Up-to-date evidence about levels and trends in disease and injury incidence, prevalence, and year... more Up-to-date evidence about levels and trends in disease and injury incidence, prevalence, and years lived with disability (YLDs) is an essential input into global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013), we estimated these quantities for acute and chronic diseases and injuries for 188 countries between 1990 and 2013. Estimates were calculated for disease and injury incidence, prevalence, and YLDs using GBD 2010 methods with some important refinements. Results for incidence of acute disorders and prevalence of chronic disorders are new additions to the analysis. Key improvements include expansion to the cause and sequelae list, updated systematic reviews, use of detailed injury codes, improvements to the Bayesian meta-regression method (DisMod-MR), and use of severity splits for various causes. An index of data representativeness, showing data availability, was calculated for each cause and impairment during three periods globally...
Statins produce additional beneficial effects, including attenuation of prothrombotic mechanisms.... more Statins produce additional beneficial effects, including attenuation of prothrombotic mechanisms. In patients at high cardiovascular risk, who have markedly elevated low-density lipoprotein (LDL) cholesterol levels, simvastatin can reduce thrombin generation. Moreover, we have described simvastatin-induced improvement of fibrin clot properties, the formation of which represents the final step of blood coagulation. The aim of the present study was to assess the effect of simvastatin on fibrin features observed in subjects with LDL cholesterol <3.4 mmol/l. Thirty subjects (24M, 6F) aged <70 years with LDL cholesterol <3.4 mmol/l with no history of cardiovascular events were enrolled in the study. Patients were excluded if they had diabetes mellitus, chronic inflammatory diseases and renal insufficiency. Prior to and following a 3-month treatment with simvastatin (40 mg/d), ex vivo plasma fibrin clot permeability and efficiency of clot lysis were measured. Simvastatin led to a...
The free radical/oxidative stress theory of ageing has received considerable attention, but the e... more The free radical/oxidative stress theory of ageing has received considerable attention, but the evidence on the association of oxidative stress markers with mortality is sparse. We measured derivatives of reactive oxygen metabolite (D-ROM) levels as a proxy for the reactive oxygen species concentration and total thiol levels (TTL) as a proxy for the redox control status in 10,622 men and women (age range, 45-85 years), from population-based cohorts from Germany, Poland, Czech Republic, and Lithuania, of whom 1,702 died during follow-up. Both oxidative stress markers were significantly associated with all-cause mortality independently from established risk factors (including inflammation) and from each other in all cohorts. Regarding cause-specific mortality, compared to low D-ROM levels (≤340 Carr U), very high D-ROM levels (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;500 Carr U) were strongly associated with both cardiovascular (relative risk (RR), 5.09; 95 % CI, 2.67-9.69) and cancer mortality (RR, 4.34; 95 % CI, 2.31-8.16). TTL was only associated with CVD mortality (RR, 1.30; 95 % CI, 1.15-1.48, for one-standard-deviation-decrease). The strength of the association of TTL with CVD mortality increased with age of the participants (RR for one-standard-deviation-decrease in those aged 70-85 years was 1.65; 95 % CI, 1.22-2.24). In these four population-based cohort studies from Central and Eastern Europe, the oxidative stress serum markers D-ROM and TTL were independently and strongly associated with all-cause and CVD mortality. In addition, D-ROM levels were also strongly associated with cancer mortality. This study provides epidemiological evidence supporting the free radical/oxidative stress theory of ageing and suggests that d-ROMs and TTL are useful oxidative stress markers associated with premature mortality.
Zinc may be involved in the pathophysiology and treatment of depressive disorder. However, data o... more Zinc may be involved in the pathophysiology and treatment of depressive disorder. However, data on this issue in bipolar disorder (BD) are limited. The aim of the study was to assess zinc concentrations in the blood serum of patients at various phases and stages of bipolar disorder. The study included 129 patients with a diagnosis of bipolar disorder type I (n=69) or type II (n=60). Fifty-eight were in a depressive episode, 23 in a manic episode and 48 in remission. Fifty healthy volunteers made a control group. Zinc concentration was measured using flame atomic absorption spectrometry. Serum zinc level in patients diagnosed with BD type I in the depressive phase was significantly reduced as compared with mania, remission and healthy subjects. In the BD type II, serum zinc level in hypomania, depression or remission phase was not significantly different from the control group. In the whole group, lower level of zinc in depression compared to remission and control subjects was found during late stage of the illness but not in the early stage. Zinc concentration was not dependent on the severity of manic or depressive symptoms and subtype of depression but correlated positively with the number of manic/hypomanic relapses in the past year. Lack of prospective model, heterogeneity of pharmacological treatment, small number of subgroups presenting specified clinical features. Decreased serum zinc concentration occurs in depression in BD type I and probably in depression in the late stage of BD.
