Cardiovascular risk factors among Polish employees of uniformed services.

OBJECTIVES: Employees of uniformed services (EoUS) were screened for cardiovascular risk factors. MATERIAL AND METHODS: A total of 1138 EoUS (age M±SD 49.9±6.0 years) and 263 controls (age M±SD 54.4±9.7 years) under the care of the cardiology clinic in Gdansk, Poland, were included in the study. Medical history and blood samples were collected, and a physical examination was performed. Ten-year cardiovascular risk of death was calculated using the systematic coronary risk evaluation (SCORE) risk algorithm for high-risk countries. RESULTS: Significantly higher values of mean systolic and mean diastolic blood pressure, mean total cholesterol level and mean BMI were recorded among the EoUS compared to controls (M±SD 141.7±11.6 mm Hg vs. 135.5±11.0 mm Hg, p < 0.001; 90.1±5.9 mm Hg vs. 84.5±6.8 mm Hg, p < 0.001; 6.01±0.76 mmol vs. 5.44±0.87 mmol, p < 0.001; 29.3±4.7 vs. 29.0±4.1, p < 0.001, respectively). Smoking cigarettes was most frequently reported by the youngest group (20-39 years old) - 47.7% and it was significantly higher in the entire EoUS group compared to control group (35.5% vs. 16.7%, p = 0.001). The occurrence of observed risk factors (blood pressure ≥140/90 mm Hg, total cholesterol concentration >5 mmol, smoking,) was significantly higher among EoUS compared to controls (92.1% vs. 57.8%, p < 0.001; 89.0% vs. 66.9%, p < 0.001; 35.5% vs. 16.7%, p < 0.001, respectively). In the male group, the mean calculated ten-year risk of fatal cardiovascular events, the percentage of high calculated risk, and very high risk were higher in the EoUS group compared to controls (M±SD 4.44±3.49 vs. 4.23±3.86, p = 0.001; 23.7% vs. 20.2%, p = 0.007; 7.4% vs. 6.5%, p = 0.03, respectively). CONCLUSIONS: The prevalence of all identified risk factors was found to be higher among employees of uniformed services when compared to the control group. The presence of these risk factors within the population of uniformed service employees results in a greater risk of mortality from cardiovascular diseases. Int J Occup Med Environ Health. 2023;36(5):656-71.

Molecular signature of renal cell carcinoma by means of a multiplatform metabolomics analysis.

Renal cell carcinoma (RCC) is a disease with no specific diagnostic method or treatment. Thus, the evaluation of novel diagnostic tools or treatment possibilities is essential. In this study, a multiplatform untargeted metabolomics analysis of urine was applied to search for a metabolic pattern specific for RCC, which could enable comprehensive assessment of its biochemical background. Thirty patients with diagnosed RCC and 29 healthy volunteers were involved in the first stage of the study. Initially, the utility of the application of the selected approach was checked for RCC with no differentiation for cancer subtypes. In the second stage, this approach was used to study clear cell renal cell carcinoma (ccRCC) in 38 ccRCC patients and 38 healthy volunteers. Three complementary analytical platforms were used: reversed-phase liquid chromatography coupled with time-of-flight mass spectrometry (RP-HPLC-TOF/MS), capillary electrophoresis coupled with time-of-flight mass spectrometry (CE-TOF/MS), and gas chromatography triple quadrupole mass spectrometry (GC-QqQ/MS). As a result of urine sample analyses, two panels of metabolites specific for RCC and ccRCC were selected. Disruptions in amino acid, lipid, purine, and pyrimidine metabolism, the TCA cycle and energetic processes were observed. The most interesting differences were observed for modified nucleosides. This is the first time that the levels of these compounds were found to be changed in RCC and ccRCC patients, providing a framework for further studies. Moreover, the application of the CE-MS technique enabled the determination of statistically significant changes in symmetric dimethylarginine (SDMA) in RCC.

Non-invasive haemodynamic assessments among hypertensive patients in a routine family doctor's office.

