerable group with limited representation in both direct and online research. OBJECTIVES: The aims of the study were to assess changes in body weight and determinants of thesechanges, and to evaluate the prevalence of COVID­19 history and its impact on the changes in body weight in older individuals. PATIENTS AND METHODS: The analysis included 2076 residents of Kraków, aged 60 to 84 years. Data on sociodemographic factors, lifestyle, history of COVID­19, and changes in body weight were collected in 2021 and 2022 by a postal survey. Multinomial logistic regression analysis was used. RESULTS: COVID­19 tests were performed in 29.3% of the participants, with one­third of them being positive. A total of 14.3% of the participants had any history of COVID­19. Almost two­thirds of the study participants declared no change in their body weight during the pandemic, while 26.2% gained weight. The weight gain was associated with unfavorable sociodemographic and lifestyle conditions. Weight loss was reported by 11.3% of the participants, and it was associated with poor perceived health and a history of COVID­19. After adjusting for covariates, the history of COVID­19 was associated with about 4 times higher odds of weight loss in any case (odds ratio [OR], 2.69; 95% CI, 1.59-4.57 for nonhospitalized, and OR, 18.96; 95% CI, 5.64-63.73 for hospitalized individuals). CONCLUSIONS: Most people with a change in their body weight gained weight due to unfavorable lifestyle modifications, but the history of COVID­19, especially hospitalization, was a strong determinant of body weight loss.

ATHLOS Healthy Aging Scale score as the predictor of all-cause mortality in Poland and Czechia.

Background: The ATHLOS consortium (Aging Trajectories of Health-Longitudinal Opportunities and Synergies) used data from several aging cohorts to develop a novel scale measuring healthy aging comprehensively and globally (ATHLOS Healthy Aging Scale). In the present study, we assessed the predictive performance of the ATHLOS Healthy Aging Scale for all-cause mortality in middle-aged and older adults. Methods: Data from the Polish and Czech HAPIEE (Health Alcohol and Psychosocial factors In Eastern Europe) prospective cohorts were used. There were 10,728 Poles and 8,857 Czechs recruited. The ATHLOS Healthy Aging Scale score was calculated for all participants using data from the baseline examination carried out from 2002 to 2005. The follow-up for all-cause mortality was completed over 14 years. The associations between quintiles of the ATHLOS Healthy Aging Scale and all-cause mortality were estimated using Cox proportional hazards models. Results: A total of 9,922 Polish and 8,518 Czech participants contributed ATHLOS Healthy Aging Scale and mortality data with 1,828 and 1,700 deaths, respectively. After controlling for age, the ATHLOS Healthy Aging Scale score was strongly associated with mortality in a graded fashion for both genders and countries (hazard ratios for lowest vs. highest quintile were 2.98 and 1.96 for Czech and Polish women and 2.83 and 2.66 for Czech and Polish men, respectively). The associations were only modestly attenuated by controlling for education, economic activity, and smoking, and there was further modest attenuation after additional adjustment for self-rated health. Conclusion: The novel ATHLOS Healthy Aging Scale is a good predictor of all-cause mortality in Central European urban populations, suggesting that this comprehensive measure is a useful tool for the assessment of the future health trajectories of older persons.

Treatment goal attainment for secondary prevention in coronary patients with or without diabetes mellitus - Polish multicenter study POLASPIRE.

Introduction: Cardiovascular disease is still a leading cause of death in Poland and across Europe. The aim of this study was to assess the attainment of the main treatment goals for secondary cardiovascular prevention in coronary patients with or without diabetes mellitus (DM) in Poland. Material and methods: The study group included 1026 patients (65.5 ±9 y.o.; males: 72%) included at least 6 months after the index hospitalisation for myocardial infarction, unstable angina, elective percutaneous coronary intervention or coronary artery bypass surgery. The target and treatment goals were defined according to the 2016 European Society of Cardiology guidelines on cardiovascular prevention. Results: Patients with DM (n = 332; 32%) were slightly older compared to non-diabetic (n = 694) individuals (67.2 ±7 vs. 64.6 ±9 years old; p < 0.0001). The DM goal was achieved in 196 patients (60%). The rate of primary (LDL: 51% vs. 35%; p < 0.0001) and secondary (non-HDL: 56% vs. 48%; p < 0.02) goal attainment was higher in DM(+) compared to DM(-) patients. The rate of target blood pressure was lower in DM(+) than in normoglycemic patients (52% vs. 61% at < 140/90 mm Hg, p < 0.01. As expected, goal achievement of normal weight (9.5% vs. 19%; p < 0.0001) and waist circumference (7% vs. 15%; p < 0.001) was lower in diabetic patients and the rate of regular physical activity was similar (DM+ 12% vs. DM- 14%; p = ns). Finally, there was no difference in active smokers (DM+ 23% vs. DM- 22%; p = ns). Conclusions: Great majority of Polish patients in secondary prevention do not achieve treatment goals. Although lipid goals attainment is better in DM and the rate of smokers is similar, the management of all risk factors needs to be improved.

