Paweł Nadrowski

Multi-centre National Population Health Examination Survey (WOBASZ II study): assumptions, methods, and implementation.

BACKGROUND Cardiovascular diseases (CVDs) are the main cause of morbidity and mortality in developed countries. Despite the progress in diagnostics and treatment, it is expected that CVD will still be the main cause of death worldwide until at least 2030. From 1991 CVD mortality in Poland systematically decreased, but it is still higher than the average in Western Europe. In 2013 CVDs were the cause of 46% of all deaths in Poland (40.9% in men and 51.1% in women) and 26.9% of deaths among persons under 65 years of age. The epidemiologic assessment of prevalence, control and treatment of CVD risk factors, and monitoring of healthy behaviour and morbidity due to diseases like coronary artery disease, hypertension and diabetes is very important for health policy planning. The WOBASZ II is the newest Polish population based survey, performed in 2013-2014 to evaluate prevalence, control, treatment, and morbidity. The study was the continuation of WOBASZ (2003-2005). AIM To describe the goals and methods of the WOBASZ II study and to present the results of the recruitment. METHODS The WOBASZ II study was planned as a cross-sectional survey of a random sample of Polish residents aged over 20 years. The selection, using the National Identity Card Registry of the Ministry of Internal Affairs, was made as a three-stage sampling, stratified according to administrative units (voivodeships), type of urbanisation (commune), and gender. The study protocol consisted of a questionnaire used in face-to-face interviews, physical examination, and blood samples. WOBASZ II was coordinated by the Department of Epidemiology, Cardiovascular Diseases Prevention and Health Promotion of the Institute of Cardiology in Warsaw in cooperation with medical universities in Gdansk, Katowice, Krakow, Lodz, and Poznan. RESULTS Out of 15,120 persons, 1557 persons were not eligible. Out of eligible persons, 6170 (2760 men and 3410 women) were examined (the response rate 45.5%). The highest response rates were observed in Warminsko-Mazurskie (64.2%), Zachodniopomorskie (58.1%), and Kujawsko-Pomorskie (53.1%). CONCLUSIONS The importance of the WOBASZ study for the monitoring of the health state of Polish society, and for the as-sessment of prophylaxis efficiency and treatment of CVD and metabolic diseases, as well as for the evaluation of the actions in the field of health promotion, is difficult to overstate.

Plasma level of N-terminal pro brain natriuretic peptide (NT-proBNP) in elderly population in Poland--the PolSenior Study.

BACKGROUND The brain natriuretic peptides (BNP, NT-proBNP) are useful diagnostic markers of heart failure (HF), as exemplified by the ESC Heart Failure guidelines. The PolSenior project was an epidemiological study carried out to examine medical, psychological and socioeconomic aspects of aging in Poland. The aim of this study is an epidemiological description of HF based on elderly population from the PolSenior Study, stratified by NT-pro-BNP concentration values. MATERIAL AND METHODS The research sample included 4979 respondents (2567 males and 2412 females) split into six equally sized age groups of elderly individuals. The study consisted of three visits performed by trained nurses and included a questionnaire survey, comprehensive geriatric assessment and blood and urine sampling with more than 50 biochemical parameters measured. Serum NT-pro-BNP was measured by electrochemiluminescence method (ECLIA). RESULTS The prevalence of chronic kidney disease (CKD) (77.8%) and atrial fibrillation (39.5%), number of hospitalizations (23.7%) and number of patients treated with HF drugs were highest in NT-proBNP > 2000 pg/ml group and least frequent in NT-proBNP < 400 pg/ml group. Obese patients had significantly more frequently NT-proBNP values < 400 pg/ml (73.0%) and less frequently NT-proBNP values >2000 pg/ml (2.8%). Age over 70 years and male gender were associated with the increased NT-pro-BNP (> 400 pg/ml) (OR 1.41; CI 1.20-1.65 for male gender). CONCLUSIONS We conclude that CKD and atrial fibrillation are associated with the occurrence of increased NT-pro-BNP, the surrogate for HF in elderly population. On the contrary, overweight or obesity is associated with lower prevalence of HF in elderly.

