Associations between Neck Circumference, Mid-Upper Arm Circumference, Wrist Circumference, and High Blood Pressure among Lithuanian Children and Adolescents: A Cross-Sectional Study.

(1) Background: High blood pressure (HBP) and obesity are significant and growing public health issues worldwide. Our study aimed to evaluate the associations of neck circumference (NC), mid-upper arm circumference (MUAC), and wrist circumference (WrC) with HBP among Lithuanian children and adolescents aged 7-17 years. (2) Methods: In this cross-sectional study, data on BP and anthropometric measurements were analysed in 3688 children and adolescents aged 7-17 years. Multivariate logistic regression analysis was used to estimate the associations between anthropometric indices and HBP. (3) Results: Overall, the prevalence rates of elevated BP and hypertension were 13.7% and 12.9%, respectively. After adjustment for age, BMI, and WC, statistically significant elevated aORs were observed for associations between greater NC, MUAC, WrC, and HBP in boys (aORs: 2.13, 2.46, and 2.48, respectively) and in girls (aORs: 2.01, 2.36, and 2.09, respectively). Moreover, per-unit increase in NC, MUAC, and WrC was also associated with greater odds of HBP in boys (aORs: 1.20, 1.21, and 1.37, respectively) and in girls (aORs: 1.10, 1.10, and 1.21, respectively). The analysed anthropometric indices presented higher area under the curve values for predicting HBP in boys than in girls. (4) Conclusions: This study suggests that higher NC, MUAC, and WrC are associated with increased odds of HBP in Lithuanian children and adolescents.

Associations between tri-ponderal mass index, body mass index, and high blood pressure among children and adolescents: a cross-sectional study.

High blood pressure (HBP) and obesity are major public health issues globally. The aim of the study was to evaluate the associations between tri-ponderal mass index (TMI) and body mass index (BMI) and HBP and to determine which anthropometric parameters may best predict HBP among Lithuanian children and adolescents aged 7-18 years. This cross-sectional study included 3710 Lithuanian children and adolescents aged 7-18 (52.7% boys and 47.3% girls). Each subject's height, weight, and other anthropometric parameters, as well as blood pressure were measured according to standardized protocols; subsequently, TMI and BMI were calculated. The prevalence of HBP was 27% (the prevalence of elevated BP and hypertension was 13.7% and 13.3%, respectively), significantly higher for boys than for girls. The Pearson correlation coefficients between the BMI z-score and BP were higher than those between the TMI z-score and BP. In both sexes combined, the adjusted odds ratios (aOR) for HBP were increased significantly with increasing quartiles of TMI and BMI as compared to the first quartile (Q1) (Q2: aOR = 1.37 and aOR = 1.69; Q3: aOR = 2.10 and aOR = 2.27; Q4: aOR = 3.95 and aOR = 4.91, respectively). Significant associations also were observed between overweight and obesity (defined according to two methods: age- and sex-specific TMI percentiles and IOTF criteria) among boys and girls separately. BMI presented a higher area under the curve value than TMI for predicting HBP in children and adolescents. The findings of the study suggest that BMI and TMI are significantly associated with HBP. However, BMI is a better predictor for HBP than TMI among Lithuanian children and adolescents aged 7-18 years.

Associations of maternal gestational hypertension with high blood pressure and overweight/obesity in their adolescent offspring: a retrospective cohort study.

