Andrzej Pająk

Vitamin D and mortality: meta-analysis of individual participant data from a large consortium of cohort studies from Europe and the United States

Objective To investigate the association between serum 25-hydroxyvitamin D concentrations (25(OH)D) and mortality in a large consortium of cohort studies paying particular attention to potential age, sex, season, and country differences. Design Meta-analysis of individual participant data of eight prospective cohort studies from Europe and the US. Setting General population. Participants 26 018 men and women aged 50-79 years Main outcome measures All-cause, cardiovascular, and cancer mortality. Results 25(OH)D concentrations varied strongly by season (higher in summer), country (higher in US and northern Europe) and sex (higher in men), but no consistent trend with age was observed. During follow-up, 6695 study participants died, among whom 2624 died of cardiovascular diseases and 2227 died of cancer. For each cohort and analysis, 25(OH)D quintiles were defined with cohort and subgroup specific cut-off values. Comparing bottom versus top quintiles resulted in a pooled risk ratio of 1.57 (95% CI 1.36 to 1.81) for all-cause mortality. Risk ratios for cardiovascular mortality were similar in magnitude to that for all-cause mortality in subjects both with and without a history of cardiovascular disease at baseline. With respect to cancer mortality, an association was only observed among subjects with a history of cancer (risk ratio, 1.70 (1.00 to 2.88)). Analyses using all quintiles suggest curvilinear, inverse, dose-response curves for the aforementioned relationships. No strong age, sex, season, or country specific differences were detected. Heterogeneity was low in most meta-analyses. Conclusions Despite levels of 25(OH)D strongly varying with country, sex, and season, the association between 25(OH)D level and all-cause and cause-specific mortality was remarkably consistent. Results from a long term randomised controlled trial addressing longevity are being awaited before vitamin D supplementation can be recommended in most individuals with low 25(OH)D levels.

Estimated dietary intake and major food sources of polyphenols in the Polish arm of the HAPIEE study.

Objective The aim of this study was to estimate the intake of known individual polyphenols and their major dietary sources in the Polish arm of the HAPIEE (Health, Alcohol and Psychosocial factors In Eastern Europe) study. Methods A total of 10,477 random sample (45–69 y) of urban population of Krakow, Poland, completed a validated 148-item food frequency questionnaire. Polyphenol intake was calculated by matching food consumption data with the recently developed Phenol-Explorer database. Results The mean intake of polyphenols was 1756.5 ± 695.8 mg/d (median = 1662.5 mg/d). The main polyphenol groups were flavonoids (897 mg/d) and phenolic acids (800 mg/d). A total of 347 polyphenols from 19 polyphenol subclasses were found. The individual compounds with the highest intakes were isomers of chlorogenic acid (i.e., 5-caffeoylquinic acid and 4-caffeoylquinic acid) among hydroxycinnamic acids (average intake 150 mg/d), that largely originated from coffee, and compounds belonging to the catechin chemical family (i.e., [+]-gallocatechin, [-]-epigallocatechin 3-O-gallate, and [-]-epicatechin) among flavanols (average intake 50 mg/d), that mostly originated from tea and cocoa products. Conclusions The current study provides the most updated data for individual polyphenols intake in the diet of a well-established nutritional cohort. These findings will be useful to assess potential beneficial role on health of specific foods with high polyphenol content and characterize the effects of individual phenolic compounds.

Validity and reliability of three commonly used quality of life measures in a large European population of coronary heart disease patients

OBJECTIVE To investigate the validity and reliability of the EuroQol-5D (EQ-5D), the 12-item Short-Form Health Survey (SF-12v2), and the Hospital Anxiety and Depression Scale (HADS) in a stable coronary population. STUDY DESIGN Cross-sectional study EUROASPIRE III. SETTING Quality of life data (QoL) were available on 8745 patients hospitalized for coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), acute myocardial infarction (AMI), or myocardial ischemia. They were interviewed and examined at least 6 months after their hospital admission. Reliability and validity of the 3 instruments were tested. Internal consistency, and discriminative, convergent, criterion and construct validity were assessed. RESULTS Cronbachs alpha indicated good internal consistency for all measures (0.73 to 0.87). Discriminative validity analyses confirmed significant QoL differences between known groups: age, gender, educational level. In addition, all hypothesized correlations between QoL constructs (convergent validity) and items (criterion validity) were confirmed with significant correlations. Confirmatory factor analyses indicated good construct validity for HADS and SF-12v2. On country-specific level, results were roughly similar. CONCLUSION The EQ-5D as well as the SF-12v2 and the HADS are reliable and valid instruments for use in a stable coronary population, both on aggregate European level and on country-specific level. However, our results must be generalized with caution, because EUROASPIRE III patients might not be representative for all patients with stable coronary heart disease.