Differences of psychological features in patients with heart failure with regard to gender and aetiology — Results of a CAPS-LOCK-HF (Complex Assessment of Psychological Status Located in Heart Failure) study

OBJECTIVE Objective of the study was to assess the psychological state of HF patients with reduced ejection fraction (HFrEF) with regard to gender and aetiology. METHODS 758 patients with HFrEF (mean age - 64±11years, men - 79%, NYHA class III-IV - 40%, ischemic aetiology - 61%) in a prospective Polish multicenter Caps-Lock-HF study. Scores on five different self-report inventories: CISS, MHLC, GSES, BDI and modified Mini-MAC were compared between the sexes taking into account the aetiology of HFrEF. RESULTS There were differences in the CISS and BDI score between the genders - women had higher CISS (emotion- and avoidance-oriented) and BDI (general score - 14.2±8.7 vs 12.3±8.6, P<0.05; subscale - somatic score - 7.3±3.7 vs 6.1±3.7, P<0.05). In the ischemic subpopulation, women had higher BDI (general and subscales) than men. In the non-ischemic subpopulation the differences between genders were limited to CISS scale. In a multivariable analysis with demographic and clinical data female sex, NYHA class, atrial fibrillation and diabetes mellitus determined BDI score. Similarly, in the ischemic subpopulation, the female sex, NYHA class and atrial fibrillation determined the BDI, while in the non-ischemic population NYHA class was the only factor that influenced the BDI score. Adding the psychological data made a significant additional contribution to the prediction of depression status. CONCLUSIONS There are distinct differences in psychological features with regard to gender in patients with HFrEF. Women demonstrate less favourable psychological characteristics. Gender-related differences in BDI score are especially explicit in patients with ischemic aetiology of HF. The BDI score is related to psychological predisposition.

Trends in hypertension prevalence, awareness, treatment, and control among Polish adults 75 years and older during 2007–2014

BACKGROUND The aim of this study was to assess changes in the prevalence, awareness, and treatment of hypertension and its effectiveness between 2007 (WOBASZ Senior study) and 2013-2014 (WOBASZ II) in a sample of the Polish population over the age of 75 years. METHODS Sampling had three stages, stratified according to voivodeships, type of community, and gen-der. Finally, the WOBASZ II study included 467 persons (290 women and 177 men). For a comparison of the data, 1096 persons (538 women and 554 men) examined in the WOBASZ Senior study were used. RESULTS Systolic and diastolic blood pressures significantly decreased from 153.0 ± 23.9 mmHg to 142.9 ± 22.3 mmHg and from 85.2 ± 11.9 mmHg to 78.4 ± 11.3 mmHg, respectively, from 2007 to 2014 (p < 0.0001). Prevalence of hypertension among people included in WOBASZ studies slightly decreased from 83.8% to 77.9% (rate ratio [RR]: 0.95; 95% confidence interval [CI]: 0.78-1.16) in men, and from 75.4% to 71.8% (RR: 0.93; 95% CI: 0.8-1.09) in women. Hypertension awareness was improved from 59.2% to 72.9% (RR: 1.23; 95% CI: 0.97-1.56) in men, and from 74,8% to 93% (RR: 1.26; 95% CI: 1.01-1.58) in women. The proportion of men and women, with implemented hypertension treatment, increased from 48.4% to 61.1% (RR: 1.26; 95% CI: 1.01-1.58), and from 63.2% to 82.0% (RR: 1.3; 95% CI: 1.1-1.53), respectively. The effectiveness of the treatment was improved over two-fold, there was an increase from 10.3% to 26.8% (RR: 2.65; 95% CI: 1.81-3.89) in men, and from 13.8% to 33.5% in women (RR: 2.44; 95% CI: 1.81-3.3). CONCLUSIONS The prevalence of hypertension in Polish seniors remains high, but has decreased slightly in the perspective of the last 7 years. Although treatment and control has improved over the last decade, it remains below expectations. Efforts to improve the diagnosis and effective treatment of hypertension in Polish seniors should be intensified.

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.

Cardiovascular health knowledge of the Polish population. Comparison of two national multi-centre health surveys: WOBASZ and WOBASZ II