Maternal hypertensive disorders during pregnancy may have an impact on fetal development and the health of the offspring in later life. The aim of the study was to evaluate the associations of maternal gestational hypertension (GH) with high blood pressure (HBP) (prehypertension/hypertension) and overweight/obesity in their adolescent offspring at the age of 12 to 15 years. We analyzed data of 4819 participants born in Kaunas city during 1995-1998 who were included in the study "Prevalence and Risk Factors of HBP in 12-15-Year-Old Lithuanian Children and Adolescents". The diagnosis of maternal gestational hypertension was obtained from medical records. Associations of maternal GH with their offspring's HBP and overweight/obesity in adolescence were assessed by multivariate logistic regression analysis. Among 4819 adolescents of 12-15 years of age, 25.7% had HBP, 12% had overweight, and 2.5% had obesity. Of 4819 mothers, 92.3% were normotensive during pregnancy, and 7.7% had GH. In the multivariate analysis after adjustment for age, sex, birth weight, adolescent BMI, and maternal pre/early pregnancy BMI, adolescent offspring born to mothers with GH had higher odds of prehypertension, hypertension, and prehypertension/hypertension (aOR 1.58; 95% CI 1.13-2.22; aOR 1.87; 95% CI 1.41-2.47; and aOR 1.76, 95% CI 1.39-2.24; respectively), compared to the offspring of normotensive mothers. After adjustment for age, sex, birth weight, and maternal pre/early pregnancy BMI, a significant association was found between maternal GH and the offspring's overweight/obesity in adolescence (aOR 1.41; 95% CI 1.04-1.91). The findings of this study suggest that maternal GH is associated with an increased odds of HBP (prehypertension and hypertension, both separately and combined) and overweight/obesity in their offspring during adolescence.

Associations between body mass index, waist circumference, waist-to-height ratio, and high blood pressure among adolescents: a cross-sectional study.

The purpose of the present study was to examine the associations between body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), and high blood pressure (HBP), and to determine which anthropometric parameters can best predict HBP among Lithuanian adolescents aged 12-15 years. Data from the survey of "Prevalence and Risk Factors of HBP in 12-15-Year-Old Lithuanian Children and Adolescents (Study 1, 2010-2012)" were used; a total of 7,457 respondents (3,494 boys and 3,963 girls) were included in this analysis. Adolescents with BP above the 90th percentile were measured on two different occasions. Logistic regression analysis was used to assess the associations and to calculate odds ratios. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive ability of the three anthropometric parameters to predict HBP. The adjusted odds ratios (aOR) in the highest quartiles of BMI, WC, and WHtR were statistically significant for both sexes separately (reference group - the first quartile): in boys, prehypertension - 4.91, 4.09, and 1.59; hypertension - 7.96, 6.44, and 2.81; and prehypertension/hypertension - 6.85, 5.65, and 2.37, respectively; and in girls, prehypertension - 3.42, 2.70, and 1.66; hypertension - 5.71, 3.54, and 2.90; and prehypertension/hypertension - 4.62, 3.17, and 2.31, respectively). According to the analyses of the ROC curve, BMI z-score provided the largest area under the curve (AUC) value, followed by WC z-score, while WHtR z-score showed the lowest AUC value in predicting elevated BP in both sexes separately. Among Lithuanian adolescents aged 12-15 years, both anthropometric indices - BMI and WC (but particularly BMI) - showed stronger associations with HBP and were better for the prediction of HBP, compared to WHtR.

Associations of the adrenomedullin gene polymorphism with prehypertension and hypertension in Lithuanian children and adolescents: a cross-sectional study.

The aim of this study was to evaluate the association of ADM genetic variant and HBP among Lithuanian adolescents aged 12-15 years. This is a cross-sectional study of a randomly selected sample of 675 12-15-years-old schoolchildren who were surveyed during November 2010 to April 2012 in the baseline survey. Single-nucleotide polymorphism (SNP) of ADM gene (rs7129220) was evaluated using real-time PCR. Logistic regression analyses were used to test the associations of ADM (rs7129220) polymorphism with HBP under four inheritance models based on the Akaike Information Criterion (AIC) and to calculate the odds ratios. In the multivariate analysis, boys carrying ADM AG genotype (vs. carriers of ADM GG genotype), ADM AG + AA genotype (vs. carriers of ADM GG genotype) and ADM AG genotype (vs. carriers of ADM GG + AA genotype) had higher odds of having hypertension in codominant, dominant, and overdominant inheritance models. Girls with ADM AG + AA had increased odds of prehypertension compared to girls with the ADM GG genotype carriers in dominant inheritance model. Significant associations were observed in additive models separately for boys (hypertension) and girls (prehypertension). Our results indicate that ADM gene polymorphism was significantly associated with higher odds of HBP in Lithuanian adolescents aged 12-15 years.

