Biomedical subjects

A Pajak

Publications and source records attributed to A Pajak.

At least 37 records · Page 2Linked to original sources

PubMed1998

Poland and U.S. collaborative study on cardiovascular epidemiology hypertension in the community: prevalence, awareness, treatment, and control of hypertension in the Pol-MONICA Project and the U.S. Atherosclerosis Risk in Communities Study.

PURPOSE: The objectives of this manuscript are to assess differences in blood pressure levels and in hypertension prevalence, awareness, treatment, and control for selected rural and urban areas in the U.S. and Poland, where ischemic heart disease mortality trends are different. METHODS: Included are white persons aged 45-64 selected in Minneapolis, MN suburbs [urban] and Washington County, MD [semi-rural] from the U.S. Atherosclerosis Risk in Communities Study (ARIC) surveyed in 1987-89, and in Warsaw [urban] and Tarnobrzeg Province [semi-rural] from Poland's Pol-MONICA Project surveyed in 1987-88. Sample sizes were: U.S.--3,696 men, 3,801 women; Poland--875 men, 960 women. RESULTS: Mean blood pressures were > 15% higher for Polish samples than for the U.S. (p < 0.01). In multivariable analysis, hypertension was significantly positively related to age and body mass index (BMI) in both U.S. and Polish samples (except age in Polish men), and to heart rate in Polish samples and U.S. rural women. Smoking was significantly negatively related to hypertension in urban Polish and rural U.S. men. Hypertension awareness, treatment, and control were better in U.S. than in Polish samples. In the U.S. > 80% of subjects with hypertension (systolic blood pressure (SBP) > or = 160 mmHg or diastolic blood pressure (DBP) > or = 95 mmHg or on treatment) were controlled whereas in Polish samples < or = 17% of hypertensive men and 16% of hypertensive women were controlled. When SBP > or = 140 mmHg or DBP > or = 90 mmHg or on treatment defined hypertension, control was about 55% in U.S. samples and about 2% in Polish samples. CONCLUSIONS: Hypertension prevalence is higher and blood pressure levels are less well controlled in Polish than in U.S. samples. These striking differences can be expected to contribute to opposing trends in coronary heart disease (CHD) mortality in the two countries. Hypertension control programs in the U.S. are almost certainly responsible for much of the observed differences. There is a clear need for similar programs in Poland.

Blood Pressure↗

PubMed1998

Constitutional, biochemical and lifestyle correlates of fibrinogen and factor VII activity in Polish urban and rural populations.

BACKGROUND: Fibrinogen and factor VII activity are known to be related to atherosclerosis and coronary heart disease, but population differences in clotting factors and modifiable characteristics that influence their levels have not been widely explored. METHODS: This paper examines correlates of plasma fibrinogen concentration and factor VII activity in 2443 men and women aged 35-64 in random samples selected from the residents in two districts in urban Warsaw (618 men and 651 women) and from rural Tarnobrzeg Province (556 men and 618 women) screened in 1987-1988, and assesses which characteristics might explain urban-rural differences. Fibrinogen and factor VII activity were determined using coagulation methods. RESULTS: Fibrinogen was 12.9 mg/dl higher in men and 14.1 mg/dl higher in women in Tarnobrzeg compared to Warsaw. Factor VII activity was higher in Warsaw (9.2% in men and 15.3% in women). After adjustment for selected characteristics, fibrinogen was higher in smokers compared to non-smokers by 28 mg/dl in men and 22 mg/dl in women. In women, a 15 mg/dl increase in HDL-cholesterol was associated with a 10 mg/dl decrease in fibrinogen (P < 0.01). After adjustment for other variables, a higher factor VII activity in Warsaw remained significant (a difference of 9.4% in men and 14.8% in women). Lower fibrinogen in Warsaw remained significant only in women (15.4 mg/dl difference). CONCLUSIONS: The study confirmed that sex, age, BMI, smoking and blood lipids are related to clotting factors. However, with the exception of gender differences and smoking, associations between clotting factors and other variables were small and of questionable practical importance.

Adult↗

PubMed1998

[Cognitive impairment and cardiovascular disease risk factors. Project CASCADE Kraków. I. Project to test exposure to risk factors for cardiovascular disease in the studied sample].