There is a paucity of Polish data describing the characteristics of and assessing treatment goals... more There is a paucity of Polish data describing the characteristics of and assessing treatment goals in patients with relatively newly diagnosed type 2 diabetes. The aim of the study was to describe the baseline characteristics of patients with newly diagnosed type 2 diabetes, who participated in the ARETAEUS1 study, and to assess to what degree diabetic control criteria recommended by the Polish Diabetes Association clinical practice guidelines are met. This cross-sectional questionnaire-based study was conducted from January to April 2009. It involved patients of any age and gender, diagnosed with type 2 diabetes after January 1, 2007, and recruited by randomly selected physicians, both diabetologists and non-diabetologists. We analyzed 1714 valid questionnaires from 333 physicians: 1150 from non-diabetologists and 564 from diabetologists. Mean age of patients was 60 years, mean body mass index -- 30.6 kg/m2, proportion of females -- 50%. The levels of median glycated hemoglobin (HbA...
Alcohol has been implicated in the high mortality in Central and Eastern Europe but the magnitude... more Alcohol has been implicated in the high mortality in Central and Eastern Europe but the magnitude of its effect, and whether it is due to regular high intake or episodic binge drinking remain unclear. The aim of this paper was to estimate the contribution of alcohol to mortality in four Central and Eastern European countries. We used data from the Health, Alcohol and Psychosocial factors in Eastern Europe is a prospective multi-centre cohort study in Novosibirsk (Russia), Krakow (Poland), Kaunas (Lithuania) and six Czech towns. Random population samples of 34,304 men and women aged 45-69 years in 2002-2005 were followed up for a median 7 years. Drinking volume, frequency and pattern were estimated from the graduated frequency questionnaire. Deaths were ascertained using mortality registers. In 230,246 person-years of follow-up, 2895 participants died from all causes, 1222 from cardiovascular diseases (CVD), 672 from coronary heart disease (CHD) and 489 from pre-defined alcohol-related causes (ARD). In fully-adjusted models, abstainers had 30-50 % increased mortality risk compared to light-to-moderate drinkers. Adjusted hazard ratios (HR) in men drinking on average ≥60 g of ethanol/day (3 % of men) were 1.23 (95 % CI 0.95-1.59) for all-cause, 1.38 (0.95-2.02) for CVD, 1.64 (1.02-2.64) for CHD and 2.03 (1.28-3.23) for ARD mortality. Corresponding HRs in women drinking on average ≥20 g/day (2 % of women) were 1.92 (1.25-2.93), 1.74 (0.76-3.99), 1.39 (0.34-5.76) and 3.00 (1.26-7.10). Binge drinking increased ARD mortality in men only. Mortality was associated with high average alcohol intake but not binge drinking, except for ARD in men.
The purpose of this study was to assess educational differences in nutrient intake in women and m... more The purpose of this study was to assess educational differences in nutrient intake in women and men, and to find out how national/WHO dietary recommendation are met in different educational groups. STUDIED GROUP AND METHODS: 2310 women and men at age 35-64, Cracow residents, participants of the HAPIEE project (Health, Alcohol and Psychosocial factors in East Europe). 24 hour food recall was used to assess the average energy, fats, P/S ratio, carbohydrates, refined sugar, antioxidant vitamins (vitamin C, E and beta-carotene), fibre and calcium intake in basic, secondary and university education groups. Comparison of the data with national/WHO dietary recommendation was performed in each education group. In women and men with university and secondary education higher fat intake was observed compared to basic education group. In women and men intake of vitamin C, beta-carotene and calcium was higher in university education group compared to basic education group by 30%, 24% and 24% in women and by 20%, 15% and 25% in men respectively. Women with university education had higher vitamin E and fibre consumption compared to basic education group. Compared to WHO and national recommendations, total and saturated fat consumption was too high in both sexes and in all education groups, however profitable P/S ratio was observed in all education groups in both sexes. Vitamin C intake was too low in women and men with basic education. In women vitamin E consumption was not satisfactory in any education group. Fibre and calcium intake was low in women and men, in all education groups. There were differences between education groups in fat, carbohydrates, fibre, antioxidant vitamins and calcium intake. Compared to WHO and national recommendations, fat intake was too high and fibre and calcium intake too low in all educational groups in both sexes. Antioxidant vitamins intake was not sufficient in women and men with basic education.