Association between ATP2B1 and CACNB2 polymorphisms and high blood pressure in a population of Lithuanian children and adolescents: a cross-sectional study.

OBJECTIVES: Recently, genome-wide associated studies have identified several genetic loci that are associated with elevated blood pressure and could play a critical role in intracellular calcium homeostasis. The aim of this study was to assess the associations of ATP2B1 rs2681472 and CACNB2 rs12258967 gene polymorphisms with high blood pressure (HBP) among Lithuanian children and adolescents aged 12-15 years. STUDY DESIGN AND PARTICIPANTS: This was a cross-sectional study of a randomly selected sample of 646 12-15-year-old adolescents who participated in the survey 'The Prevalence and Risk Factors of HBP in 12-15 Year-Old Lithuanian Children and Adolescents (from November 2010 to April 2012)'. Anthropometric parameters and BP were measured. The participants with HBP were screened on two separate occasions. Subjects were genotyped ATP2B1 rs2681472 and CACNB2 rs12258967 gene polymorphisms using real-time PCR method. RESULTS: The prevalence of HBP was 36.7%, significantly higher for boys than for girls. In the multivariate analysis, after adjustment for body mass index and waist circumference, boys with CACNB2 CG genotype, CACNB2 GG genotype and CACNB2 CG +GG genotype had higher odds of having HBP in codominant (adjusted OR (aOR)=1.92; 95% CI 1.16 to 3.18, p=0.011; and aOR=2.64; 95% CI 1.19 to 5.90, p=0.018) and in dominant (aOR=2.05; 95% CI 1.27 to 3.30, p=0.003) inheritance models. Girls carrying CACNB2 CG genotype and CACNB2 CG +GG genotype had increased odds of HBP in codominant (aOR=1.82; 95% CI 1.02 to 3.24, p=0.044) and in dominant (aOR=1.89; 95% CI 1.09 to 3.28, p=0.023) inheritance models. Furthermore, significant associations were found in additive models separately for boys (aOR=1.72; 95% CI 1.20 to 2.46, p=0.003) and girls (aOR=1.52; 95% CI 1.05 to 2.20, p=0.027). No significant association was found between ATP2B1 gene polymorphism and the odds of HBP. CONCLUSIONS: Our results indicate that CACNB2 gene polymorphism was significantly associated with higher odds of HBP in Lithuanian adolescents aged 12-15 years.

Associations between high birth weight, being large for gestational age, and high blood pressure among adolescents: a cross-sectional study.

PURPOSE: Low birth weight and being small for gestational age are associated with increased risk of cardiometabolic diseases. However, the results from the studies examining the associations between high birth weight (HBW), being large for gestational age (LGA), and high blood pressure (HBP) are inconsistent. The aim of this study was to evaluate the associations between HBW and being LGA alone and in combinations with body mass index (BMI) categories in adolescence and HBP among Lithuanian adolescents aged 12-15 years. METHODS: The participants with HBP (≥90th percentile) were screened on two separate occasions. Data on the BMI, birth weight (BW), gestational age, and BP were analyzed in 4598 adolescents. Adjusted odds ratios (aORs) with 95% confidence intervals (CI) for the associations were estimated using multivariate logistic regression models. RESULTS: The overall prevalence of HBW (>4000 g), being LGA, adolescent overweight/obesity, and HBP were 13.9, 10.4, 14.5, and 25.6%, respectively. After adjustment for age, sex, and BMI, significant positive associations were found between HBW and being LGA and HBP (HBW: aOR 1.34; 95% CI, 1.11-1.63; LGA: aOR 1.44; 95% CI, 1.16-1.79). After adjustment for age and sex and compared to BW 2500-4000 g and being AGA (appropriate for gestational age) with normal weight in adolescence, the combinations that included both risk factors-HBW with overweight/obesity and being LGA with overweight/obesity-showed higher aORs (aOR 4.36; 95% CI, 3.04-6.26; and aOR 5.03; 95% CI, 3.33-7.60, respectively) than those with either of these risk factors alone did. CONCLUSIONS: HBW and being LGA were positively associated with HBP in Lithuanian adolescents aged 12-15 years. The highest odds of having HBP were observed for subjects with both risk factors-neonatal HBW or being LGA and overweight/obesity in adolescence.

