Egidija Rinkūnienė

Lithuanian High Cardiovascular Risk (LitHiR) primary prevention programme - rationale and design

Lithuanian High Cardiovascular Risk (LitHiR) primary prevention programme - rationale and design Objectives: According to the latest WHO data, coronary heart disease deaths in Lithuania reached 38.3% of total deaths. Based on the unfavourable situation with cardiovascular morbidity and mortality in Lithuania the Lithuanian High Cardiovascular Risk (LitHiR) programme aimed at estimation and aggressive managing of cardiovascular risk factors. This paper describes the Lithuanian High Cardiovascular Risk programme protocol. Design and methods: In 2006 the Lithuanian High Cardiovascular Risk programme was started. LitHiR programme recruited men - at the age of 40-54 years and women - 50-64 years without overt cardiovascular disease. The two-level approach - primary health care institutions (PHCI) and specialized cardiovascular prevention units (CVPU) - was applied. The subjects selected were tested for cardiovascular risk and those with high cardiovascular risk were sent to secondary (CVPU) level, for other the plan of preventive measures of risk factor reduction was created. In years 2006-2010 overall 266,391 persons (36.9% from all target population) were examined. Among them 164,657 subjects (61.8%) were tested for the first time, 68,832 (25.8%) were tested repeatedly one time, 32,848 subjects (12.3%) were tested repeatedly for two and more times. Conclusions: The programme aimed at estimation and managing of cardiovascular risk factors striving to reduce acute cardiovascular event related morbidity and mortality, to slow down the progression of sub-clinical atherosclerosis into overt cardiovascular disease, to increase the number of newly identified cases of diabetes, metabolic syndrome and latent course of atherosclerosis related diseases, to decrease hospitalizations for treatment of arterial hypertension and coronary heart disease.

Vitamin D and functional arterial parameters in postmenopausal women with metabolic syndrome

PURPOSE Our cross sectional study aimed to identify the relation between vitamin D level and functional arterial parameters in postmenopausal women with metabolic syndrome. MATERIAL AND METHODS 100 postmenopausal women at age 50-65 with diagnosed metabolic syndrome were included in this study. Laboratory tests were performed to determine lipid profile, serum glucose, creatinine, C-reactive protein, serum levels of 25(OH) D, ionized calcium and urine albumin/creatinine ratio. Also non-invasive assessment of arterial function (arterial stiffness, flow-mediated dilatation and carotid artery ultrasound examinations) was performed. RESULTS The mean vitamin D blood concentration was 47.4±16.9nmol/l. The prevalence of modest insufficiency and deficiency of vitamin D was 62%. Vitamin D concentration in samples assembled from January to March was significantly lower than concentration levels from September to November. No significant relationship was observed between vitamin D and endothelial function, arterial stiffness, carotid intima-media thickness. Week negative correlation was stated between mean arterial pressure and 25(OH) D concentration (p=0.04). A positive correlation was found between high density lipoprotein cholesterol and vitamin 25(OH) D (r=0.3, p<0.05). No significant difference between 25(OH) D and other lipoproteins, calcium ions, glucose, albumin/creatinine ratio and C-reactive protein blood concentrations were found. CONCLUSIONS The prevalence of vitamin D deficiency in postmenopausal women with metabolic syndrome is high. No relation was found between vitamin D levels and parameters that indicate atherosclerotic vascular lesions. Nevertheless our study revealed the relation between concentrations of vitamin D and mean blood pressure and high density lipoprotein cholesterol.

The prevalence of dislipidemia and its relation to other risk factors: a nationwide survey of Lithuania

Abstract Aim: The aim of this study was to assess the prevalence of dyslipidemia and its relation to other cardiovascular risk factors in Lithuania. Design & methods: The Lithuanian High Cardiovascular Risk Primary Prevention program recruited men and women without overt cardiovascular disease. This report describes the group of 23,204 subjects. Results: Dyslipidemia was diagnosed in 89.7% of subjects. All the main cardiovascular risk factors except for smoking were present more often among patients with dyslipidemia. The average number of risk factors (arterial hypertension, abdominal obesity, diabetes mellitus, metabolic syndrome, smoking, insufficient physical activity, unbalanced diet and family history of CVD) in subjects with dyslipidemia was 3.09 (compared with 2.42 in subjects without it). Conclusion: Dyslipidemia is a most frequent risk factor among middle-aged Lithuanian subjects without cardiovascular disease and has been diagnosed in nine out of ten subjects.