Dietary Antioxidants, Quality of Nutrition and Cardiovascular Characteristics among Omnivores, Flexitarians and Vegetarians in Poland-The Results of Multicenter National Representative Survey WOBASZ.

Several reports have shown that more plant-based dietary patterns provide a higher intake of antioxidants compared to diets rich in meat and animal products. Data on the intake of key nutrients in cardiovascular disease (CVD) prevention in relation to particular diets in countries of Central and Eastern Europe are scarce. The aim of this study was to assess quality of nutrition and CVD characteristics in a representative sample of Polish adults following different dietary patterns. Special regard was paid to the intake of natural antioxidants. The study comprised 13,318 (7159 females) randomly selected adults aged ≥ 20 years participating in the National Multicentre Health Surveys WOBASZ and WOBASZ II. The subjects were categorized into groups of omnivores (92.4%), flexitarians (7.4%) and vegetarians (0.16%) according to type of diet using the Food Frequency Questionnaire and 24 h dietary recall. The obtained results showed that neither flexitarians nor vegetarians represented better dietary habits or lifestyle behaviors compared to omnivores. Flexitarians had significantly lower daily energy intake than omnivores, but their diet was rich in total fat (above 30% of daily energy consumption) and low in fiber. Omnivores declared a higher consumption of fresh vegetables (p < 0.001), fresh fruit (p < 0.01), coffee (p < 0.01) and tea (p < 0.05, in women only) than flexitarians. Omnivores had significantly higher intake of natural antioxidants (vitamin C, E, zinc in both genders and vitamin A in men) as compared with flexitarians. Among women, the highest adherence to the intake of recommended amounts of antioxidant nutrients was noted among omnivores. Among men, vegetarians had the highest proportion of meeting the guidelines for vitamin A (77.8%), E (66.7%) and C (66.7%), while the lowest proportions were found in flexitarians (69.9%, 39.5% and 32.4%, respectively). The groups did not differ in terms of smoking and physical activity level. There were no significant differences in the analyzed CVD characteristics between omnivores and flexitarians. In women, vegetarians had substantially lower BMI than omnivores (p < 0.05) and flexitarians (p < 0.05) and a lower mean serum glucose compared with omnivores (p < 0.01) and flexitarians (p < 0.05). Vegetarians had lower prevalence of hypertension and obesity than meat eaters. In conclusion, the results of the current research showed an inappropriate intake of several nutrients, including highly potent antioxidants, irrespective of the dietary regimen. Flexitarians did not have a more favorable CVD profile than omnivores. Taking into account the growing popularity of diets with reduced animal products, there is a need to elaborate strategies providing Polish adults with guidance regarding properly balanced nutrition.

Is area-level socioeconomic deprivation associated with mortality due to circulatory system diseases in Poland?

BACKGROUND: Socioeconomic deprivation (SED) is known to influence cardiovascular health. However, studies analyzing the relationship between deprivation and circulatory system diseases (CSD) in Central and Eastern Europe are limited. This study aimed to assess the relationship between SED and mortality due to CSD at a population level in 66 sub-regions of Poland. METHODS: The 2010-2014 data regarding mortality and SED components were obtained from the Central Statistical Office. An area-based SED index was calculated based on the higher education rates, employment structure, wages, unemployment, and poverty. The dynamics of changes in mortality due to CSD was expressed by the number of deaths prevented or postponed (DPP) in terciles of the SED index. The associations between the mortality from CSD and SED index were analyzed using multivariate Poisson regression models and generalized estimating equations. RESULTS: Among men, the percentage of DPP in 2014 was 13.1% for CSD, 23.4% for ischemic heart disease (IHD), and 21.4% for cerebrovascular diseases (CeVD). In the case of women, the proportion of DPP was 12.8, 25.6, and 21.6%, respectively. More deprived sub-regions experienced a greater decrease in CSD-related mortality than less deprived sub-regions. The disparity in mortality reduction between more deprived and less deprived sub-regions was even more pronounced for women. After adjusting for smoking prevalence, average BMI, population density, and changes in mortality over time, it was found that the SED index over the 2010-2014 time period was significantly associated with CSD- and IHD-related mortality for men (respectively 5.3 and 19.5% expected mortality increase per 1-unit increase of SED index), and with IHD- and CeVD-related mortality for women (respectively 30.3 and 23.0% expected mortality increase per 1-unit increase of SED index). CONCLUSIONS: Significant differences in mortality changes due to CSD in Poland could be observed in relation to socioeconomic deprivation, resulting in reduced health inequalities. To reduce CSD mortality, more comprehensive preventive measures, including approaches addressing the socioeconomic factors, mainly poverty, education and employment, are needed, particularly in less urbanized areas.