INTRODUCTION AND OBJECTIVE: Difficult-to-control blood pressure can be attributed to a mismatch between the haemodynamic type of hypertension and the drug class used in treatment. Impedance cardiography may be a useful tool for enabling the individualization of antihypertensive therapy. The aim was to investigate the distribution of haemodynamic types of HT among hypertensive patients in an outpatient clinic. MATERIAL AND METHODS: This was a prospective, observational study of patients with primary hypertension at an outpatient clinic. A 10-minute ICG examination was performed in 189 consecutive, patients (118 men and 71 women). Patients were divided into groups based on whether their hypertension was well-controlled (140/90 mmHg, n=95). They were also stratified according to haemodynamic states. RESULTS: Patients with poorly controlled blood pressure compared to patients with well controlled blood pressure had a high haemodynamic output in 6.3% vs. 2.1% (p=0.153), and high vascular resistance in 41.1% vs. 27.7% (p=0.037), and balanced haemodynamic states in 52.6% vs. 70.2% (0 80 beats/min) and fluid retention (p<0.01). CONCLUSIONS: Half of the examined patients did not achieve the therapeutic goals for hypertension treatment. Differences in haemodynamic state of well and poor controlled hypertension groups suggests the usefulness of impedance cardiography-targeted hypertension treatment.

Effects of an outpatient intervention comprising nurse-led non-invasive assessments, telemedicine support and remote cardiologists' decisions in patients with heart failure (AMULET study): a randomised controlled trial.

AIM: Prevention of heart failure (HF) hospitalisations and deaths constitutes a major therapeutic aim in patients with HF. The role of telemedicine in this context remains equivocal. We investigated whether an outpatient telecare based on nurse-led non-invasive assessments supporting remote therapeutic decisions (AMULET telecare) could improve clinical outcomes in patients after an episode of acute HF during 12-month follow-up. METHODS AND RESULTS: In this prospective randomised controlled trial, patients with HF and left ventricular ejection fraction (LVEF) ≤49%, after an episode of acute HF within the last 6 months, were randomly assigned to receive either an outpatient telecare based on nurse-led non-invasive assessments (n = 300) (AMULET model) or standard care (n = 305). The primary composite outcome of unplanned HF hospitalisation or cardiovascular death occurred in 51 (17.1%) patients in the telecare group and 73 (23.9%) patients in the standard care group up to 12 months after randomization [hazard ratio (HR) 0.69, 95% confidence interval (CI) 0.48-0.99; P = 0.044]. The implementation of AMULET telecare, as compared to standard care, reduced the risk of first unplanned HF hospitalisation (HR 0.62, 95% CI 0.42-0.91; P = 0.015) as well as the risk of total unplanned HF hospitalisations (HR 0.64, 95% CI 0.41-0.99; P = 0.044).There was no difference in cardiovascular mortality between the study groups (HR 1.03, 95% CI 0.54-1.67; P = 0.930). CONCLUSIONS: AMULET telecare as compared to standard care significantly reduced the risk of HF hospitalisation or cardiovascular death during 12-month follow-up among patients with HF and LVEF ≤49% after an episode of acute HF.

Rationale and design of the AMULET study: A new Model of telemedical care in patients with heart failure.

AIMS: Heart failure (HF) is characterized by high mortality and hospital readmission rates. Limited access to cardiologists restricts the application of guideline-directed, patient-tailored medical therapy. Some telemedicine solutions and novel non-invasive diagnostic tools may facilitate real-time detection of early HF decompensation symptoms, prompt initiation of appropriate treatment, and optimal management of medical resources. We describe the rationale and design of the AMULET trial, which investigates the effect of comprehensive outpatient intervention, based on individualized haemodynamic assessment and teleconsultations, on cardiovascular mortality and unplanned hospitalizations in HF patients. METHODS AND RESULTS: The AMULET trial is a multicentre, prospective, randomized, open-label, and controlled parallel group trial (ClinicalTrials.gov Identifier: NCT03476590). Six hundred and five eligible patients with HF (left ventricular ejection fraction ≤49%, at least one hospitalization due to acute HF decompensation within 6 months prior to enrolment) were randomly assigned in a 1:1 ratio to either an intervention group or a standard care group. The planned follow-up is 12 months. The AMULET interventions are performed in ambulatory care points operated by nurses, with the remote support of cardiologists. The comprehensive clinical evaluation comprises measurements of heart rate, blood pressure, body mass, thoracic fluid content, and total body water. A recommendation support module based on these objective parameters is implemented in remote therapeutic decision-making. The primary complex endpoints are cardiovascular mortality and unplanned HF hospitalization. CONCLUSIONS: The AMULET trial will provide a prospective assessment of the effect of comprehensive ambulatory intervention, based on telemedicine and haemodynamically guided therapy, on mortality and readmissions in HF patients.

