S. Kutkiene

Cardiovascular risk assessment of dyslipidemic middle-aged adults without overt cardiovascular disease over the period of 2009–2016 in Lithuania

BackgroundCardiovascular mortality in Lithuania is extremely high and abnormal lipid levels are very common among Lithuanian adults. Dyslipidemia is one of the main independent risk factors for cardiovascular diseases (CVD) leading to high absolute CVD risk. The aim of this study was to assess CVD risk in dyslipidemic middle-aged subjects.MethodsDuring the period of 2009–2016 a total of 92,373 people (58.4% women and 41.6% men) were evaluated. This study included men aged 40–54 and women aged 50–64 without overt CVD.ResultsAny type of dyslipidemia was present in 89.7% of all study population. 7.5% of dyslipidemic patients did not have any other conventional risk factors. Three and more risk factors were detected in 60.1% of dyslipidemic subjects. All analyzed risk factors, except smoking, were more common in dyslipidemic adults compared to subjects without dyslipidemia: arterial hypertension (55.8% vs. 43.3%, pu2009<u20090.001), diabetes (11.1% vs. 7.3%, pu2009<u20090.001), abdominal obesity (45.3% vs. 30.2%, pu2009<u20090.001), BMI ≥30xa0kg/m2 (35.8% vs. 23.7%, pu2009<u20090.001), metabolic syndrome (34.0% vs. 9.2%, pu2009<u20090.001), family history of coronary heart disease (26.3% vs. 23.1%, pu2009<u20090.001), unbalanced diet (62.5% vs. 52.9%, pu2009<u20090.001) and insufficient physical activity (52.0% vs. 44.2%, pu2009<u20090.001). The prevalence of all evaluated risk factors, except smoking, increased with age. Average SCORE index was 1.87 in all study population, while dyslipidemic subjects had higher SCORE compared to control group (1.95 vs 1.20, pu2009<u20090.001).ConclusionsAlmost two thirds of dyslipidemic middle-aged Lithuanian adults without overt cardiovascular disease had three or more other CVD risk factors, which synergistically increase absolute risk of CVD. The average 10-year risk of CVD death in patients with dyslipidemia was 1.95%. The importance of managing dyslipidemia as well as other risk factors in order to reduce burden of cardiovascular disease in Lithuania is evident.

Cardiovascular risk profile of patients with atherogenic dyslipidemia in middle age Lithuanian population

BackgroundAtherogenic dyslipidemia (AD) is a blood serum lipid profile abnormality characterized by elevation of triglycerides and reduced levels of high density lipoprotein cholesterol (HDL-C). It is associated with residual cardiovascular risk. This study evaluated and compared the risk profiles of patients with hypertriglyceridemia, low-HDL-C levels or AD, in order to understand, which lipid profile is associated with greater risk.MethodsDuring the period of 2009–2016 a population of 92,373 Lithuanian adults (men 40–54xa0years old and women 50–64xa0years old) without overt cardiovascular disease were analyzed. Data of 25,746 patients (68.6% women and 31.4% men) with hypertriglyceridemia and/or low HDL-C low levels were collected and used for further statistical analysis.ResultsParticipants with AD tend to have more unfavorable risk profile than participants with hypertriglyceridemia or low-HDL-C. AD tends to cluster with other atherogenic risk factors, such as arterial hypertension [odds ratio (OR) 1.96, 95% confidence intervals (CI) 1.87–2.01], smoking [OR 1.20, 95% CI 1.14–1.27], diabetes mellitus [OR 2.74, 95% CI 2.58–2.90], obesity [OR 2.92, 95% CI 2.78–3.10], metabolic syndrome [OR 22.27, 95% CI 20.69–23.97], unbalanced diet [OR 1,59, 95% CI 1.51–1.68], low physical activity [OR 1.80, 95% CI 1.71–1,89], CHD history in first degree relatives [OR 1.18, 95% CI 1.12–1.25] and total number of risk factors [OR 1.47, 95% CI 1.38–1.57].ConclusionAD is associated with more unfavorable cardiovascular risk profile than hypertriglyceridemia or low-HDL cholesterol levels. Once identified AD should require additional medical attention since it is an important factor of residual cardiovascular risk.