Health related quality of life in coronary patients and its association with their cardiovascular risk profile: Results from the EUROASPIRE III survey

BACKGROUND Cardiovascular patients are likely to have an impaired health-related quality of life (HRQoL) due to functional and psycho-social limitations. The main objective of this study was to assess the distribution of HRQoL scores in coronary heart disease (CHD) patients across 22 European countries and to identify factors associated with the variation between patients. METHODS Data from the EUROASPIRE III survey (European Action on Secondary and Primary Prevention by Intervention to Reduce Events), on 8734 patients, were used. Patients with a diagnosis of CHD (coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), acute myocardial infarction (AMI) or myocardial ischemia) were interviewed and examined at least 6 months after their acute coronary event. Quality of life of each patient was measured using 2 standardized questionnaires: the EuroQoL-5D (EQ-5D) and the 12-item short-form health survey (SF-12v2). RESULTS HRQoL values differed significantly across countries. Lower HRQoL estimates were found in women, older patients, less educated patients, patients with myocardial infarction or ischemia as recruiting diagnosis, patients with a history of stroke and patients who suffered from a recurring CHD event. In addition, HRQoL was significantly associated with current smoking, central obesity, lack of exercise and inappropriate HbA1c control in patients with diabetes. Furthermore the number of risk factors is inversely associated with HRQoL. CONCLUSION Overall, a large heterogeneity was observed in HRQoL values between countries and patient groups. There seems to be a significant association between quality of life and patient characteristics with lifestyle risk factors as important determinants of HRQoL.

Depression, anxiety, and risk factor control in patients after hospitalization for coronary heart disease: the EUROASPIRE III Study:

Objective: To assess in coronary heart disease (CHD) patients: (1) differences in the prevalence of depression and anxiety between samples selected from 22 countries; (2) the association of depression and anxiety with age, education, diagnostic category, favourable behaviours, use of cardioprotective drugs, and reaching the secondary prevention treatment targets. Design: Cross-sectional study. Methods: The study group consisted of 8580 patients from 22 European countries examined at least 6 months after hospitalization due to CHD. Depression and anxiety were assessed using Hospital Anxiety and Depression Scale (HADS). Results: Prevalence of depression (HADS depression score ≥8) varied from 8.2% to 35.7% in men and from 10.3% to 62.5% in women. Prevalence of anxiety (HADS anxiety score ≥8) varied from 12.0% to 41.8% in men and from 21.5% to 63.7% in women. Older age, female sex, low education, and no history of invasive treatment were associated with more frequent depression and anxiety. Depression and anxiety were associated with less frequent modification of lifestyle. Depression was related with body mass index, waist circumference, fasting glucose, and more frequent self-reported diabetes but not with reaching the treatment targets for blood pressure and lipids. Conclusions: High prevalence of depression and anxiety in CHD patients, and relation with less frequent lifestyle modification, call to integrate methods of identification and minimizing unfavourable effects of depression and anxiety into the cardiac rehabilitation and prevention programmes.

Cost-effectiveness of optimizing prevention in patients with coronary heart disease: the EUROASPIRE III health economics project

AIMS The EUROASPIRE III survey indicated that the guidelines on cardiovascular disease prevention are poorly implemented in patients with established coronary heart disease (CHD). The purpose of this health economic project was to assess the potential clinical effectiveness and cost-effectiveness of optimizing cardiovascular prevention in eight EUROASPIRE III countries (Belgium, Bulgaria, Croatia, Finland, France, Italy, Poland, and the U.K.). METHODS AND RESULTS The individual risk for subsequent cardiovascular events was estimated, based on published Framingham equations. Based on the EUROASPIRE III data, the type of suboptimal prevention, if any, was identified for each individual, and the effects of optimized tailored prevention (smoking cessation, diet and exercise, better management of elevated blood pressure and/or LDL-cholesterol) were estimated. Costs of prevention and savings of avoided events were based on country-specific data. A willingness to pay threshold of €30,000/quality-adjusted life year (QALY) was used. The robustness of the results was validated by sensitivity analyses. Overall, the cost-effectiveness analyses for the eight countries showed mainly favourable results with an average incremental cost-effectiveness ratio (ICER) of €12,484 per QALY. Only in the minority of patients at the lowest risk for recurrent events, intensifying preventive therapy seems not cost-effective. Also, the single impact of intensified cholesterol control seems less cost-effective, possibly because their initial 2-year risk was already fairly low, hence the room for improvement is rather limited. CONCLUSION These results underscore the societal value of optimizing prevention in most patients with established CHD, but also highlight the need for setting priorities towards patients more at risk and the need for more studies comparing intensified prevention with usual care in these patients.

Socio-demographic and lifestyle correlates of commuting activity in Poland.