Nurse-led ambulatory care supported by non-invasive haemodynamic assessment after acute heart failure decompensation.

Heart failure (HF) is characterized by frequent decompensation and an unpredictable trajectory. To prevent early hospital readmission, coordinated discharge planning and individual therapeutic approach are recommended. AIMS: We aimed to assess the effect of 1 month of ambulatory care, led by nurses and supported by non-invasive haemodynamic assessment, on the functional status, well-being, and haemodynamic status of patients post-acute HF decompensation. METHODS AND RESULTS: This study had a multicentre, prospective, and observational design and included patients with at least one hospitalization due to acute HF decompensation within 6 months prior to enrolment. The 1 month ambulatory care included three visits led by a nurse when the haemodynamic state of each patient was assessed non-invasively by impedance cardiography, including thoracic fluid content assessment. The pharmacotherapy was modified basing on haemodynamic assessment. Sixty eight of 73 recruited patients (median age = 67 years; median left ventricular ejection fraction = 30%) finished 1 month follow-up. A significant improvement was observed in both the patients' functional status as defined by New York Heart Association class (P = 0.013) and sense of well-being as evaluated by a visual analogue score (P = 0.002). The detailed patients' assessment on subsequent visits resulted in changes of pharmacotherapy in a significant percentage of patients (Visit 2 = 39% and Visit 3 = 44%). CONCLUSIONS: The proposed model of nurse-led ambulatory care for patients after acute HF decompensation, with consequent assessment of the haemodynamic profile, resulted in: (i) improvement in the functional status, (ii) improvement in the well-being, and (iii) high rate of pharmacotherapy modifications.

GC-MS-based untargeted metabolomics of plasma and urine to evaluate metabolic changes in prostate cancer.

Prostate cancer (CaP) is a common cancer in men. Its late detection and inefficient diagnosis are a challenge for researchers who are currently searching for new cancer-related indicators that would facilitate better detectability of CaP and explain its pathogenesis. In the present preliminary study, endogenous volatile metabolites were detected in plasma and urine samples by using the metabolic fingerprinting approach. The analyses were performed using the GC-QqQ/MS technique in the scan mode. The detected and putatively identified metabolites were statistically analyzed using advanced univariate and multivariate statistical methods. Eleven urinary and three plasma metabolites were selected as statistically significant in patients with CaP as compared to those in healthy controls. Supervised methods such as logistic regression and quadratic support vector machine were applied to obtain the classification models. The accuracy, sensitivity, and specificity of the models were above 83%, 85%, and 81%, respectively. The putatively identified metabolites were associated with biochemical pathways such as tricarboxylic acid cycle, glycolysis, carbohydrate conversion, and steroidal lipid metabolism that are mainly involved in energy production for cell growth and proliferation.

Non-invasive assessment of haemodynamic parameters in patients after Fontan procedure.