Establishing a national screening programme for familial hypercholesterolaemia in Lithuania

BACKGROUND AND AIMSnFamilial hypercholesterolaemia (FH) is a widely underdiagnosed genetic disorder characterized by severely elevated levels of serum cholesterol and associated with premature mortality. Screening programmes and registries have been established worldwide to find and monitor patients with FH. The aim of this paper was to describe the approaches currently applied to identify patients with possible FH in Lithuania.nnnMETHODSnAn electronic extraction tool was applied to the medical records of 92,373 subjects evaluated in primary care settings from 2009 to 2016, 1714 secondary prevention patients with early onset (<50 years) coronary heart disease (CHD) treated in tertiary care hospital from 2005 to 2016 and high-risk subjects in specialized cardiovascular prevention units. The electronic databases were screened for likely FH phenotype, which was described simply as LDL-C ≥6.5u202fmmol/l.nnnRESULTSnLikely FH phenotype was observed in 1385 (1.5%) middle-aged Lithuanians, 290 (16.9%) people with premature CHD and 330 adults from high-risk subjects referred to specialized cardiovascular prevention units. A total of 2005 patients with likely phenotypic FH were included in the Lithuanian FH screening programme, covering about 15% of estimated FH cases in Lithuania.nnnCONCLUSIONSnScreening for extremely elevated LDL-C levels in primary prevention database and additional enrolment of patients with premature CVD as well as high-risk subjects may be a valid way to set up a national FH screening programme. It is crucially important to identify and initiate the treatment of FH patients as early as possible to reduce high cardiovascular mortality in these patients.

Lipid profile evaluation and severe hypercholesterolaemia screening in the middle-aged population according to nationwide primary prevention programme in Lithuania

BACKGROUND AND AIMSnCardiovascular disease (CVD) is a major cause of premature death in Lithuania where abnormal lipid levels are very common among middle-aged adults. The aim of this study was to evaluate lipid profile in middle-aged Lithuanians and perform population-based severe hypercholesterolaemia (SH) screening.nnnMETHODSnThis study included men aged 40-54 and women aged 50-64 years without overt CVD, participating in the Lithuanian High Cardiovascular Risk (LitHiR) primary prevention programme during the period 2009-2016. Lipidograms of 92,373 adults (58.4% women and 41.6% men) included in the database were analysed and screening for SH was performed.nnnRESULTSnThe mean levels of total cholesterol, LDL cholesterol (LDL-C) and triglycerides (TG) among participants were 6.08u202fmmol/l, 3.87u202fmmol/l, and 1.59u202fmmol/l, respectively. Any type of dyslipidaemia was present in 89.7%, and severe dyslipidaemia in 13.4% of the study population. 80.2% of adults without overt CVD had LDL-C ≥3u202fmmol/l. SH (LDL-C ≥6u202fmmol/l) was detected in 3.2% of study participants. Prevalence of SH decreased from 2.91% to 2.82% during the period 2009-2016 (p for trendu202f=u202f0.003). LDL-C ≥6.5u202fmmol/l was observed in 1.5% of subjects while both LDL-C ≥6.5u202fmmol/l, and TGu202f≤u202f1.7u202fmmol/l was found in 0.6% of subjects.nnnCONCLUSIONSnSH was present in 3.2% of the middle-aged population without overt CVD. Slightly decreasing prevalence of SH was observed during the period 2009-2016 in Lithuania. Likely phenotypic familial hypercholesterolaemia was observed in 1.5% of middle-aged Lithuanians. Further clinical and genetic evaluation of people with SH is needed to detect familial forms of SH.