Thrombosis plays a major role in the development of atherosclerosis and its acute vascular compli... more Thrombosis plays a major role in the development of atherosclerosis and its acute vascular complications. Epidemiological studies have shown that elevated levels of plasma fibrinogen are associated with an increased risk of coronary heart disease (CHD). It is not clear whether this association is linked to hemostatic functions of fibrinogen which serves as a substrate for thrombin. Generation of thrombin in vivo can be evaluated by measurement of its specific markers in plasma, i.e. thrombin-antithrombin III complex (TAT) and prothrombin fragment 1 + 2 (F1 + 2). We determined plasma levels of TAT and F1 + 2 in a population sample of southeastern Poland and evaluated relations of these markers with plasma fibrinogen, factor VII coagulant activity (FVIIc), and other known CHD risk factors. The population studied consisted of 215 men and 251 women, aged 43-75 years. Final analysis was performed on 195 men and 222 women. The distribution of plasma TAT and F1 + 2 concentrations were highly skewed with the higher median values for women than for men. Log values of TAT correlated with log values of F1 + 2 in men (r = 0.27, p &lt; 0.01) and in women (r = 0.15, p &lt; 0.05). In the regression analysis both markers were positively related to age in women but not in men. After adjustment to age there was a positive relation between TAT and fibrinogen in both sexes. In women, but not in men, F1 + 2 showed a positive association with FVIIc. Total plasma cholesterol was negatively related to TAT in women only. There was no association between thrombin generation markers and plasma triglycerides, HDL-cholesterol, LDL-cholesterol, blood pressure, cigarette smoking and body mass index (BMI). The association of plasma fibrinogen and FVIIc with thrombin generation markers points to an important role of the hemostatic system in the pathogenesis of atherosclerosis and coronary heart disease in humans.
There is a paucity of data on meeting treatment goals in patients with newly diagnosed type 2 dia... more There is a paucity of data on meeting treatment goals in patients with newly diagnosed type 2 diabetes (DM2). The aim of the study was to characterize Polish patients with newly diagnosed DM2, to assess management of hyperglycemia, and to estimate the proportion of patients achieving the criteria of disease control recommended by the national clinical practice guidelines published in 2008. ARETAEUS1 was a cross-sectional questionnaire-based study conducted in several regions of Poland in 2009 (January-April). It involved 1714 patients with DM2 of any age and sex, treated for less than 24 months, and recruited by randomly selected physicians. Only 28.9% of patients with DM2 met the goal for glycated hemoglobin (HbA1c) control (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;6.5%). In the total population, only 1.4% of all patients met all 3 goals (HbA1c, blood pressure, and lipid levels), 12.5%--2 goals, and 35.3%--only 1 goal; 50.7% did not meet any of the treatment goals. Achieving all of the treatment goals varied between the patient subgroups (in relation to the current diabetes treatment, age, sex, body mass index, and diabetes duration). Most patients with newly diagnosed DM2 do not meet all their major treatment goals, which indicates relatively low adherence to the national guideline recommendations for diabetes control and primary cardiovascular prevention in DM2. Metformin seems to be underused and titration of other glucose lowering medications may be insufficiently target-driven. Assuming that adherence to the current clinical practice guidelines is beneficial for patients, we recommend that both practitioners and patients have increased awareness of these guidelines and of the ways to achieve and maintain treatment goals.
The practice guidelines of cardiological and diabetological societies emphasise that cardiovascul... more The practice guidelines of cardiological and diabetological societies emphasise that cardiovascular (CV) risk control in diabetic patients is especially important and should be stricter than in subjects without diabetes. There are little data on the frequency of meeting treatment goals in patients with newly diagnosed diabetes mellitus type 2 (DM2). To characterise Polish patients with DM2 diagnosed within the previous two years and to assess if the treatment targets from the current (2008) guidelines of Diabetes Poland regarding control of CV risk factors are met. ARETAEUS1 was a cross-sectional questionnaire-based study conducted in various regions of Poland in 2009 (January-April). It involved 1,714 patients of all ages and both genders, who had DM2 treated for less than 24 months. They were recruited by randomly selected physicians. Total cholesterol treatment goal (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 4.5 mmol/L) was met in 22% of all patients, triglycerides treatment goal (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 1.7 mmol/L) in 44%, LDL cholesterol treatment goal (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 2.6 mmol/L) in 20% and HDL cholesterol treatment goal (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 1.0 mmol/L in men and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 1.3 mmol/L in women) in 55%. Only 13% of the overall population met the goal of blood pressure (BP) below 130/80 mm Hg. When a less restrictive BP control threshold (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 140/90 mm Hg) was applied, 48% of patients had their BP below the threshold. In the analysis of subgroups (patients with and without previous CV events; receiving 1-5 or not receiving antihypertensive drugs; receiving and not receiving statins and fibrates) we observed from 0% to 3.3% of patients meeting three (HbA1c, BP and cholesterol) treatment goals. The percentages of patients meeting two out of three treatment goals were between 8% and 33% in different subgroups. The percentages of patients meeting only one out of three treatment goals ranged from 27.8% to 46.7% or at least one - from 39% to 69%. Most patients with newly diagnosed diabetes are not meeting their treatment goals regarding control of CV risk factors, which indicates relatively low adherence to national guideline recommendations for diabetes control and primary CV prevention in DM2. Difficulties in achieving CV treatment targets in the diabetic population indicate the need for a great deal of effort on the part of clinicians and patients. Practice guidelines developers should consider what…
Higher cortical dysfunctions, like dysphasia, dysgnosia and dyspraxia, relatively frequent in the... more Higher cortical dysfunctions, like dysphasia, dysgnosia and dyspraxia, relatively frequent in the elderly, are related to progressive neurodegenerative or vascular disorders with dementia. The aim of the study was to assess the prevalence and the intensity of higher cerebral dysfunctions in the population over 65 years and to investigate the association between these disorders and the presence of other neurological abnormalities, i.e. extrapyramidal signs, primitive reflexes as well as cognitive impairment assessed by Mini-Mental State Examination (MMSE). There were 92 women and 90 men, aged from 65-78 years included in the study. All patients were interviewed for the presence of vascular risk factors. The battery of 21 detailed test of higher cerebral functions testing speech, calculation, reading, writing, praxia and gnosia were performed in each person. Extra-pyramidal signs and primitive reflexes were also examined. Among the disorders of higher cortical functions, slight dyspra...
This paper extracts the Policy Implications from ENEPRI Research Report Nos. 26-31, prepared unde... more This paper extracts the Policy Implications from ENEPRI Research Report Nos. 26-31, prepared under Work Package II of the AHEAD Project (Ageing, Health Status and Determinants of Health Expenditure) for the European Commission. Below are listed the titles of the full reports, which are available for free downloading (http://shop.ceps.eu): No. 26 Health and Morbidity in the Accession Countries: Country Report – Bulgaria, Rossitsa Rangelova, December 2006 No. 27 Health and Morbidity in the Accession Countries: Country Report – Estonia, Liis Rooväli, December 2006 No. 28 Health and Morbidity in the Accession Countries: Country Report – Hungary, Edit Remák, Róbert I. Gál and Renáta Németh, December 2006 No. 29 Health and Morbidity in the Accession Countries: Country Report – Poland, Stanisława Golinowska and Agnieszka Sowa, December 2006 No. 30 Health and Morbidity in the Accession Countries: Country Report – Slovakia, Vladimír Kvetan, Viliam Páleník, December 2006 No. 31 Health Status ...
INTRODUCTION Patients with resistant hypertension (RHT) are at high risk for coronary artery dise... more INTRODUCTION Patients with resistant hypertension (RHT) are at high risk for coronary artery disease (CAD) and cerebrovascular disease (CVD) events, compared with the general hypertensive population. OBJECTIVES To evaluate factors associated with RHT in a large sample of hypertensive patients under the care of general practitioners (GPs) and specialists in Poland. PATIENTS AND METHODS We included 12,375 patients (mean age 64.0±12.3 years; age range 18-98 years; 59% females) with hypertension treated for at least one year. Patients were divided into 3 groups: controlled hypertension, uncontrolled hypertension (not fulfilling the criteria of RHT) and RHT. RESULTS Controlled hypertension, uncontrolled hypertension and RHT were found in 47.3%, 27.9% and 24.7% of patients respectively. The RHT rate was higher in specialist offices (29.8%) and in patients with diabetes (32.5%), CAD (31.5%), CVD (33.3%) and impaired renal function (31.9%). Patients with RHT were characterized by having the...
While clinical practice guidelines reflect the best known evidence-based approach to patient care... more While clinical practice guidelines reflect the best known evidence-based approach to patient care, it is individual clinicians and patients who make decisions and treatment choices, and individual patients who actually achieve (or not) the treatment goals. The aim of the study was to describe the population of diabetic patients attending specialty outpatient clinics, to characterize the management of patients with different types of diabetes, and to assess the accordance of management with the recommendations developed by Diabetes Poland. The OPTIMO observational study was conducted from 2006 to 2009 and included patients with diabetes diagnosed according to the 1999 World Health Organization criteria who were observed for 1 to 3 years, with control visits at least every 6 months. Participating physicians used pocket PCs equipped with specially developed software to collect patients' data and to provide educational reminders to clinicians. The final analysis involved 9600 patien...