Prevalence of cardiovascular risk factors in Lithuanian middle-aged subjects participating in the primary prevention program, analysis of the period 2009–2012

Abstract Background. The aim of this study was to assess the prevalence and changes of cardiovascular risk factors in the middle-aged Lithuanian subjects after conducting the primary prevention program. Design and methods. Four cross-sectional investigations of cardiovascular risk factors were conducted in 2009 (n = 9625), 2010 (n = 7716), 2011 (n = 5018) and 2012 (n = 4348). The program recruited men aged 40–54 and women aged 50–64 without overt cardiovascular disease. Results. During the period 2009–2012, the mean number of risk factors significantly increased (from 3.95 to 4.03, p < 0.001), while the numbers of people having metabolic syndrome (from 34.1% to 28.7%; p < 0.001), arterial hypertension (from 60.2% to 54.5%; p < 0.001), the average body mass index (BMI) value (from 29.17 to 28.92 kg/m2; p = 0.001) and abdominal obesity (from 48.4% to 45.3%; p < 0.001) significantly decreased. The percentage of subjects with dyslipidemia, as well as the average values of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglycerides, remained unchanged. The percentage of smoking subjects have significantly increased (from 19.3% to 22.7%; p < 0.001). Conclusions. The analysis showed that the prevalence of arterial hypertension, metabolic syndrome and obesity in Lithuania is slowly decreasing while conducting the primary prevention program; however, dyslipidemia, diabetes mellitus and smoking are still hard to manage for both genders.

The fact not to ignore: Mean blood pressure is the main predictor of increased arterial stiffness in patients with systemic rheumatic diseases

PURPOSE We aimed to evaluate the association between carotid-radial pulse wave velocity (PWV), augmentation index (AIx), and flow-mediated dilatation (FMD) of the brachial artery and factors potentially influencing them in patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and systemic sclerosis (SSc). MATERIAL AND METHODS 316 patients diagnosed with RA (32%), SLE (20%), SSc (16%) and 156 controls (32%) were included in the study. Parameters of arterial stiffness AIx and PWV were obtained using applanation tonometry. FMD reflecting endothelial function was measured by ultrasound. RESULTS AIx was increased in all three diseases (p<0.0001), but no differences were found between rheumatic diseases. In most of the RA cases PWV values were abnormal (on average by 0.52m/sec higher than in controls), while in SSc patients FMD values were diminished (p=0.006). Mean blood pressure (MBP) was the most consistent predictive factor in all three diseases, influencing both PWV and AIx, although patient age was also important in variation of AIx. The disease activity score (DAS28) was relevant only in RA patients. Furthermore, SLE disease activity index in SLE or Rodnan skin thickness score had no statistical significance in SSc and inflammatory markers. CONCLUSIONS Both, PWV and AIx are dependent on MBP and age DAS28 may affect AIx in RA patients, while other disease or inflammatory markers are unlikely to have any effect. MBP is one of the main cardiovascular risk factors affecting the arterial stiffness in RA, SLE and SSc patients therefore controlling MBP in systemic rheumatic disease patients is mandatory.

Prevalence of high-risk profile in middle-aged subjects with arterial hypertension: A nationwide survey

Abstract Hypertension is the most common non-communicable disease and the leading cause of cardiovascular disease in the world. It presents an important public health challenge in both economically developed and developing countries. In 2006, the Lithuanian High Cardiovascular Risk programme was launched. The programme recruited men aged 40–54 and women aged 50–64 without overt cardiovascular disease. We analysed a group of 23,204 subjects included in the programme at the primary level. Arterial hypertension was present in 57.6% of the subjects: 63.2% in the females and 49.2% in the males. In the hypertensive middle-aged subjects, grade 1 hypertension was present in 53.1%, grade 2 in 22.4%, and grade 3 in merely 5.9% of the subjects. The prevalence of a minimum of three concomitant risk factors among the hypertensive patients was 78.0%, compared with 52.1% in the patients without hypertension (p < 0.001). Blood pressure goals were attained in 20.8% of the hypertensive women and in 14.4% of the hypertensive men. In Lithuania, a high prevalence of hypertension was characteristic of middle-aged subjects. Although the blood pressure elevation had not reached high levels, the presence of at least three risk factors concomitant to hypertension was more expressed in them compared with the non-hypertensive subjects.

Diagnostic value of electrocardiogram stress testing in patients with metabolic syndrome

Summary Objectives:The aim of this study was to assess the diagnostic value of exercise stress testing to detect coronary heart disease (CHD) in the group of patients with metabolic syndrome. Design and methods: 2803 patients without prior diagnosis of CHD and identified metabolic syndrome were investigated. Subjects underwent electrocardiogram (ECG) stress testing and, depending on the results, coronary angiography and/or coronary computed tomography angiography to detect hemodynamically significant stenosis. CHD was confirmed, if lumen narrowing ≥ 50% of coronary arteries was found. Results: Exercise stress testing was interpreted as positive in 12% patients (71.7% women and 28.3% men). CHD was diagnosed in 45 patients (1.6%), 23 of them had positive exercise stress testing. ECG stress testing was more frequently positive in patients, who had typical/atypical anginal chest pain, dyspnea and/or non-anginal chest pain, in comparison to asymptomatic patients (16.6% vs 8.9%, p <0.001). CHD was more often diagnosed in symptomatic patients compared to patients with no symptoms (6.1% vs 0.7%, p < 0.001, women 5.3% vs 0.6%, p < 0.001, men respectively 8% vs 0.8%, p < 0.001). Conclusions: Diagnostic value of exercise stress testing for detecting CHD is limited in population with metabolic syndrome. CHD was more prevalent in patients with chest pain or dyspnea than in asymptomatic patients.