Renin-angiotensin system gene polymorphisms and high blood pressure in Lithuanian children and adolescents.

BACKGROUND: Epidemiological studies have demonstrated the influence of environmental factors on HBP in the population of Lithuanian children, although the role of genetic factors in hypertension has not yet been studied. The aim of this study was to assess the distribution of AGTR1, AGT, and ACE genotypes in the Lithuanian child population and to determine whether these genotypes have an impact on HBP in childhood. METHODS: This cross-sectional study enrolled 709 participants aged 12-15 years. The subjects were genotyped for AGT (M235 T, rs699), AGTR1 (A1166C, rs5186), and ACE (rs4340) gene polymorphisms using real-time and conventional polymerase chain reactions. Blood pressure and anthropometric parameters were measured. RESULTS: The prevalence of HBP was 38.6% and was more frequently detected in boys than in girls (47.9% vs. 29.5%; p < 0.001). No significant differences in the frequencies of the AGT or AGTR1 genotypes or alleles between boys and girls were observed, except for ACE genotypes. The mean SBP value was higher in HBP subjects with ACE ID genotype compared to those with ACE II homozygotes (p = 0.04). No significant differences in BP between different AGT and AGTR1 genotype groups were found. Boys who carried the ACE ID + DD genotypes had higher odds of having HBP than carriers of the ACE II genotype did (controlling for the body mass index (BMI): ORMH = 1.83; 95% CI, 1.11-3.02, p = 0.024; and controlling for waist circumference (WC): ORMH = 1.76; 95% CI, 1.07-2.92, p = 0.035). These associations were not significant among girls. The same trend was observed in the multivariate analysis - after adjustment for BMI and WC, only boys with ACE ID genotype and ACE ID + DD genotypes had statistically significantly increased odds of HBP (aOR = 2.05; 95% CI, 1.19-3.53 (p = 0.01) and aOR = 1.82; 95% CI, 1.09-3.04 (p = 0.022), respectively). CONCLUSIONS: The evaluated polymorphisms of the AGT and AGTR1 genes did not contribute to the presence of HBP in the present study and may be seen as predisposing factors, while ACE ID genotypes were associated with significantly increased odds for the development of HBP in the Lithuanian child and adolescent population - especially in boys.

Association of neck circumference and high blood pressure in children and adolescents: a case-control study.

BACKGROUND: High blood pressure (BP) is a serious, common and growing global public health problem. The aim of this study was to evaluate the associations between high NC (neck circumference) alone and in combinations with BMI (body mass index), WC (waist circumference), and high BP among Lithuanian children and adolescents aged 12 to 15 years. METHODS: An epidemiological case-control study was performed between May 2012 and November 2013. NC, WC, hip circumference (HC), mid-upper arm circumference (MUAC), body height, weight, and BP were measured. The participants with high BP (≥ 90th percentile) were screened on two separate occasions. Data on NC, WC, HC, MUAC, BMI, body adiposity index (BAI), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), and BP were analyzed in 1947 children and adolescents aged 12-15 years. Age- and sex-adjusted odds ratios (aORs) with 95% confidence intervals (CI) for the associations were estimated using multivariate logistic regression models. RESULTS: The prevalence rates of prehypertension (BP ≥ 90th- < 95th percentile) and hypertension (BP ≥ 95th percentile) was 6.3 and 25.1%, respectively. The overall prevalence of high NC (if NC was in the ≥ 90th percentile), overweight/obesity (as measured by BMI), and abdominal overweight/obesity (if WC was in the ≥ 75th percentile) were 14.3, 15.8, and 13%, respectively. After adjustment for age and sex, NC in the ≥ 90th percentile was significantly associated with an increased risk of elevated BP (prehypertension: aOR = 2.99; 95% CI, 1.88-4.77; hypertension aOR = 4.05; 95% CI, 3.03-5.41, and prehypertension/hypertension aOR = 3.75; 95% CI, 2.86-4.91), compared to the participants with NC in the <90th percentile. Overweight/obesity and abdominal overweight/obesity were also significantly associated with an elevated BP. The combinations including both risk factors (high NC with overweight/obesity, and high NC with abdominal overweight/obesity) showed higher aORs than those with either risk factor alone. CONCLUSIONS: High NC alone-but particularly in combinations with overweight/obesity and abdominal overweight/obesity-was associated with an increased risk of high BP.

