Maciej Polak

Coffee consumption and risk of hypertension in the Polish arm of the HAPIEE cohort study

Background/Objectives:Coffee consumption has been hypothesized to be associated with blood pressure (BP), but previous findings are not homogeneous. The aim of this study was to evaluate the association between coffee consumption and the risk of developing hypertension.Subjects/Methods:Data on coffee consumption, BP and use of anti-hypertensive medicament were derived from 2725 participants of the Polish arm of the HAPIEE project (Health, Alcohol and Psychosocial factors In Eastern Europe) who were free of hypertension at baseline and followed up for an average of 5 years. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by multivariate logistic regression analyses and stratified for potential confounding factors.Results:Coffee consumption was related to decreased age, smoking status and total energy intake. Compared with persons who drink <1 cup coffee per day, systolic BP was significantly associated with coffee consumption and the risk of hypertension was lower for individuals consuming 3–4 cups per day. Despite the analysis stratified by gender showed that the protective effect of coffee consumption on hypertension was significant only in women, the analysis after stratification by smoking status revealed a decreased risk of hypertension in non-smokers drinking 3–4 cups of coffee per day in both sexes (OR 0.41, 95% CI: 0.21, 0.79 for men and OR 0.54, 95% CI: 0.29, 0.99 for women). Upper category coffee consumption (>4 cups per day) was not related to significant increased risk of hypertension.Conclusions:Relation between coffee consumption and incidence of hypertension was related to smoking status. Consumption of 3–4 cups of coffee per day decreased the risk of hypertension in non-smoking men and women only.

Prevalence of familial hypercholesterolemia: a meta-analysis of six large, observational, population-based studies in Poland.

Introduction Familial hypercholesterolemia (FH) is a severely underdiagnosed and undertreated genetic disorder. Little is known about regional variation in the prevalence of FH, and information for Central and Eastern Europe (CEE) is scarce. This paper assesses the prevalence of FH and related cardiovascular disease (CVD) risk factors in Poland. Material and methods We performed a meta-analysis of six population-based studies in Poland. The FH was assessed using the Dutch Lipids Clinics Network (DLCN) criteria. The categories “definite” (> 8 points) and “probable” (6–8 points) were combined into “potential FH”. Combined estimates of proportions across studies were pooled by meta-analysis with a random effects model. Results A total of 37,889 persons aged 20–79 years were included in the analysis. The distribution of DLCN scores was skewed, and there were only 7 cases of definite FH. Prevalence of potential FH was 404/100,000 people (95% CI = 277–531/100,000). Familial hypercholesterolemia was more prevalent in women than in men, and the prevalence was the highest in the age group 45–54 years in men and 55–64 years in women. After adjustment for age and sex, compared to participants with normal cholesterol, persons with potential FH had twice the prevalence of hypertension (p < 0.01); smoking was more prevalent by about 80% (p < 0.01) and hypertriglyceridemia was nine times more frequent (p < 0.001). There was no difference in the prevalence of low high-density lipoprotein (HDL)-cholesterol or diabetes. Conclusions We believe that our study might facilitate the planning of a strategy to manage the disease at a population level, i.e. to develop a national strategy for the detection, diagnosis, and treatment of FH.

Association between tea and coffee consumption and prevalence of metabolic syndrome in Poland – results from the WOBASZ II study (2013–2014)

Abstract The study aimed to assess a relationship between tea and coffee consumption and metabolic syndrome (MetS). Cross-sectional study of a random sample of total Polish population was done (The WOBASZ II Study), and the present analysis included 5146 participants at age 20 years and above. Tea and coffee consumption was assessed by 24-h recall method. MetS was defined according to IDF/NHLBI/AHA criteria. After adjustment for covariates, coffee consumption was related to blood pressure and HDL cholesterol, and moderate drinkers had 17% lower odds of MetS compared with non-drinkers (OR = 0.83, 95%CI = 0.72–0.97). Tea consumption was related to some components but not to MetS in general. Inverse association between coffee consumption and MetS may reflect the content of the antioxidants that offer cardiovascular protection. However, weak relation of tea with components of MetS points toward the potential importance of composition of polyphenols and the types of tea consumed.