INTRODUCTION AND OBJECTIVE: Single ventricle anomaly is one of the complex congenital heart defects. A dependable non-invasive method of evaluation of Fontan circulation haemodynamics for early diagnosing unstable patients is hardly available in routine clinical practice. The aim of the study is non-invasive evaluation of the haemodynamic parameters in patients after Fontan operation. MATERIAL AND METHODS: The study involved 11 participants (age 24.4±4.3 years) with functionally univentricular hearts after Fontan operation. Evaluation of haemodynamic parameters was performed in supine and sitting positions using the impedance cardiography method. RESULTS: In comparative analysis, heart rate (70.1 vs.78.3 1/min; p=0.001), diastolic blood pressure (73.9 vs. 76.7 mm Hg; p=0.026), mean arterial blood pressure (84.5 vs. 88.0 mm Hg; p=0.013), systemic vascular resistance (1284.8 vs. 1334.9 dyn*s*cm-5; p=0.024), systemic vascular resistance index (2178.7 vs. 2272.8 dyn*s*cm-5*m2 ; p=0.018), pre-ejection period (124.2 vs. 136.2 ms; p=0.009), systolic time ratio (0.43 vs. 0.53; p=0.0001), and Zo (26.2 vs. 28.7 Ω; p<0.00001), were significantly higher in the sitting position. Stroke volume (75.4 vs. 68.5 ml; p=0.013), stroke index (42.7 vs. 39.0 ml*m-2; p=0.014), thoracic fluid content (38.5 vs. 35.4 1*kΩ-1; p=<0.00001), thoracic fluid content index (22.8 vs. 21.0 1*kΩ-1*m-2; p=<0.00001), and leftventricular ejection time 291.1 vs. 260.1 ms; p <0.00001, were significantly higher in the supine position. CONCLUSIONS: In patients after Fontan procedure, impedance cardiography can be a useful tool the assessment of shortterm haemodynamic changes provoked by postural changes. Its clinical value in patients with congenital heart defects should be further investigated.

Cardiovascular testing of seasickness in healthy volunteers on life rafts.

OBJECTIVES: The role of the cardiovascular system in the development of seasickness remains uncertain. MATERIAL AND METHODS: Overall, 18 healthy students (10 males and 8 females) aged 18-24 years volunteered in the project, spending 2-7 h on life rafts. The cardiovascular system was examined with impedance cardiography. Susceptibility and symptoms of seasickness were evaluated by the Motion Sickness Susceptibility Questionnaire Shortform (MSSQ-Short) and the Motion Sickness Assessment Questionnaire (MSAQ). The Visual Analogue Scale (VAS), ranging 0-10, was used to assess nausea, dizziness and mood. The parameters were assessed at 2 time points. RESULTS: Differences in the heart rate (HR), the thoracic fluid content index (TFCI), the stroke index (SI) and the Heather index (HI) before launching the life rafts and after leaving them were observed (78.6, 20.8, 55.6 and 15.9 vs. 70.1, 19.7, 60.5 and 17.9, with p-values of 0.002, <0.001, 0.003 and 0.004, respectively). Females reacted with changes in SI and HR more vividly, whereas males regulated more HI and TFCI. In addition, HR correlated significantly with the central and peripheral symptoms in MSAQ, stroke volume (SV) with peripheral and sopite-related ones, SI with overall ones, and pulse pressure with overall, gastrointestinal and central ones (Spearman's rank correlation coefficient [ρ] was -0.478, -0.711, 0.476, 0.472, 0.525, -0.476, -0.579 and -0.584, respectively). As regards MSSQ-Short, it correlated negatively with sopite-related symptoms in MSAQ (ρ= -0.486). Mood in VAS correlated significantly with gastrointestinal symptoms, SI and the cardiac index (CI) (ρ = -0.752, -0.492 and -0.489, respectively). CONCLUSIONS: It was found that HR correlated negatively, and SV/SI correlated positively, with the severity of seasickness symptoms measured with MSAQ. Gender is probably an independent factor influencing reactions to motion. Women react with SI increase whereas men react with increased heart contractility (HI rise). Negative mood in seasickness evaluated with VAS seems to be mostly determined by gastrointestinal symptoms assessed with MSAQ and diminished cardiovascular indices (both CI and SI). Int J Occup Med Environ Health. 2020;33(4):467-77.

Haemodynamic parameters in postmenopausal women - beneficial effect of moderate continuous exercise training.