Association between obesity and high blood pressure among Lithuanian adolescents: a cross-sectional study.

BACKGROUND: Most epidemiological studies have shown that the prevalence of high blood pressure (BP) has significantly increased among children and adolescents in various countries of the world. The aim of this study was to examine the associations between overweight, obesity, abdominal obesity and prehypertension and hypertension among Lithuanian adolescents aged 12-15 years. METHODS: The subjects with increased BP (≥90th percentile) were screened on two separate occasions. Data on the body mass index (BMI), waist circumference (WC), and BP were analysed in 7,457 adolescents aged 12-15 years. Adjusted odds ratios (aORs) with 95% confidence intervals (CI) for the associations were estimated using multivariate logistic regression models. RESULTS: After two screenings, the study participants were categorised as prehypertensive (12.8%), hypertensive (22.2%), and normotensive (65%). The overall prevalence of overweight, obesity, and abdominal obesity (if WC was in the ≥75th percentile) were 12.1%, 2.4%, and 9%, respectively. After adjusting for age and sex, significant associations were found between overweight and obesity and high BP, namely, prehypertension (overweight: aOR = 2.62; 95% CI 2.13-3.23; obesity: aOR = 4.81; 95% CI 3.08-7.52) and hypertension (overweight: aOR = 3.56; 95% CI 3.02-4.19; obesity: aOR = 6.64; 95% CI 4.65-9.49). Prehypertension was found to be significantly associated with WC in the 75th- < 90th percentiles (aOR = 3.16; 95% CI 2.43-4.10) and WC in the ≥90th percentile (aOR = 4.08; 95% CI 2.35-7.10). For hypertension, significant associations were detected with WC in the 75th- < 90th percentiles (aOR = 3.92; 95% CI 3.18-4.82) and WC in the ≥90th percentile (aOR = 7.41; 95% CI 4.97-11.05). CONCLUSIONS: Overweight, obesity, and abdominal obesity were associated with prehypertension and hypertension.

Associations of short sleep duration with prehypertension and hypertension among Lithuanian children and adolescents: a cross-sectional study.

BACKGROUND: Recent epidemiological studies have found that the prevalence of high blood pressure (BP) has significantly increased among children and adolescents. The aim of this study was to examine the associations between short sleep duration and prehypertension and hypertension in Lithuanian children and adolescents aged 12 to 15 years. METHODS: A cross-sectional study was conducted from November 2010 to April 2012. The participants with high BP (≥90th percentile) were screened on two separate occasions. Self-reported sleep duration was evaluated using questionnaires. Data on 6,940 subjects aged 12-15 years were analyzed. Adjusted odds ratios (aORs) with 95% confidence intervals for the associations were estimated using multivariate logistic regression models. Short sleep duration was defined as <8 hours per day (h/day). RESULTS: The prevalence of prehypertension and hypertension in the current sample was 12.6% and 22.5%, respectively. The percentages of the subjects with sleep durations of <7 (h/day), 7-<8 h/day, and ≥8 h/day were 8.7%, 21.0%, and 70.3%, respectively. After adjusting for age, sex, body mass index, physical activity, and smoking, significant associations were found between short sleep duration and high BP, including prehypertension (7-<8 h/day: aOR=1.77; 95% CI, 1.48-2.12; <7 h/day: aOR=2.18; 95% CI, 1.70-2.79) and hypertension (7-<8 h/day: aOR=1.99; 95% CI, 1.72-2.31; <7 h/day: aOR=2.28; 95% CI, 1.85-2.80) (all P values<0.001), compared to participants who were sleeping longer (≥8 h/day). CONCLUSIONS: Prehypertension and hypertension were associated with short sleep duration among Lithuanian children and adolescents aged 12 to 15 years.