Risk and surrogate benefit for pediatric Phase I trials in oncology: A systematic review with meta-analysis

Background Pediatric Phase I cancer trials are critical for establishing the safety and dosing of anti-cancer treatments in children. Their implementation, however, must contend with the rarity of many pediatric cancers and limits on allowable risk in minors. The aim of this study is to describe the risk and benefit for pediatric cancer Phase I trials. Methods and findings Our protocol was prospectively registered in PROSPERO (CRD42015015961). We systematically searched Embase and PubMed for solid and hematological malignancy Phase I pediatric trials published between 1 January 2004 and 1 March 2015. We included pediatric cancer Phase I studies, defined as “small sample size, non‑randomized, dose escalation studies that defined the recommended dose for subsequent study of a new drug in each schedule tested.” We measured risk using grade 3, 4, and 5 (fatal) drug-related adverse events (AEs) and benefit using objective response rates. When possible, data were meta-analyzed. We identified 170 studies meeting our eligibility criteria, accounting for 4,604 patients. The pooled overall objective response rate was 10.29% (95% CI 8.33% to 12.25%), and was lower in solid tumors, 3.17% (95% CI 2.62% to 3.72%), compared with hematological malignancies, 27.90% (95% CI 20.53% to 35.27%); p < 0.001. The overall fatal (grade 5) AE rate was 2.09% (95% CI 1.45% to 2.72%). Across the 4,604 evaluated patients, there were 4,675 grade 3 and 4 drug-related AEs, with an average grade 3/4 AE rate per person equal to 1.32. Our study had the following limitations: trials included in our review were heterogeneous (to minimize heterogeneity, we separated types of therapy and cancer types), and we relied on published data only and encountered challenges with the quality of reporting. Conclusions Our meta-analysis suggests that, on the whole, AE and response rates in pediatric Phase I trials are similar to those in adult Phase I trials. Our findings provide an empirical basis for the refinement and review of pediatric Phase I trials, and for communication about their risk and benefit.

Differences in knowledge among patients with atrial fibrillation receiving non-vitamin K antagonist oral anticoagulants and vitamin K antagonists

BACKGROUND Non-vitamin K antagonist oral anticoagulants (NOACs) are increasingly used for stroke prevention in patients with atrial fibrillation (AF) worldwide. Few articles have compared current understanding of AF patients about the disease and anticoagulant therapy in relation to the medications used. AIM We sought to compare the knowledge of AF and anticoagulation between AF patients treated with NOACs and those on vitamin K antagonists (VKAs). METHODS We used the Jessa AF Knowledge Questionnaire (JAKQ), developed and validated in Belgium. Patients were re-cruited at a tertiary centre in Kraków, Poland. RESULTS A total of 479 AF patients completed the JAKQ. Patients on NOACs (n = 276, 57.6%) compared with those on VKAs (n = 175, 36.5%) did not differ regarding demographic and clinical variables. The mean score of the JAKQ was very similar in the NOAC and VKA group (60.7 ± 17.0% vs. 61.6 ± 17.1%; p = 0.4, respectively). The differences in the proportion of correct responses referred to three questions. Consequences of AF, such as blood clots and cerebral infarction, were more obvious for patients on NOACs compared with those on VKAs (81.5% vs. 70.9%; p = 0.01). The patients on NOACs (78.7% vs. 67.6%; p = 0.009) more frequently considered consulting a physician for advice concerning anticoagulant treatment before surgery, while fewer patients on NOACs were aware of the need to take their medication even if they did not feel AF (76.1% vs. 89.7%; p = 0.0004). Only 25.9% of the VKA patients and 49.3% of the NOAC users knew what to do if they missed a dose of the anticoagulant. CONCLUSIONS The knowledge of arrhythmia and anticoagulation is better regarding the safety issues among subjects on NOACs compared with those on VKAs. Irrespective of the type of oral anticoagulation therapy, education of AF patients should be improved.