Up-to-date evidence about levels and trends in disease and injury incidence, prevalence, and year... more Up-to-date evidence about levels and trends in disease and injury incidence, prevalence, and years lived with disability (YLDs) is an essential input into global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013), we estimated these quantities for acute and chronic diseases and injuries for 188 countries between 1990 and 2013. Estimates were calculated for disease and injury incidence, prevalence, and YLDs using GBD 2010 methods with some important refinements. Results for incidence of acute disorders and prevalence of chronic disorders are new additions to the analysis. Key improvements include expansion to the cause and sequelae list, updated systematic reviews, use of detailed injury codes, improvements to the Bayesian meta-regression method (DisMod-MR), and use of severity splits for various causes. An index of data representativeness, showing data availability, was calculated for each cause and impairment during three periods globally...
Statins produce additional beneficial effects, including attenuation of prothrombotic mechanisms.... more Statins produce additional beneficial effects, including attenuation of prothrombotic mechanisms. In patients at high cardiovascular risk, who have markedly elevated low-density lipoprotein (LDL) cholesterol levels, simvastatin can reduce thrombin generation. Moreover, we have described simvastatin-induced improvement of fibrin clot properties, the formation of which represents the final step of blood coagulation. The aim of the present study was to assess the effect of simvastatin on fibrin features observed in subjects with LDL cholesterol <3.4 mmol/l. Thirty subjects (24M, 6F) aged <70 years with LDL cholesterol <3.4 mmol/l with no history of cardiovascular events were enrolled in the study. Patients were excluded if they had diabetes mellitus, chronic inflammatory diseases and renal insufficiency. Prior to and following a 3-month treatment with simvastatin (40 mg/d), ex vivo plasma fibrin clot permeability and efficiency of clot lysis were measured. Simvastatin led to a...
The free radical/oxidative stress theory of ageing has received considerable attention, but the e... more The free radical/oxidative stress theory of ageing has received considerable attention, but the evidence on the association of oxidative stress markers with mortality is sparse. We measured derivatives of reactive oxygen metabolite (D-ROM) levels as a proxy for the reactive oxygen species concentration and total thiol levels (TTL) as a proxy for the redox control status in 10,622 men and women (age range, 45-85 years), from population-based cohorts from Germany, Poland, Czech Republic, and Lithuania, of whom 1,702 died during follow-up. Both oxidative stress markers were significantly associated with all-cause mortality independently from established risk factors (including inflammation) and from each other in all cohorts. Regarding cause-specific mortality, compared to low D-ROM levels (≤340 Carr U), very high D-ROM levels (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;500 Carr U) were strongly associated with both cardiovascular (relative risk (RR), 5.09; 95 % CI, 2.67-9.69) and cancer mortality (RR, 4.34; 95 % CI, 2.31-8.16). TTL was only associated with CVD mortality (RR, 1.30; 95 % CI, 1.15-1.48, for one-standard-deviation-decrease). The strength of the association of TTL with CVD mortality increased with age of the participants (RR for one-standard-deviation-decrease in those aged 70-85 years was 1.65; 95 % CI, 1.22-2.24). In these four population-based cohort studies from Central and Eastern Europe, the oxidative stress serum markers D-ROM and TTL were independently and strongly associated with all-cause and CVD mortality. In addition, D-ROM levels were also strongly associated with cancer mortality. This study provides epidemiological evidence supporting the free radical/oxidative stress theory of ageing and suggests that d-ROMs and TTL are useful oxidative stress markers associated with premature mortality.
Zinc may be involved in the pathophysiology and treatment of depressive disorder. However, data o... more Zinc may be involved in the pathophysiology and treatment of depressive disorder. However, data on this issue in bipolar disorder (BD) are limited. The aim of the study was to assess zinc concentrations in the blood serum of patients at various phases and stages of bipolar disorder. The study included 129 patients with a diagnosis of bipolar disorder type I (n=69) or type II (n=60). Fifty-eight were in a depressive episode, 23 in a manic episode and 48 in remission. Fifty healthy volunteers made a control group. Zinc concentration was measured using flame atomic absorption spectrometry. Serum zinc level in patients diagnosed with BD type I in the depressive phase was significantly reduced as compared with mania, remission and healthy subjects. In the BD type II, serum zinc level in hypomania, depression or remission phase was not significantly different from the control group. In the whole group, lower level of zinc in depression compared to remission and control subjects was found during late stage of the illness but not in the early stage. Zinc concentration was not dependent on the severity of manic or depressive symptoms and subtype of depression but correlated positively with the number of manic/hypomanic relapses in the past year. Lack of prospective model, heterogeneity of pharmacological treatment, small number of subgroups presenting specified clinical features. Decreased serum zinc concentration occurs in depression in BD type I and probably in depression in the late stage of BD.