Parental cigarette smoking and the risk of congenital heart septal defects.

UNLABELLED: The objective of this study was to determine the association between parental cigarette smoking and the risk of congenital heart septal defects in Kaunas infant population in 1995-2005. MATERIAL AND METHODS: An epidemiological case-control study was conducted. The study comprised 261 newborns with congenital heart septal defects (cases) and 1122 randomly selected newborns without any defects (controls), born in Kaunas city during 1995-2005. Information on potential risk factors of newborns' health was collected through an interview with parents using standardized questionnaires. Multivariate logistic regression analysis was used to assess the association between parental smoking and septal defects while controlling for possible confounders. RESULTS: According to the validated registry, 371 newborns with congenital heart malformations were born in Kaunas city during 1995-2005; 70.3% of cases had ventricular and/or atrial septal defects. After adjustment for possible confounding factors - maternal education, social status, marital status - a statistically significant relationship was observed between parental smoking and congenital heart septal defects. Parental, maternal, and paternal smoking was significantly associated with a 2.27-fold (adjusted OR=2.27; 95% CI, 1.49-3.46), 2.2-fold (adjusted OR=2.20; 95% CI, 1.01-4.79), and 1.45-fold (adjusted OR=1.45; 95% CI, 1.03-2.03) increased risk of defects if compared with nonsmoking parents. CONCLUSIONS: According to the results of our study, parental smoking was significantly associated with an increased risk of congenital heart septal defects in infants.

Maternal socioeconomic and lifestyle factors during pregnancy and the risk of congenital heart defects.

UNLABELLED: The objective of study was to estimate the importance of maternal socioeconomic and lifestyle factors during pregnancy in the risk of congenital heart defects in Kaunas infant population in 1999-2005. MATERIAL AND METHODS: An epidemiological case-control study was conducted. The study comprised 187 newborns with congenital heart defects (cases) and 643 randomly selected newborns without any defects (controls), born in Kaunas city during 1999-2005. Modern epidemiological methods were used for data analysis. A multivariate logistic regression was used to determine adjusted risk factors of congenital heart defects. RESULTS: The logistic multivariate regression analysis showed that low and moderate maternal education significantly increased the risk of congenital heart defects (primary or basic [OR=3.43; 95% CI, 1.54-7.64] and secondary [OR=1.56; 95% CI, 1.00-2.45] vs advanced vocational or higher education). The housewives and workers had a higher risk of delivering a newborn with congenital heart defects than the office workers (OR=2.34; 95% CI, 1.34-4.10 and OR=1.28; 95% CI, 0.79-2.07, respectively). Maternal smoking during pregnancy tended to increase the risk of congenital heart defects by 48% (OR=1.48; 95% CI, 0.82-2.67). CONCLUSIONS: According to our study results, unfavorable maternal socioeconomic factors and smoking during pregnancy increased the risk of congenital heart defects.

[The incidence and diagnostics of congenital heart defects in Kaunas infant population during 1999-2005]. / Igimtu sirdies ydu paplitimas ir diagnostika Kauno vaiku populiacijoje 1999-2005 m.