OBJECTIVES The aim of this study is to analyse the epidemiology of active transportation and to investigate the relationship between commuting physical activity (PA) and socio-demographic and lifestyle characteristics in Poland. METHODS A cross sectional analysis was conducted among 7280 randomly selected individuals (3747 men and 3533 women) aged 20-74 years participating in the National Multicentre Health Survey WOBASZ (2002-2005). Socio-demographic, smoking and physical activity details were assessed by an interviewer-administered questionnaire. RESULTS Only 36% of the participants (30% men and 42% of women) are active commuters. Moreover, 55.4% of them spend less than 15 min/day on walking or cycling. The highest risk of commuting inactivity was noticed among residents of large urban settings, with university education, the highest income and low occupational PA in both genders. Smoking and leisure-time PA were not significantly associated with commuting activity. CONCLUSIONS Active commuting is not common in Poland. There are several differences in commuting patterns as compared with the US or Western European populations. Due to important differences between various socio-demographic groups, future interventions should be specific for the targeted subpopulations.

Commuting physical activity and prevalence of metabolic disorders in Poland

OBJECTIVES The aim of this study was to examine the relationship between walking or cycling to work and prevalence of metabolic syndrome (MetS) and its components. METHODS Cross-sectional analysis of 6401 randomly selected individuals (3297 men and 3104 women) aged 20-74 years, who participated in the National Multicentre Health Survey WOBASZ, Poland (2002-2005). Commuting physical activity (PA) was assessed by asking about type and time spent on transportation to/from work using an interviewer-administered questionnaire. Weight, height, waist circumference (WC), blood pressure (BP), fasting plasma glucose (FPG), triglycerides (TG) and high-density cholesterol, (HDL-C) were measured by standard methods. MetS was defined according to the NCEP-ATP III and IDF criteria. RESULTS Active commuting was associated with decreased likelihood of abdominal obesity (WC≥94 cm), lower HDL-C and elevated TG in men and abdominal obesity (WC≥80 cm) in women. In a subgroup of postmenopausal women (n=317) active commuting was favourably associated with abdominal obesity, low HDL-C and elevated FPG. Prevalence of MetS was significantly lower among those who spent above 30 min/day daily on walking/cycling to work than among other gender subgroups. CONCLUSION Increasing of commuting PA level may have an important influence on reducing the prevalence of metabolic disorders.

A Mediterranean-type diet is associated with better metabolic profile in urban Polish adults: Results from the HAPIEE study

Objective The aim of this study was to evaluate the relationship between adherence to a Mediterranean-type diet and metabolic syndrome (MetS) in the Polish arm of the Health, Alcohol and Psychosocial factors In Eastern Europe (HAPIEE) cohort study. Materials/methods A cross-sectional survey including 8821 adults was conducted in Krakow, Poland. Food intake was evaluated through a validated food frequency questionnaire and adherence to the dietary pattern was assessed using a score specifically developed for non-Mediterranean countries (MedTypeDiet score). Linear and logistic regression models were performed to estimate beta and odds ratios (ORs) and 95% confidence intervals (CIs), respectively. Results Significant associations between the MedTypeDiet score and waist circumference (β = − 0.307 ± 0.239 cm), systolic blood pressure (β = − 0.440 ± 0.428 mmHg), and triglycerides (β = − 0.021 ± 0.016 mmol/L) were observed. After multivariable adjustment, individuals in the highest quartile of the score were less likely to have MetS, central obesity, high triglycerides, and hypertension. Increase of one standard deviation of the score was associated with 7% less odds of having MetS (OR 0.93, 95% CI: 0.88, 0.97). When analyzing the relation of single components of the MedTypeDiet score, wine, dairy products, and the total unsaturated:saturated fatty acids ratio were associated with MetS. Conclusions Adherence to a Mediterranean-like diet may decrease the risk of MetS also among non-Mediterranean populations.

Smoking status, the menopausal transition, and metabolic syndrome in women.

ObjectiveData on the relationship between tobacco use and metabolic risk among women with regard to their menopause status are scarce. This study assessed the prevalence of metabolic disorders in relation to smoking status in premenopausal and postmenopausal women. MethodsA cross-sectional analysis of 7,462 randomly selected women aged 20 to 74 years who are participating in the WOBASZ (Polish National Multicentre Health Survey) was carried out. Lifestyle and menopause status details were collected via an interviewer-administered questionnaire. Weight, height, waist circumference, blood pressure, fasting plasma glucose, triglycerides, and high-density lipoprotein cholesterol (HDL-C) levels were measured by standard methods. Metabolic syndrome (MetS) was defined according to the International Diabetes Federation criteria. ResultsThe prevalence of MetS was 3.3-fold higher among postmenopausal than premenopausal women. Regardless of menopause status, the prevalence of central obesity was significantly higher among never and past smokers versus current smokers (P < 0.001). Past smoking was associated with a significantly higher probability of elevated blood pressure, fasting plasma glucose, and MetS (P < 0.05). However, premenopausal never and past smokers had a substantially lower prevalence of decreased HDL-C than did current smokers. Among postmenopausal nonsmoking women, high levels of leisure time and commuting physical activity were associated with a reduced likelihood of MetS (P < 0.01). Making an additional adjustment for calorie consumption did not substantially influence the results. ConclusionsExcept for HDL-C level, not smoking is associated with an unfavorable metabolic profile in women, regardless of menopause status. High level of physical activity may reduce the prevalence of MetS among never and past smokers after the menopausal transition.