Work stress, overcommitment personality and alcohol consumption based on the Effort-Reward Imbalance model: A population-based cohort study.

Work stress has been extensively supported to predict health outcomes like health behaviors. Evidence has linked work stress and personality independently to health, but the interrelationships between work stress and personality and their joint effects on health might deserve more attention in research. This study attempts to integrate recent developments in psychological research (diverse roles of personality in stress processes) into the well-established Effort-Reward Imbalance (ERI) model for work stress. Based on the ERI model, this population-based cohort study aims to investigate the relationships between work stress, personality and alcohol consumption; it particularly focuses on potential roles of overcommitment (OC) personality in ERI-drinking relations, including modifying, antecedent, mediator or direct effects. This two-wave cohort study was conducted in population samples of 3782 men and 3731 women (aged 45-69 years) from Czech Republic, Poland and Russia. Alcohol consumption was assessed by three drinking outcomes: binge drinking, heavy drinking and problem drinking. To assess modifying effect of OC in ERI-drinking relations, logistic regression was used. To assess antecedent or mediator role of OC in ERI-drinking relations, path analysis with the autoregressive and cross-lagged model was conducted. The results showed that OC had no significantly modifying effect in ERI-drinking relations. OC and ERI might have bidirectional relationships in the average follow-up period of 3.5 years; the effect of OC on ERI was remarkably stronger than the reversed causation. Antecedent role of OC in ERI-drinking relationship was significant, but mediator role of OC was not. In conclusion, our findings imply that "antecedent role" of OC in ERI-drinking relations is significant and promising as a potential target for individual intervention; future interventions are suggested to identify and target potential cognitive-behavioral mechanisms via which personality might influence work stress and subsequently health behaviors.

Socioeconomic position over the life course and impaired lung function of older adults in Central and Eastern Europe: the HAPIEE study.

BACKGROUND: Social differences in lung functioning have been reported, but the role of socioeconomic position (SEP) at different stages of life is less well understood, particularly in Central and Eastern Europe. This study addressed this question. METHODS: The analysis included 10 160 individuals aged 45-70 years from the Czech Republic, Poland and Lithuania. Lung function was either normal if values of forced expiratory volume in the first second divided by forced vital capacity (FEV1/FVC) and FVC were higher than the lower limit of normality or impaired if otherwise. SEP at three stages of life was assessed using maternal education (childhood), participant's education (young adulthood), and current ability to pay for food, clothes and bills (late adulthood). SEP measures were dichotomised as advantaged versus disadvantaged. The associations between impaired lung function and life-course SEP were estimated by logistic regression. RESULTS: Disadvantaged SEP in young and late adulthood had higher odds of impaired lung function. In young adulthood, age-adjusted ORs were 1.26 (95% CI 1.06 to 1.49) in men and 1.56 (95% CI 1.29 to 1.88) in women, while in late adulthood, the ORs were 1.15 (95% CI 0.99 to 1.34) in men and 1.26 (95% CI 1.09 to 1.46) in women. Men and women disadvantaged at all three stages of life had ORs of 1.42 (95% CI 1.06 to 1.91) and 1.83 (95% CI 1.32 to 2.52), respectively, compared with those always advantaged. Smoking substantially attenuated the ORs in men but not in women. CONCLUSION: Reducing socioeconomic inequalities in young and late adulthood may contribute to reducing the risk of impaired lung function in late adulthood.

Changes in Socioeconomic Status as Predictors of Cardiovascular Disease Incidence and Mortality: A 10-Year Follow-Up of a Polish-Population-Based HAPIEE Cohort.