Relationship between past myocardial infarction, periodontal disease and Porphyromonas gingivalis serum antibodies: A case-control study

BACKGROUND The relationship between chronic periodontitis (CP) and increased risk for cardiovas-cular disease (CVD) is known but quantitative assessments and mechanisms are not fully understood. The aim of this study was to assess the relationship between past myocardial infarction (MI) and the severity of CP, and the level of serum antibody titer against Porphyromonas gingivalis gingipains. METHODS The study sample consisted of 97 patients after MI and 113 high risk controls with no history of coronary heart disease (CHD) matched with age, sex and place of residence (urban vs. rural). Data on the history of CHD and presence of risk factors were collected. Periodontal status was assessed using the Community Periodontal Index (CPI), clinical attachment loss (CAL), bleeding on probing (BOP) and pocket depth. RESULTS After adjustment for potential confounders patients with BOP = 20-50% and BOP > 50% had more than four times higher odds of past MI (OR = 4.56; 95% CI 2.03-10.27). Patients with CPI code = 4 had a three times higher odds of past MI (OR = 3.18, 95% CI 1.01-10.06). CAL ≥ 6 was related to higher odds of past MI (OR = 1.28, 95% CI 1.11-1.49). Patients with moderate antibody titer levels had an almost 3 times higher odds of past MI (OR = 2.82, 95% CI 1.02-7.84). CONCLUSIONS There was an association between CP and past MI, which was independent of classical CVD risk factors and confirmed by an association between past MI and immunological reaction against P. gingivalis gingipains.

Cardiovascular risk assessment, cardiovascular disease risk factors, and lung function parameters

BACKGROUND Decreased lung function is related to higher cardiovascular disease (CVD) incidence and mortality. However, little is known about the relationship between the risk factors of CVD and pulmonary function. AIM The aim of the study was to assess the relationship between the prevalence of cardiovascular risk factors, the total CVD risk, and pulmonary function. METHODS The analysis included 4104 men and women aged 45 to 69 years, participants of the Polish part of the Health, Alcohol, and Psychosocial factors In Eastern Europe (HAPIEE) Project, who provided valid measurements of forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) using a Micro-Medical Microplus spirometer. The prevalence of CVD risk factors was defined as follows: hypertension (systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg or taking hypertension medication), diabetes (glucose ≥ 7.1 mmol/L or self-reported diabetes), and hypercholesterolaemia (total cholesterol ≥ 5 mmol/L or low-density lipoprotein-cholesterol ≥ 3 mmol/L or taking lipid lowering medication). Categories of total CVD risk were defined according to the 2016 European Guidelines on CVD prevention in clinical practice. The analysis of covariance was used to compare the lung function in the CVD risk factors and the total CVD risk categories. RESULTS Mean values of FEV1 and FVC, adjusted for age and height, were significantly higher in men than in women (3.02 L; 95% confidence interval [CI] 2.96-3.08 L vs. 2.52 L; 95% CI 2.45-2.63 L for FEV1 and 3.62 L; 95% CI 3.56-3.69 L vs. 3.05 L; 95% CI 2.98-3.12 L for FVC). Obesity was significantly associated with FVC in men and women; it was associated with FEV1 only in men. Compared with participants with normal body mass index, obese men and women had 280 mL and 112 mL lower mean FVC, respectively. Men without hypertension had almost 100 mL higher mean FVC than those with hypertension. The difference in FVC in women was approximately 80 mL. Diabetes was associated with lower values of FVC in both sexes and with FEV1 in women. A significant negative trend was observed in the mean FVC and FEV1 by the considered CVD risk categories. CONCLUSIONS Impaired lung function was associated with higher CVD risk, which could be explained partly by an adverse association between lung function and prevalence of obesity, hypertension, and diabetes.