There is a paucity of Polish data describing the characteristics of and assessing treatment goals... more There is a paucity of Polish data describing the characteristics of and assessing treatment goals in patients with relatively newly diagnosed type 2 diabetes. The aim of the study was to describe the baseline characteristics of patients with newly diagnosed type 2 diabetes, who participated in the ARETAEUS1 study, and to assess to what degree diabetic control criteria recommended by the Polish Diabetes Association clinical practice guidelines are met. This cross-sectional questionnaire-based study was conducted from January to April 2009. It involved patients of any age and gender, diagnosed with type 2 diabetes after January 1, 2007, and recruited by randomly selected physicians, both diabetologists and non-diabetologists. We analyzed 1714 valid questionnaires from 333 physicians: 1150 from non-diabetologists and 564 from diabetologists. Mean age of patients was 60 years, mean body mass index -- 30.6 kg/m2, proportion of females -- 50%. The levels of median glycated hemoglobin (HbA...
Alcohol has been implicated in the high mortality in Central and Eastern Europe but the magnitude... more Alcohol has been implicated in the high mortality in Central and Eastern Europe but the magnitude of its effect, and whether it is due to regular high intake or episodic binge drinking remain unclear. The aim of this paper was to estimate the contribution of alcohol to mortality in four Central and Eastern European countries. We used data from the Health, Alcohol and Psychosocial factors in Eastern Europe is a prospective multi-centre cohort study in Novosibirsk (Russia), Krakow (Poland), Kaunas (Lithuania) and six Czech towns. Random population samples of 34,304 men and women aged 45-69 years in 2002-2005 were followed up for a median 7 years. Drinking volume, frequency and pattern were estimated from the graduated frequency questionnaire. Deaths were ascertained using mortality registers. In 230,246 person-years of follow-up, 2895 participants died from all causes, 1222 from cardiovascular diseases (CVD), 672 from coronary heart disease (CHD) and 489 from pre-defined alcohol-related causes (ARD). In fully-adjusted models, abstainers had 30-50 % increased mortality risk compared to light-to-moderate drinkers. Adjusted hazard ratios (HR) in men drinking on average ≥60 g of ethanol/day (3 % of men) were 1.23 (95 % CI 0.95-1.59) for all-cause, 1.38 (0.95-2.02) for CVD, 1.64 (1.02-2.64) for CHD and 2.03 (1.28-3.23) for ARD mortality. Corresponding HRs in women drinking on average ≥20 g/day (2 % of women) were 1.92 (1.25-2.93), 1.74 (0.76-3.99), 1.39 (0.34-5.76) and 3.00 (1.26-7.10). Binge drinking increased ARD mortality in men only. Mortality was associated with high average alcohol intake but not binge drinking, except for ARD in men.
The purpose of this study was to assess educational differences in nutrient intake in women and m... more The purpose of this study was to assess educational differences in nutrient intake in women and men, and to find out how national/WHO dietary recommendation are met in different educational groups. STUDIED GROUP AND METHODS: 2310 women and men at age 35-64, Cracow residents, participants of the HAPIEE project (Health, Alcohol and Psychosocial factors in East Europe). 24 hour food recall was used to assess the average energy, fats, P/S ratio, carbohydrates, refined sugar, antioxidant vitamins (vitamin C, E and beta-carotene), fibre and calcium intake in basic, secondary and university education groups. Comparison of the data with national/WHO dietary recommendation was performed in each education group. In women and men with university and secondary education higher fat intake was observed compared to basic education group. In women and men intake of vitamin C, beta-carotene and calcium was higher in university education group compared to basic education group by 30%, 24% and 24% in women and by 20%, 15% and 25% in men respectively. Women with university education had higher vitamin E and fibre consumption compared to basic education group. Compared to WHO and national recommendations, total and saturated fat consumption was too high in both sexes and in all education groups, however profitable P/S ratio was observed in all education groups in both sexes. Vitamin C intake was too low in women and men with basic education. In women vitamin E consumption was not satisfactory in any education group. Fibre and calcium intake was low in women and men, in all education groups. There were differences between education groups in fat, carbohydrates, fibre, antioxidant vitamins and calcium intake. Compared to WHO and national recommendations, fat intake was too high and fibre and calcium intake too low in all educational groups in both sexes. Antioxidant vitamins intake was not sufficient in women and men with basic education.