Although the inverse association between socioeconomic status (SES) and cardiovascular disease (CVD) is well established, research on the effect of changes in the SES throughout life on CVD risk in populations with different social backgrounds remains scarce. This study aimed to assess the relationship between childhood SES, adulthood SES, and changes in SES over time, and CVD incidence and mortality in a Polish urban population. In addition, the predictive performance of the SES index was compared with education alone. A cohort study with a 10-year follow-up was conducted, in which a random sample of 10,728 residents in Kraków aged 45-69 years were examined. The SES was assessed at baseline using data on education, parents' education, housing standard at the age of 10 years, professional activity, household amenities, and difficulties in paying bills and buying food. SES categories (low, middle, and high) were extracted using cluster analyses. Information on new CVD cases was obtained from questionnaires in subsequent phases of the study and confirmed by reviewing clinical records. Data on deaths and causes were obtained from the residents' registry, Central Statistical Office, and the participants' families. The effect of the SES index on the risk of CVD was assessed using Cox proportional hazard models. In male and female participants, the CVD incidence and mortality were observed to be 27,703 and 32,956 person-years (384 and 175 new CVD cases) and 36,219 and 40,048 person-years (159 and 92 CVD deaths), respectively. Childhood SES was not associated with CVD incidence and mortality. A protective effect of high adulthood SES against CVD mortality was observed in men and women (HR = 0.59, 95% CI = 0.31-0.97; HR = 0.33, 95% CI = 0.14-0.75, respectively). In women, downward social mobility was related to 2.24 and 3.75 times higher CVD incidence and mortality, respectively. In men, a protective effect against mortality was observed in upward mobility (HR = 0.50, 95% CI = 0.29-0.84). Model discrimination was similar for the SES index and education alone for the association with CVD incidence. In women, the SES index was a slightly better predictor of CVD mortality than education alone (C-index = 0.759, SE = 0.0282 vs. C-index = 0.783, SE = 0.0272; p = 0.041). In conclusion, high adulthood SES, but not childhood SES, may be considered to be a protective factor against CVD in urban populations in high-CVD-risk regions. No effects of critical periods in early life were observed on CVD risk. In later life, social mobility was found to affect CVD mortality in both men and women. In men, a protective effect of upward mobility was confirmed, whereas in women, an increased CVD risk was related to downward mobility. It can be concluded that CVD prevention may be beneficial if socioeconomic potentials are strengthened in later life.

Trajectories of Blood Pressure in Patients with Established Coronary Artery Disease over 20 years.

Objective: To evaluate changes in blood pressure (BP) values in patients with established coronary artery disease (CAD) over 20 years (1997-2017). Materials and Methods: Consecutive patients aged <71 years and hospitalized for acute coronary syndrome or myocardial revascularization procedures were recruited and interviewed 6-18 months after their discharge from the hospital. BP was measured in 1997-1998, 1999-2000, 2006-2007, 2011-2013, and 2016-2017. The same five hospitals took part in the surveys at each time point. Results: We examined 412 patients in 1997-1998, 427 in 1999-2000, 422 in 2006-2007, 462 in 2011-2013, and 272 in 2016-2017. The proportion of patients with BP at the recommended goal was 49.2% in 1997-98, 44.5% in 1999-2000, 44.7% in 2006-07, 51.1% in 2011-13, and 58.8% in 2016-17 (p < 0.001). Mean systolic and diastolic BP decreased significantly independent of age, sex, and education (systolic BP: 137.9 ± 21.4 mmHg in 1997-98, 139.5 ± 21.6 mmHg in 1999-2000, 136.1 ± 20.3 mmHg in 2006-07, 134.8 ± 22.0 mmHg in 2011-13, and 134.2 ± 18.6 mmHg in 2016-17, p < 0.001; diastolic BP: 83.4 ± 11.0 mmHg in 1997-98, 84.8 ± 12.0 mmHg in 1999-2000, 85.2 ± 11.0 mmHg in 2006-07, 80.9 ± 12.5 mmHg in 2011-13, and 81.1 ± 10.4 mmHg in 2016-17; p < 0.001). Conclusion: The analysis of five multicenter surveys provides evidence of a decrease in BP in patients with established CAD over two decades. This trend is independent of age, sex, and the education level of the patients.

All-cause and cardiovascular mortality in relation to lung function in the full range of distribution across four Eastern European cohorts.