INTRODUCTION AND OBJECTIVE: Physical effort plays a positive role in reducing the risk of cardiovascular diseases. The aim of this study was to assess the cardiovascular status in postmenopausal women after several years of regular amateur training. MATERIAL AND METHODS: A total of 55 generally healthy females aged 50-70 years, of whom 38 were members of a senior exercise group and 17 comprised a control group, were enrolled in the study. Parameters of blood flow, vascular resistance, myocardial contractility and thoracic fluid content were measured in a 10-minute supine resting test by impedance cardiography. Thereafter, central blood pressure, augmentation index and pulse wave velocity were measured by applanation tonometry. RESULTS: Exercising women have a better outcome than the control group, when evaluated both with impedance cardiography and with applanation tonometry. They have a lower heart rate - HR (65.1 vs 71.5; p = 0.033), higher blood flow (stroke index - SI, 58.6 vs 50.3; p = 0.040), better myocardial contractility (acceleration index - ACI, 108.8 vs 88.1; p = 0.027), higher preload (thoracic fluid content index - TFCI, 20.5 vs 18.1; p = 0.002), lower afterload (systemic vascular resistance index - SVRI, 1972.9 vs 2110.5; p = 0.026), lower central systolic blood pressure - cBPsys (119.0 vs 129.5; p = 0.037), lower augmentation pressure - AP (10.3 vs 15.0; p = 0.044) and lower pulse wave velocity - PWV (7.4 vs 8.4; p = 0.001). CONCLUSIONS: Regular moderate continuous aerobic exercise training has a beneficial impact on the cardiovascular system in postmenopausal women.

Urinary metabolomic signature of muscle-invasive bladder cancer: A multiplatform approach.

Bladder cancer (BCa) is ninth amongst the most common types of cancer in the human population worldwide. The statistics of incidence and mortality of BCa are alarming and the currently applied diagnostic methods are still not sensitive enough. This leads to a large number of undiagnosed BCa cases, usually among patients in the early stages of the disease. Despite the fact that many risk factors of BCa have been recognized, the pathomechanism of development of bladder cancer has not been fully explained yet. Therefore, in the present study, multiplatform urinary metabolomics has been implemented in order to scrutinize potential diagnostic indicators of BCa that might help to explain its pathomechanism and be potentially useful in diagnosis and determination of stage of the disease. Urine samples collected from muscle-invasive high grade BCa patients (n = 24) and healthy volunteers (n = 24) were matched in terms of most common BCa risk factors i.e. gender, age, BMI and smoking status. They were analyzed by high performance liquid chromatography coupled with time of flight mass spectrometry detection (HPLC-TOF/MS) using RP and HILIC chromatography, gas chromatography hyphenated with triple quadruple mass spectrometry detection (GC-QqQ/MS) in scan mode, and proton nuclear magnetic resonance (1H NMR). The six datasets obtained were submitted to univariate and multivariate statistical analyses. 17 metabolites significantly discriminated urinary profiles of BCa patients from urinary profiles of healthy volunteers. These metabolites are mainly involved in amino acid metabolism, pyrimidine and purine metabolism, as well as energy metabolism and might play a crucial role in the pathogenesis of BCa.

New mechanisms of CCR5-Δ32 carriers' advantage - Impact on progenitor cells and renal function.

BACKGROUND: CCR5 is a chemokine receptor expressed by various populations including leukocytes, smooth muscle cells and endothelium. Δ32 polymorphism of CCR5 gene has been connected with, inter alia, cardiovascular disease development. The aim of our study was to evaluate impact of CCR5 variant on CD34+ and CD34+VEGFR2+ cells - populations involved in cardiovascular system homeostasis and regeneration. METHODS AND RESULTS: We have examined 170 Polish subjects from Pomeranian region. The analysis concerned CCR5 polymorphism and flow cytometry evaluation of whole blood cells. Our results indicate that individuals with at least one CCR5-Δ32 allele are characterized by greater number of CD34+CXCR4+, CD34+VEGFR2+ and CD34+VEGFR2+c-Kit + cells than their wild type counterparts. This group also exhibits more beneficial values of renal function parameters. CONCLUSION: Maintaining greater size of CD34+ and CD34+VEGFR2+ populations as well as proper kidney function may constitute mechanisms that connect chemokine receptor polymorphism with cardiovascular system health.

CD34+ and CD34+VEGFR2+ cells in poorly controlled hypertensive patients.