UNLABELLED: The objective of this study was to determinate the incidence and diagnostics of congenital heart defects in Kaunas infant population in 1999-2005 and to compare the data obtained with the data of years 1995-1998. SUBJECT AND METHODS: The study population comprised all newborns born in Kaunas city during 1999-2005. Congenital heart defects were registered based on clinical diagnosis after its verification using the data from consulting centers and pediatric outpatient departments. To assess the incidence of congenital heart malformations in newborn population, we conducted a validated newborn register based on maternal residential district. Modern epidemiological methods were used for data analysis. RESULTS: In 1999-2005, there were 24 069 live births in Kaunas: 2231 newborns were born with congenital anomalies, 198 had congenital heart malformations. The incidence of congenital heart defects was 8.2 per 1000 live newborns. The majority of congenital heart malformations were diagnosed in delivery units (93.94%). We have analyzed the relationship between birth weight and gestational age of newborns with congenital heart malformations. Newborns with low birth weight were at significantly higher risk of congenital heart malformation than newborns with normal birth weight (OR=3.52, 95% CI, 2.25-5.47). Our data also showed that newborns born before 32 weeks of gestation had a 5-fold increased risk of congenital heart malformation (OR=5.20; 95% CI, 2.50-10.84) and infants born before 37 weeks of gestation had a 4-fold increased risk (OR=4.08; 95% CI, 2.68-6.19) compared with newborns born after 37 weeks of gestation. CONCLUSIONS: This study shows that incidence of congenital heart anomalies in Kaunas newborn population was 8.2 cases per 1000 live newborns in 1999-2005. It was determined that during 1999-2005, the number of above-mentioned anomalies diagnosed in delivery units increased by 23%.

Selected environmental risk factors and congenital heart defects.

The aim of the article is to review the published scientific literature and epidemiological studies about the effect of selected environmental risk factors on congenital heart defects in infants. According to recent reports, the prevalence of congenital heart defects is around 1% of live births. Congenital heart malformations are the leading cause of infant mortality. Unfortunately, the majority of the causes of heart defects remain unknown. These malformations are caused by interaction of genetic and environmental factors. The article reviews selected environmental risk factors: maternal illnesses and conditions associated with metabolic disorder (maternal diabetes, obesity, phenylketonuria), maternal lifestyle factors (alcohol use, smoking), which may increase the risk of congenital heart defects.

Risk factors for heart failure in survivors after first myocardial infarction.

OBJECTIVE: We examined the prevalence and risk factors of heart failure among 25- to 64-year-old men treated in hospitals for first-time myocardial infarction. MATERIAL AND METHODS: A nested case-control study included 448 men with first-time myocardial infarction, treated in Kaunas hospitals during 1997-2000. Questionnaires elicited information on demographic characteristics and health problems of respondents, psychological stress, and other risk factors. A multivariate logistic regression was used to determine adjusted risk factors for heart failure. RESULTS: Adjustment for age, education, smoking, blood pressure, body mass index, psychological stress, and impaired glucose tolerance showed that main risk factors for development of chronicle heart failure among myocardial infarction patients were impaired glucose tolerance (OR=2.32; 95% CI 1.38-3.88), hypertension (OR=1.51; 95% CI 1.01-2.25), and overweight (OR=1.60; 95% CI 1.00-2.57). Psychological stress and smoking also tended to increase the risk for heart failure. Acute heart failure was significantly associated with impaired glucose tolerance (OR=3.15; 95% CI 1.27-7.84). CONCLUSION: Risk factors for heart failure were similar to those for coronary heart disease, and their combinations significantly increased the heart failure risk.

[Environmental risk factors and outdoor formaldehyde and risk of congenital heart malformations]. / Kenksmingi aplinkos veiksniai bei oro uzterstumas formaldehidu ir igimtos sirdies anomalijos.

UNLABELLED: The aim of the study was to assess the relationships between environmental risk factors and the risk of congenital heart malformations. METHODS AND MATERIALS: An epidemiological case-control study was conducted. We investigated the effect of 43 potential risk factors for congenital heart malformations and calculated their crude and adjusted odds ratios. RESULTS: The analysis revealed that maternal age at delivery (< 19 or > or = 35 years), marital status, chronic diseases, reproductive history, maternal and paternal smoking, occupational and residential hazards were associated with increased risk of congenital heart malformations. Residential exposure to ambient formaldehyde (>2.42 microg/m3) tended to increase the risk of congenital heart malformations by 24% (OR=1.24; 95% CI 0.81-2.07). CONCLUSION: Stratified analysis of effects of exposure to occupational and residential hazards together showed that the risk of congenital heart malformations has increased significantly.