Thrombosis plays a major role in the development of atherosclerosis and its acute vascular compli... more Thrombosis plays a major role in the development of atherosclerosis and its acute vascular complications. Epidemiological studies have shown that elevated levels of plasma fibrinogen are associated with an increased risk of coronary heart disease (CHD). It is not clear whether this association is linked to hemostatic functions of fibrinogen which serves as a substrate for thrombin. Generation of thrombin in vivo can be evaluated by measurement of its specific markers in plasma, i.e. thrombin-antithrombin III complex (TAT) and prothrombin fragment 1 + 2 (F1 + 2). We determined plasma levels of TAT and F1 + 2 in a population sample of southeastern Poland and evaluated relations of these markers with plasma fibrinogen, factor VII coagulant activity (FVIIc), and other known CHD risk factors. The population studied consisted of 215 men and 251 women, aged 43-75 years. Final analysis was performed on 195 men and 222 women. The distribution of plasma TAT and F1 + 2 concentrations were highly skewed with the higher median values for women than for men. Log values of TAT correlated with log values of F1 + 2 in men (r = 0.27, p &lt; 0.01) and in women (r = 0.15, p &lt; 0.05). In the regression analysis both markers were positively related to age in women but not in men. After adjustment to age there was a positive relation between TAT and fibrinogen in both sexes. In women, but not in men, F1 + 2 showed a positive association with FVIIc. Total plasma cholesterol was negatively related to TAT in women only. There was no association between thrombin generation markers and plasma triglycerides, HDL-cholesterol, LDL-cholesterol, blood pressure, cigarette smoking and body mass index (BMI). The association of plasma fibrinogen and FVIIc with thrombin generation markers points to an important role of the hemostatic system in the pathogenesis of atherosclerosis and coronary heart disease in humans.
There is a paucity of data on meeting treatment goals in patients with newly diagnosed type 2 dia... more There is a paucity of data on meeting treatment goals in patients with newly diagnosed type 2 diabetes (DM2). The aim of the study was to characterize Polish patients with newly diagnosed DM2, to assess management of hyperglycemia, and to estimate the proportion of patients achieving the criteria of disease control recommended by the national clinical practice guidelines published in 2008. ARETAEUS1 was a cross-sectional questionnaire-based study conducted in several regions of Poland in 2009 (January-April). It involved 1714 patients with DM2 of any age and sex, treated for less than 24 months, and recruited by randomly selected physicians. Only 28.9% of patients with DM2 met the goal for glycated hemoglobin (HbA1c) control (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;6.5%). In the total population, only 1.4% of all patients met all 3 goals (HbA1c, blood pressure, and lipid levels), 12.5%--2 goals, and 35.3%--only 1 goal; 50.7% did not meet any of the treatment goals. Achieving all of the treatment goals varied between the patient subgroups (in relation to the current diabetes treatment, age, sex, body mass index, and diabetes duration). Most patients with newly diagnosed DM2 do not meet all their major treatment goals, which indicates relatively low adherence to the national guideline recommendations for diabetes control and primary cardiovascular prevention in DM2. Metformin seems to be underused and titration of other glucose lowering medications may be insufficiently target-driven. Assuming that adherence to the current clinical practice guidelines is beneficial for patients, we recommend that both practitioners and patients have increased awareness of these guidelines and of the ways to achieve and maintain treatment goals.
The practice guidelines of cardiological and diabetological societies emphasise that cardiovascul... more The practice guidelines of cardiological and diabetological societies emphasise that cardiovascular (CV) risk control in diabetic patients is especially important and should be stricter than in subjects without diabetes. There are little data on the frequency of meeting treatment goals in patients with newly diagnosed diabetes mellitus type 2 (DM2). To characterise Polish patients with DM2 diagnosed within the previous two years and to assess if the treatment targets from the current (2008) guidelines of Diabetes Poland regarding control of CV risk factors are met. ARETAEUS1 was a cross-sectional questionnaire-based study conducted in various regions of Poland in 2009 (January-April). It involved 1,714 patients of all ages and both genders, who had DM2 treated for less than 24 months. They were recruited by randomly selected physicians. Total cholesterol treatment goal (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 4.5 mmol/L) was met in 22% of all patients, triglycerides treatment goal (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 1.7 mmol/L) in 44%, LDL cholesterol treatment goal (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 2.6 mmol/L) in 20% and HDL cholesterol treatment goal (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 1.0 mmol/L in men and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 1.3 mmol/L in women) in 55%. Only 13% of the overall population met the goal of blood pressure (BP) below 130/80 mm Hg. When a less restrictive BP control threshold (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 