BACKGROUND AND AIM To compare the cardiovascular health knowledge (CHK) of the adult Polish population in the years 2003-2005 and 2013-2014, and to evaluate the CHK determinants in the Polish adult population. METHODS Data came from the two random samples of the Polish population, screened in 2003-2005 in the WOBASZ health survey (6392 men and 7153 women, aged 20-74 years) and in 2013-2014 in the WOBASZ II health survey (2751 men and 3418 women, aged 20+ years). For the present analysis, the population of WOBASZ II was limited to persons aged 20-74 years. A CHK score (CHKs) was constructed based on questionnaire answers of responders, and the results of physical examination and ranged from -1 (lowest knowledge) to +6 (highest knowledge). RESULTS Women had greater CHK than men. In both studies, about 30% of women and 40% of men did not know their blood pressure (BP). About 20% of men and women that declared their BP awareness was not able to classify it correctly to the normal or high category. Most persons that declared body weight awareness could give their body weight to within 2 kg and could correctly classify it as normal or overweight/obesity. The mean CHKs raised in men from 1.74 in WOBASZ to 1.93 in WOBASZ II (in women, respectively, from 2.10 to 2.23). The chance of having CHK greater than mean value of CHKs increased in men by 31% and in women by 27% in WOBASZ II compared to WOBASZ (ORCHK = 1.31, p < 0.0001 in men; ORCHK = 1.27, p < 0.0001 in women). Younger, better educated persons and men with coronary artery disease history and persons with familial history of death from myocardial infarction or stroke had greater health knowledge. CONCLUSIONS Since 2003 Polish adults significantly advanced their knowledge and awareness of cardiovascular risk factors. Gender, age, education level, coronary artery disease history, and family history of cardiovascular disease death are significant determinants of CHK. From 20% to 30% of studied persons who declared their awareness, were shown to be unaware of their own cardiovascular disease risk factors.

A single-centre, randomised study on platelet reactivity after abrupt or gradual discontinuation of long-term clopidogrel therapy in patients after percutaneous coronary intervention

BACKGROUND Clinical studies have suggested increased risk of thrombotic events after planned cessation of clopidogrel therapy, due to increased platelet reactivity (platelet rebound); however, in many studies platelet function was not assessed before introducing clopidogrel. Patients who are scheduled to stop clopidogrel therapy, do it abruptly, so a gradual drug cessation might provide a beneficial treatment strategy. AIM To determine whether a clopidogrel discontinuation results in platelet rebound hyperaggregability with increased activity compared to pre-treatment values and to assess whether abrupt or tapering clopidogrel cessation may affect platelet reactivity. METHODS Patients with stable coronary artery disease (n = 49), on chronic acetylsalicylic acid treatment, who underwent coronary angiography, and were scheduled for elective percutaneous coronary intervention with stent implantation were en-rolled. Patients were randomised to either a tapering clopidogrel discontinuation during a two-week period (tapering group, n = 25) or abrupt drug cessation (abrupt group, n = 24). After 12 months of dual antiplatelet therapy with clopidogrel and acetylsalicylic acid, we performed three follow-up visits with blood sampling. Platelet aggregation was assessed using a mul-tiple electrode aggregometer at inclusion, at cessation day, and seven and 14 days after complete clopidogrel discontinuation. The primary endpoint was the level of adenosine-diphosphate (ADP)-induced platelet aggregation. We also analysed platelet function in the ASPI test and platelet count as secondary endpoints. RESULTS In 36 patients included in the main analysis, we found significant differences between the two study groups in the levels of ADP-induced platelet aggregation at days seven and 14 after cessation of clopidogrel (p = 0.004 and p = 0.04, respectively). In the abrupt group, platelet aggregation returned to the values similar to baseline at day seven. There were no significant differences between baseline, seven, and 14 days after drug cessation (p = 0.92 and p = 0.37, respectively). However, in the tapering group, ADP values at seven and 14 days after drug cessation were significantly decreased, comparing to baseline (p < 0.0001 and p = 0.009, respectively). For the ASPI test and platelet count we did not find significant differ-ences between the groups. All values returned to levels similar to the baseline. During the follow-up there were no serious cardiovascular events or bleedings. CONCLUSIONS Tapering vs. abrupt discontinuation of clopidogrel treatment results in significantly lower platelet aggregation values after 14 days from complete drug cessation. We found no evidence of a platelet rebound effect.

Cardiovascular diseases prevention in Poland - results of WOBASZ and WOBASZ II

BACKGROUND Cardiovascular diseases are the main cause of morbidity and an important cause of disability and premature death in European countries. Current guidelines recommend prevention delivery by physicians during medical consultations. AIM We sought to evaluate the prevention support offered by Polish physicians in 2013-2014 compared to 2003-2005, and its determinants. METHODS The data from two population surveys were analysed: WOBASZ (6392 men and 7153 women, aged 20-74 years, screened in 2003-2005) and WOBASZ II (2751 men and 3418 women, aged ≥ 20 years, screened in 2013-2014). For comparison analysis, the population of WOBASZ II was restricted to persons aged 20-74 years. Prevention delivery was assessed using a questionnaire. RESULTS Overall, 64% of men and 75% of women screened in 2003-2005 consulted their physicians at least once in the preceding year; 10 years later these rates were 70% and 82%, respectively. In both studies, 70% of respondents recalled having received one piece of prevention advice during a medical consultation. One-third of participants neither received any prevention advice nor had their blood pressure or cholesterol level measured. In WOBASZ II we observed a significant increase in the frequency of counselling regarding smoking cessation, nutrition, and increased physical activity, as well as in the frequency of cholesterol measurements, compared to WOBASZ. The prevention support was related to the health status. CONCLUSIONS The prevention support in the years 2013-2014 was better than in 2003-2005, but was still insufficient. About one-third of participants did not receive any preventive advice. The prevention support was offered more often to patients with worse health status.