It is unclear whether the dose-response relationship between lung function and all-cause and cardiovascular mortality in the Central and Eastern European populations differ from that reported in the Western European and American populations. We used the prospective population-based HAPIEE cohort that includes randomly selected people with a mean age of 59 ± 7.3 years from population registers in Czech, Polish, Russian and Lithuanian urban centres. The baseline survey in 2002-2005 included 36,106 persons of whom 24,944 met the inclusion criteria. Cox proportional hazards models were used to estimate the dose-response relationship between lung function defined as FEV1 divided by height cubed and all-cause and cardiovascular mortality over 11-16 years of follow-up. Mortality rate increased in a dose-response manner from highest to lower FEV1/height3 deciles. Adjusted hazard ratios (HR) of all-cause mortality for persons in the 8th best, the 5th and the worst deciles were 1.27 (95% CI 1.08‒1.49), 1.37 (1.18-1.60) and 2.15 (1.86‒2.48), respectively; for cardiovascular mortality, the respective HRs were 1.84 (1.29-2.63), 2.35 (1.67-3.28) and 3.46 (2.50‒4.78). Patterns were similar across countries, with some statistically insignificant variation. FEV1/height3 is a strong predictor of all-cause and cardiovascular mortality, across full distribution of values, including persons with preserved lung function.

Relationship between Dietary Macronutrients Intake and the ATHLOS Healthy Ageing Scale: Results from the Polish Arm of the HAPIEE Study.

BACKGROUND: Despite extensive research, our knowledge on the relationship between nutrition and healthy ageing is limited. The aim of this study was to evaluate the associations between the intake of macronutrients and a single measure of healthy ageing (ATHLOS Healthy Ageing Scale). METHODS: A cross-sectional analysis was performed using data from 9906 randomly selected citizens of Krakow (Poland) who were 45-69 years of age and participants of the Health, Alcohol and Psychosocial factors in Eastern Europe (HAPIEE) study. Macronutrient intake was evaluated using a food frequency questionnaire. ATHLOS Health Ageing Scale was estimated from 41 variables in pooled data from 16 cohorts. Standardized beta coefficients were estimated using multivariable linear regression models. RESULTS: In multivariable adjusted models, there were significant positive associations between the ATHLOS Healthy Ageing Scale score and intake of protein (b = 0.030, 95% CI 0.001; 0.059 in men; b = 0.056, 95% CI 0.027; 0.085 in women), monounsaturated fatty acids (MUFA) (b = 0.042, 95% CI 0.013; 0.071 in men; b = 0.035, 95% CI 0.006; 0.064 in women), polyunsaturated fatty acids (PUFA) (b = 0.053, 95% CI 0.024; 0.082 in men; b = 0.063, 95% CI 0.034; 0.092 in women), and omega-3 PUFA (b = 0.031, 95% CI 0.002;0.060 in men; b = 0.054, 95% CI 0.026; 0.082 in women). Carbohydrate intake was inversely associated with the ATHLOS Healthy Ageing Scale in women. Total fat intake was positively associated with the ATHLOS Healthy Ageing Scale in men. CONCLUSIONS: A number of nutrients were associated with the healthy ageing score, suggesting that dietary habits may play an important role in healthy ageing. Further research in other settings and with a prospective design is strongly warranted.

Impaired lung function and mortality in Eastern Europe: results from multi-centre cohort study.

BACKGROUND: The association between impaired lung function and mortality has been well documented in the general population of Western European countries. We assessed the risk of death associated with reduced spirometry indices among people from four Central and Eastern European countries. METHODS: This prospective population-based cohort includes men and women aged 45-69 years, residents in urban settlements in Czech Republic, Poland, Russia and Lithuania, randomly selected from population registers. The baseline survey in 2002-2005 included 36,106 persons of whom 24,993 met the inclusion criteria. Cox proportional hazards models were used to estimate the hazard ratios of mortality over 11-16 years of follow-up for mild, moderate, moderate-severe and very severe lung function impairment categories. RESULTS: After adjusting for covariates, mild (hazard ratio (HR): 1.25; 95% CI 1.15‒1.37) to severe (HR: 3.35; 95% CI 2.62‒4.27) reduction in FEV1 was associated with an increased risk of death according to degree of lung impairment, compared to people with normal lung function. The association was only slightly attenuated but remained significant after exclusion of smokers and participants with previous history of respiratory diseases. The HRs varied between countries but not statistically significant; the highest excess risk among persons with more severe impairment was seen in Poland (HR: 4.28, 95% CI 2.14‒8.56) and Lithuania (HR: 4.07, 95% CI 2.21‒7.50). CONCLUSIONS: Reduced FEV1 is an independent predictor of all-cause mortality, with risk increasing with the degree of lung function impairment and some country-specific variation between the cohorts.