140/90 mm Hg) was applied, 48% of patients had their BP below the threshold. In the analysis of subgroups (patients with and without previous CV events; receiving 1-5 or not receiving antihypertensive drugs; receiving and not receiving statins and fibrates) we observed from 0% to 3.3% of patients meeting three (HbA1c, BP and cholesterol) treatment goals. The percentages of patients meeting two out of three treatment goals were between 8% and 33% in different subgroups. The percentages of patients meeting only one out of three treatment goals ranged from 27.8% to 46.7% or at least one - from 39% to 69%. Most patients with newly diagnosed diabetes are not meeting their treatment goals regarding control of CV risk factors, which indicates relatively low adherence to national guideline recommendations for diabetes control and primary CV prevention in DM2. Difficulties in achieving CV treatment targets in the diabetic population indicate the need for a great deal of effort on the part of clinicians and patients. Practice guidelines developers should consider what…
Higher cortical dysfunctions, like dysphasia, dysgnosia and dyspraxia, relatively frequent in the... more Higher cortical dysfunctions, like dysphasia, dysgnosia and dyspraxia, relatively frequent in the elderly, are related to progressive neurodegenerative or vascular disorders with dementia. The aim of the study was to assess the prevalence and the intensity of higher cerebral dysfunctions in the population over 65 years and to investigate the association between these disorders and the presence of other neurological abnormalities, i.e. extrapyramidal signs, primitive reflexes as well as cognitive impairment assessed by Mini-Mental State Examination (MMSE). There were 92 women and 90 men, aged from 65-78 years included in the study. All patients were interviewed for the presence of vascular risk factors. The battery of 21 detailed test of higher cerebral functions testing speech, calculation, reading, writing, praxia and gnosia were performed in each person. Extra-pyramidal signs and primitive reflexes were also examined. Among the disorders of higher cortical functions, slight dyspra...
This paper extracts the Policy Implications from ENEPRI Research Report Nos. 26-31, prepared unde... more This paper extracts the Policy Implications from ENEPRI Research Report Nos. 26-31, prepared under Work Package II of the AHEAD Project (Ageing, Health Status and Determinants of Health Expenditure) for the European Commission. Below are listed the titles of the full reports, which are available for free downloading (http://shop.ceps.eu): No. 26 Health and Morbidity in the Accession Countries: Country Report – Bulgaria, Rossitsa Rangelova, December 2006 No. 27 Health and Morbidity in the Accession Countries: Country Report – Estonia, Liis Rooväli, December 2006 No. 28 Health and Morbidity in the Accession Countries: Country Report – Hungary, Edit Remák, Róbert I. Gál and Renáta Németh, December 2006 No. 29 Health and Morbidity in the Accession Countries: Country Report – Poland, Stanisława Golinowska and Agnieszka Sowa, December 2006 No. 30 Health and Morbidity in the Accession Countries: Country Report – Slovakia, Vladimír Kvetan, Viliam Páleník, December 2006 No. 31 Health Status ...
INTRODUCTION Patients with resistant hypertension (RHT) are at high risk for coronary artery dise... more INTRODUCTION Patients with resistant hypertension (RHT) are at high risk for coronary artery disease (CAD) and cerebrovascular disease (CVD) events, compared with the general hypertensive population. OBJECTIVES To evaluate factors associated with RHT in a large sample of hypertensive patients under the care of general practitioners (GPs) and specialists in Poland. PATIENTS AND METHODS We included 12,375 patients (mean age 64.0±12.3 years; age range 18-98 years; 59% females) with hypertension treated for at least one year. Patients were divided into 3 groups: controlled hypertension, uncontrolled hypertension (not fulfilling the criteria of RHT) and RHT. RESULTS Controlled hypertension, uncontrolled hypertension and RHT were found in 47.3%, 27.9% and 24.7% of patients respectively. The RHT rate was higher in specialist offices (29.8%) and in patients with diabetes (32.5%), CAD (31.5%), CVD (33.3%) and impaired renal function (31.9%). Patients with RHT were characterized by having the...
While clinical practice guidelines reflect the best known evidence-based approach to patient care... more While clinical practice guidelines reflect the best known evidence-based approach to patient care, it is individual clinicians and patients who make decisions and treatment choices, and individual patients who actually achieve (or not) the treatment goals. The aim of the study was to describe the population of diabetic patients attending specialty outpatient clinics, to characterize the management of patients with different types of diabetes, and to assess the accordance of management with the recommendations developed by Diabetes Poland. The OPTIMO observational study was conducted from 2006 to 2009 and included patients with diabetes diagnosed according to the 1999 World Health Organization criteria who were observed for 1 to 3 years, with control visits at least every 6 months. Participating physicians used pocket PCs equipped with specially developed software to collect patients' data and to provide educational reminders to clinicians. The final analysis involved 9600 patien...
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