Socioeconomic status and cardiovascular risk SCORE

BACKGROUND Cardiovascular diseases (CVD) are one of the most frequent causes of morbidity and death both in men and women. The influence of the following factors on the occurrence and progression of atherosclerosis is well known: hyperten-sion, hypercholesterolaemia, tobacco smoking, obesity, diabetes, age, and sex. As well as the typical risk factors of CVD, there is also a significant association between the incidence of those diseases and socioeconomic status (SES). AIM The aim of this study was to establish the correlation between SES status and CVD risk assessed according to the SCORE algorithm. METHODS The study encompassed 516 participants (207 men and 309 women) aged 40-74 years, who had never been diagnosed with any CVD. The SES was calculated by multiplying the patients education and net monthly income. The cor-relation between the SES and SCORE was established using linear and logistic regression analysis. RESULTS After considering the influence of age, an inverse correlation between the SCORE risk value and the SES index was established, both in the entire group (p = 0.006) and in the mens group (p = 0.007). In the analysis of individual age subgroups, this correlation was demonstrated in the following groups: 55-59-year-olds (p = 0.011), 60-64-year-olds (p = 0.014), and 65-69-year olds (p = 0.034). A similar relationship was established in men aged 65-69 years (p = 0.038) and women aged 40-44 years (p = 0.003). The logistic regression analysis demonstrated that, after considering the influence of age, the odds of the SCORE risk value being ≥ 10% were becoming smaller along with the increase in the SES index value in the entire group (p = 0.048) and in the mens group (p = 0.011). The odds ratio (OR) for the SCORE risk value being ≥ 10% depending on the SES index value was OR = 0.978 (95% confidence interval [CI] 0.956-0.999) in the entire group and OR = 0.964 (95% CI 0.938-0.992) in men. Furthermore, we also established that the risk of SCORE ≥ 5% decreased with the increase in the SES index value in the womens group (OR = 0.970; 95% CI 0.941-0.999; p = 0.042). CONCLUSIONS 1. We demonstrated a statistically significant correlation between the SES and the CVD risk assessed according to the SCORE algorithm. 2. The value of the CVD risk according to SCORE was inversely correlated with SES status.

How does the risk of cardiovascular death and cardiovascular risk factor profiles differ between socioeconomic classes in Poland: A country in transition

BACKGROUND Socioeconomic status (SES) is an important factor of cardiovascular diseases (CVD) development. A decline in death from CVD among subjects with high SES is observed in developed countries. The aim of this study was to assess differences in cardiovascular risk between socioeconomic classes in Poland, a country currently in transition. METHODS A sample of 15200 people was drawn. A three stage selection was performed. Eventually, 6170 patients were examined (2013/2014). Data was collected using a questionnaire in face-to-face interviews, anthropometric data and blood tests were also obtained. Education was categorized as incomplete secondary, secondary and higher than secondary school. Monthly income per person was categorized as low (≤ 1000 PLN), medium (1001-2000 PLN) and high (≥ 2001 PLN). Education and income groups were analyzed by prevalence of CVD risk factors and high CVD risk (SCORE ≥ 5%). RESULTS Higher education was associated with lower prevalence of all analyzed CVD risk factors (p < 0.001), having the highest income with lower prevalence of hypertension, currently smoking, obesity and lower HDL-cholesterol. Multivariable analysis showed that frequency of high CVD risk decreased with increasing education level (OR 0.61; 95% CI 0.49-0.76; p < 0.01), a similar favorable impact of higher income on high CVD risk was demonstrated in the whole group (OR 0.81; 95% CI 0.67-0.99; p = 0.04). CONCLUSIONS SES is an independent predictor of high cardiovascular (CV) risk of death. A favorable impact on the prevalence of high CV risk was demonstrated for education and partly for income in the whole group. It may reflect a transition being undergone in Poland, moreover, it predicts how socioeconomic factors may generate health inequalities in other transitioning countries.