CD34+ and CD34+VEGFR2+ cells participate in the repair of damaged endothelium and vascular remodelling. As their number and activity change due to the development of cardiovascular diseases, they are recognised as useful markers of cardiovascular health. As ineffective blood pressure control concerns high percentage of hypertensive patients, the purpose of our study was to investigate if proportions of various CD34+ and CD34+VEGFR2+ populations change due to hypertension occurrence and the effectiveness of the therapy. We also wanted to establish which factors impact these cells. Circulating populations of CD34+ and CD34+VEGFR2+ cells were analysed in peripheral blood samples by flow cytometry. Serum/plasma levels of sICAM-1, sVCAM-1 and vWF were determined using immunoenzymatic assay. We did not observe differences in CD34+ populations, but proportions of CD34+VEGFR2+ (p = 0.006), CD34+VEGFR2+CD133+ (p = 0.002) and CD34+VEGFR2+c-Kit+ (p = 0.003) cells were reduced in patients with poorly controlled blood pressure. We have also established that these cells exhibit connections with age, blood pressure and sICAM-1 serum levels. However, multiparametric regression analyses did not indicate any of the analysed variables as independent factors affecting CD34+VEGFR2+ populations. CD34+VEGFR2+, CD34+VEGFR2+CD133+ and CD34+VEGFR2+c-Kit+ cells are reduced in poorly controlled hypertensive patients, which may be partially connected with increased cardiovascular complications and mortality observed in this group.

Circulating CD34+ and CD34+VEGFR2+ progenitor cells are associated with KLOTHO KL-VS polymorphism.

BACKGROUND: KLOTHO is a regulator of endothelial cells activity and integrity. It has been described for the first time because of its anti-aging properties. KLOTHO encoding gene is present in many functional variants in humans, including "KL-VS" variant that has been connected with longevity and cardiovascular disease development. Few mechanisms have been proposed to explain these associations, but none of them focused on cells from CD34+ population. The aim of our study was to investigate influence of KLOTHO KL-VS polymorphism on populations of CD34+ and CD34+VEGFR2+ cells. METHODS AND RESULTS: We examined 167 Polish subjects from Pomeranian region. The analysis concerned KL-VS polymorphism, flow cytometry evaluation of whole blood cells and determination of endothelium-associated serum/plasma factors. Our results indicate that individuals possessing at least one KL-VS allele are characterized by greater number of CD34+ and CD34+VEGFR2+ and their various subpopulations (CD34+CD133+, CD34+c-Kit+, CD34+CXCR4+ and CD34+VEGFR2+c-Kit+) than wild-type volunteers. This group also exhibited more favorable lipid profile and statistically insignificant decrease of vWF and angiotensin II in their blood, whereas VEGF levels were elevated. CONCLUSION: One of the mechanisms that are responsible for previously described KL-VS heterozygote advantage may be connected with maintaining greater size of hematopoietic and endothelial progenitor cells population.

Association of circulating progenitor cells with angiotensin II in newly diagnosed hypertensive patients.

Populations of CD34- and VEGFR2-expressing cells are responsible for regeneration of damaged endothelium and vascular remodelling. As their quantity and activity changes during cardiovascular diseases, they are potentially useful markers of cardiovascular health. The aim of our study was to investigate changes of various CD34+ and CD34+ VEGFR2+ populations in subjects with newly recognised hypertension and to evaluate whether observed alterations are influenced by clinical parameters and angiotensin II. Circulating CD34+ and CD34+ VEGFR2+ cells were analysed in peripheral blood samples by flow cytometry. Serum levels of angiotensin II were determined using immunoenzymatic assay. We discovered increased proportions of various CD34+ populations and CD34+ VEGFR2+ c-Kit+ cells in newly diagnosed patients. CD34+ cells seem to be influenced by angiotensin II, but we did not observe comparable results when populations co-expressing VEGFR2 were analysed. The quantity of CD34+ VEGFR2+ cells in patients with newly recognised primary hypertension ought to be determined by other factors. Increased proportions of CD34+ progenitors in blood could comprise compensatory mechanism for increased endothelial damage in hypertension.

Fatal cardiovascular risk in Poland as determined via Internet.