Exposure to urban nitrogen dioxide pollution and the risk of myocardial infarction.

OBJECTIVES: This study attempted to determine whether long-term exposure to nitrogen dioxide (NO2), an indicator of motor vehicle exhaust, increases the risk of myocardial infarction (MI). METHODS: A population-based case-control study was conducted among men aged 25-64 years and residing in Kaunas, Lithuania. The study included all cases of first-time myocardial infarction in 1997-2000. Interviews with patients treated in hospitals elicited information on smoking and other risk factors, including residential histories. A high response rate (77.4%) resulted in 448 cases and 1777 controls. Nitrogen dioxide (NO2) was selected for analysis as an indicator of traffic-related air pollution. The annual air pollution levels were estimated for the residential districts; thereafter the data were linked to the home addresses of the cases and controls. RESULTS: After adjustment for age, education, smoking, blood pressure, body mass index, marital status, and psychological stress, the risk of myocardial infarction was higher for the men exposed to medium [odds ratio (OR) 1.43, 95% confidence interval (95% CI) 1.04-1.96] and high (OR 1.43, 95% CI 1.07-1.92) NO2 levels. The data suggested a stronger association among 55- to 64-year-old men. The risk of myocardial infarction increased by 17% among the 25- to 64-year-old men (OR 1.17, 95% CI 1.01-1.35) and by 34% among those aged 55-64 years (OR 1.34, 95% CI 1.08-1.67) from the first to the third tertile of NO2 exposure. CONCLUSIONS: The results indicate that urban NO2 pollution may increase the risk of myocardial infarction and that vehicle emissions may be of particular importance.

[Environmental pollution with lead and myocardial infarction morbidity]. / Aplinkos oro uzterstumas svinu ir sergamumas miokardo infarktu.

The aim of the study was to assess the effect of exposure to ambient lead and other environmental factors on first myocardial infarction incidence. Epidemiological case-control study comprised 579 male cases (25-64 year old) of myocardial infarction, treated in Kaunas hospitals and 1777 controls of the same age group without ischemic heart disease. Myocardial infarction incidence in the area of low exposure to lead was 2.34 per 1000, while in the high exposure area it was 2.61 per 1000. We determined the distribution of potential myocardial infarction risk factors among cases and controls and calculated corresponding crude odds ratios. Variables considered for inclusion in multivariate logistic regression model were those with higher prevalence among cases and values of odds ratios greater than 1.5. The analysis revealed that smoking, arterial hypertension and stress significantly increased the risk of first myocardial infarction among 25-64 year old men. Occupational exposure to chemical substances increased myocardial infarction risk by 26%, while residential exposure to ambient lead concentrations, exceeding 0.225 microg/m (3), tended to increase myocardial infarction risk by 12% (95% PI 0.94-1.34).

[Social status, psychological stress and myocardial infarction risk among 35-64-year-old women]. / Socialiniu ir psichologiniu veiksniu itaka 35-64 metu moterims susirgti miokardo infarktu.

We examined the association between social status, assessed by education and occupational categories and risk of myocardial infarction. We conducted a case-control study among 35-64 year-old women of Kaunas. Cases were 191 women with first myocardial infarction treated in hospitals in 1997-2000, and controls were 482 women in the same age group, randomly selected, without ischemic heart disease. We used multiple logistic regression to estimate the adjusted odds ratios of developing myocardial infarction in relation to social status and psychological stress. The study results indicated that stress, arterial hypertension, smoking, overweight and low education increased the risk of first myocardial infarction among 35-64 years old women. Managers and service, market sales workers had about twice higher risk for myocardial infarction than associate professionals (OR = 2.64; 95% CI 1.17-6.62 and OR = 2.18; 95% CI 1.03-4.63 correspondingly).