Prevalence, awareness, treatment and control of hypertension in the adult Polish population – Multi-center National Population Health Examination Surveys – WOBASZ studies

Introduction Hypertension is one of the main risk factors of cardiovascular diseases. The first aim of the study was to evaluate the prevalence, awareness and treatment of hypertension as well as treatment effectiveness (blood pressure < 140/90 mm Hg) in a representative sample of the Polish population over the age of 19, examined in the WOBASZ II program. The second aim was to assess the changes in these parameters between 2003–2005 (WOBASZ study) and 2013–2014 in adults aged 20–74. Material and methods Sampling was performed in three stages, stratified according to voivodeship (province), type of commune, and gender. Finally, the study included 6163 persons (3406 women and 2757 men) examined in the years 2013–2014 (aged ≥ 19 years). For comparison the data from 14 755 persons (7783 women and 6452 men aged 20–74 years) examined in the years 2003–2005 were used. Results In the years 2013–2014, the age-standardized prevalence of hypertension, awareness, treatment and control was 42.7%, 59.3%, 46.1%, and 23% respectively. In the last decade an increase in the prevalence of hypertension (relative ratio (RR) 1.12; 95% confidence interval (CI): 1.07–1.18), treatment (RR = 1.26; 95% CI: 1.17–1.36) and control (RR = 2.16; 95% CI: 1.9-12.45) was found. In contrast, the awareness decreased nonsignificantly (RR = 0.98; 95% CI: 0.92–1.05). Conclusions The prevalence of hypertension in Poland is high, and increased by about 12% in 10 years. Although the number of treated patients and blood pressure control improved nearly twofold over the last decade, this is still below expectations. Efforts to improve the diagnosis and effective treatment of hypertension in Poland should still be intensified.

Study on changing patterns of reproductive behaviours due to maternal features and place of residence in Poland during 1995-2014.

INTRODUCTION The sharp decline in the total fertility rate in Poland coincided with broader socio-economic changes, which resulted in its reduction to the lowest level observed among the countries of Central and Eastern Europe. Objective. The aim of the study was to investigate and evaluate the changing patterns of reproductive behaviour in rural and urban areas, depending on the demographic and socio-economic features in Poland. MATERIAL AND METHODS Information about live births in Poland in the years 1995-2014 were obtained from the Central Statistical Office. Registered cases of live births in rural and urban areas were analyzed considering the maternal features (age, marital status, main source of income). To evaluate the changes in fertility and comparisons between rural and urban areas, Joinpoint Regresssion was used. RESULTS In 1995-2014, a shift in the age of highest fertility from 20-24 years to 25-29 years was observed. This occurred at the same time as a reduction in the fertility rate per 1,000 women aged 15-29 years, more pronounced in rural areas (95.8 to 60.0) than in urban areas (63.4 to 51.5), while in women aged 30-49 years, a faster increase in fertility was observed in urban areas (16.4 to 32.0) than in rural areas (27.5-29.2). Fertility trends between rural and urban areas differed significantly. A significant increase in live births for employed mothers was shown mainly in 2005-2009; later, the growth rate in rural areas was slower and in urban areas the growth trend stopped. CONCLUSIONS The postponement of births and reduction of fertility in women aged 15-29 requires active measures aimed at creating favourable conditions for achieving economic independence for the younger generation, as well as combining work with raising children, especially in rural areas. ABBREVIATIONS APC - annual percentage change; AAPC - average annual percentage change; CSO - Central Statistical Office; TFR - total fertility rate.

Ocena ryzyka sercowo-naczyniowego przy pomocy funkcji SCORE w odniesieniu do ryzyka określonego na podstawie umieralności z powodu chorób układu krążenia w Polsce.

Polish Cardiac Society recommends to use SCORE tables to estimate the risk of cardiovascular disease (CVD) in clinical practice. The aim of the study was (1) to compare the estimates of the risk of death from cardiovascular disease (CVD) obtained by using a SCORE function calibrated for the Polish population in 2007 with the risk calculated from the observed number of CVD deaths in the last decade, and (2) to compare the estimates of the risk of death from CVD obtained by using a SCORE function calibrated for the Polish population in 2015 with the CVD risk estimated from the observed number of deaths in 2012, using data on the prevalence of risk factors from the two studies of the representative samples of Polish adult population (WOBASZ and WOBASZ 2). The risk identified by the SCORE 2007 function was higher than the observed risk by 20–40% in men and 18–33% in women. This indicated that the SCORE 2007 function overestimated cardiovascular risk. The risk calculated by using the SCORE 2015 function was more similar to the CVD risk estimated by using the current mortality data. However, SCORE 2015 function may overestimate CVD risk in future if the decreasing mortality trend would persist in Poland.