[b]Abstract Introduction.[/b] Web information systems can serve as a diagnostic tool for Internet users and to support the epidemiological work of doctors and health care providers. As part of this work, a system for detecting and calculating cardiovascular risk has been created. [b]Objectives[/b]. 1) Application of web-based risk assessment of cardiovascular death; 2) an attempt to evaluate the distribution of selected risk factors among the population of Polish Internet users; 3) implementation of the epidemiological imaging system of cardiovascular risk factors. [b]Materials and method[/b]. The 'Ryzyko' programme (www.ryzyko.gumed.edu.pl.) available on the Internet. To assess cardiovascular death risk in a ten year period the algorithm of the SCORE project was used. 28,320 solutions of the algorithm have been registered. [b]Results[/b]. Over 28,000 webpage visitors entered the required data and received the outcome. More than 71% of Internauts who entered the data received the recommendation for medical control. The result of the programme is a graphic presentation of the distribution of the calculated risk of death, based on previously gathered information given by the Internauts in particular provinces in Poland. [b]Conclusion[/b]. Automatic monitoring of the incidence of cardiovascular risk factors in Poland provides information for epidemiological studies. The system meets the characteristics of diagnostic programmes that can assist epidemiologic-based and therapeutic decisions.

Cardiovascular risk factors determined via the Internet in 2 periods of time: 2004-2009 and 2010-2015 in Poland.

OBJECTIVES: Web information systems may serve as a diagnostic tool for the Internet users and they also support the epidemiological work of doctors and health care providers. As part of this study, a system has been created for detecting and calculating cardiovascular risk. The aim of this study has been the comparison of cardiovascular risk factors and calculated fatal cardiovascular risk in 2 periods of time: 2004-2009 and 2010-2015 in Poland, as determined via the Internet. MATERIAL AND METHODS: The "Ryzyko program" ("Risk program") is available on the website of the Medical University of Gdansk. To assess the cardiovascular death risk in a 10-year period, the algorithm of the SCORE (Systematic Coronary Risk Evaluation) project was used and 30 402 results of the algorithm have been analyzed. RESULTS: Over 30 402 webpage visitors entered the required data and received the outcome. More than 78% of the Internet users who had entered the data, received a recommendation for medical check-up. Significant differences between the data collected in 2004- 2009 and 2010-2015 were noticed. Hypercholesterolemia prevalence (67.3% vs. 70.8%; p < 0.001), mean total cholesterol concentration in blood (5.60±1.65 mml/l vs. 5.66±1.35 mml/l; p < 0.001), prevalence of hypertension (36.6% vs. 35.3%; p = 0.039), mean systolic blood pressure (131.5±20.3 mm Hg vs. 132.6±18.0 mm Hg; p < 0.001), prevalence of declared smoking (30.7% vs. 26.5%; p < 0.001), declared diabetes mellitus (DM) (6.4% vs. 9.7%; p < 0.001), and declared coronary artery disease (CAD) (7.2% vs. 14.1%; p < 0.001), respectively. CONCLUSIONS: The prevalence of cardiovascular risk factors has changed during the observed period of time. Online automatic gathering of new data by "Ryzyko program" provides up-to-date observations. Int J Occup Med Environ Health 2017;30(3):499-510.

Vascular endothelial growth factor polymorphism (-460 T/C) is related to hypertension-associated chronic kidney disease.

Our aim was to characterize the endothelial progenitor cells (EPCs) in normotensive controls and treated hypertensive individuals within the vascular endothelial growth factor (VEGF) -460 C/T polymorphism as well as to investigate whether this polymorphism predisposes to hypertension-related chronic kidney disease. The hypertensive patients bearing the TT genotype had the highest levels of immature EPC with the following phenotypes: CD34(+), CD34(+)CD45(dim), CD34(+)CD133(+)CD45(dim). The study showed the estimated glomerular filtration rate values significantly lower and creatinine and BUN parameters higher among the TT hypertensive patients. We presume that the highest mobilization of EPCs from bone marrow may signalize more severe renal hypertension-related complications in the VEGF -460 TT genotype.