Dementia is found in a small percent of general population but remains a significant problem in the elderly population. Little is known whether prevention of dementia in the elderly is possible. Some evidence exists that both vascular dementia and Alzheimer's type dementia are related to cardiovascular disease risk factors. The main goal of the CASCADE Kraków Project is to study the relation between the exposure to cardiovascular disease risk factors in the middle age and cognitive impairment and cerebral white matter lesions in old age. Project CASCADE Kraków is an independent part of the international project CASCADE, which is carried out in 11 research centres from 9 countries. Polish part of the study includes a longitudinal observation of the sample screened earlier in POL-MONICA Kraków Project, which was selected from population of residents of rural province (Tarnobrzeg Voivodship). Studied sample are 1318 persons, for whom cardiovascular disease risk factors were measured in 1983-84 and who completed at least 64 years in 1997. Two-stage examination was designed. In the first stage collection of the following data was designed: socio-economic factors, history of cardiovascular disease, perceived health, blood pressure and cognitive function assessment using Mini-Mental State Examination (MMSE) procedure. In the second stage (sub-sample of 300 persons included) the following procedures were designed: detailed neuro-psychological testing, neurolo-gical examination, MRI, determination of total- and HDL-cholesterol and determination of apoE isoforms. There were 625 (47%) men and 693 (53%) women selected for the first stage. Out of them 128 (43%) men and 172 (57%) women were selected for the second stage. There were no important differences in age, education, health status and exposure to cardiovascular disease risk factors between the studied groups in the baseline assessment. However, there were important differences between men and women. Compared to men, women had lower education (higher than elementary education in 17% and 9% respectively), more frequent obesity (respectively 12% and 36%), hypertension (respectively 57% and 71%) and hyperlipoproteinemia (respectively 17% and 30%) but lower smoking rate (respectively 53% and 4%). Integration of neuropsychological testing and neuroimaging with the epidemiological approach to risk factors could contribute to better understanding of the mechanisms on which the disease affects the brain morphology and functions. The results of CASCADE and CASCADE Kraków projects will contribute also to the development of the strategies of medical care and management of the cognitive impairment in the elderly.

Aged↗

PubMed1998

[Cognitive impairment and cardiovascular disease risk factors. Project CASCADE Kraków. II. Agreement of Mini-Mental State Examination (MMSE) obtained by nurses and by psychologists from the same persons at age 67-78 years of age].

Mini-Mental State Examination (MMSE) can be used for screening procedures by personnel with no university training in psychology. However, little is known on the reliability of the results of MMSE obtained by medical personnel with little experience in cognitive function assessment. The goal of the paper was to assess the agreement between the results of MMSE obtained by trained community nurses and by psychologists, and to study whether the agreement depends on age, sex and education of examined persons. Studied group were 92 women and 90 men at age 65-78 years. Most of them (81.3%) had only elementary education. There was no significant difference between the distribution of the results obtained by nurses and obtained by psychologists. Individual difference < or = 2 points was found in 63.1% participants and difference < or = 3 points in 78.4% participants. There was a significant correlation between the results obtained by nurses and by psychologists (r = 0.64, p < 0.001). The correlation was also significant within the age, sex and education strata. Variation of the results obtained by nurses was explained in 42% by variation of the results obtained by psychologists. The best agreement in classification in cognitive function was found for the MMSE cut-off point < or = 19 (kappa = 0.75 in women and kappa = 0.58 in men). The worst agreement was found for the cut-off point < or = 25. Also weak agreement was found for the cut-off point < or = 23. There was a significant agreement between the results of MMSE obtained by nurses and results obtained by psychologists on the population level. However at the level of individuals the agreement in classification of cognitive function depended of cut-off point used. The agreement was only fair if cut-off point < or = 23 and < or = 25 were used.

Aged↗

PubMed1998

[Cognitive impairment and cardiovascular disease risk factors. Project CASCADE Kraków. III. Assessment of cognitive function in elderly women and men (65-78 years old)].

There are commonly used simple tests for cognitive function that allow for rather superficial assessment in population based study. The goal of the paper was to present the results of cognitive function assessment in elderly men and women recruited from Polish rural population obtained using the battery of tests designed for the CASCADE Project and to assess the relations between the results of tests included in the battery. Studied group were 182 persons at the age of 65-78 years. The battery of tests included: MMSE, Stroop Test, Test Purdue Pegboard (TPP), letter-digit substitution test, word recall test (3 word lists including one with distraction), word fluency test and prospective memory test. The battery allowed for the assessment of short, semantic and prospective memory, attention, speed of perception and processing, word fluency and motoric function. The results of all tests were strongly correlated and indicated for a decreased cognitive function in men and women at the age of 65-78 years with low level of education. Decreased level of cognitive function could be related both to physiological ageing of the brain and to the presence of pathological process.

Aged↗

PubMed1998

[Cognitive impairment and cardiovascular disease risk factors. Project CASCADE Kraków. IV. Prevalence of cognitive impairment in relation to age, sex, education and history of myocardial infarction in men and women at age 65-78, residents of a rural province in Poland (Tarnobrzed)].

Decrease in cardiovascular disease mortality below age of 65 years, which has been observed in Poland since 1992, is followed by increasing number of elderly people. One of the typical problems of ageing is deterioration of cognitive function. Little is known on prevalence of cognitive impairment and its correlates in Polish population. The goal of this paper was to assess the prevalence of cognitive impairment in the elderly Polish rural population and to study the differences in the distribution of cognitive function and frequency of cognitive impairment by age, sex, education and by history of previous MI. Studied group were 943 men and women at age 65-78 from the cohort representing the population of Polish rural province (Tarnobrzeg Voivodship). Participants were visited at their homes. Interview and cognitive function assessment by Mini-Mental State Examination (MMSE) procedure were carried out according to the standard questionnaire. Participation rate was 94%--882 persons were examined. There were 58% women and 17% persons at age 75 or older in the examined group. 87% had only elementary (7 years of schooling) education or less. History of previous myocardial infarction was found in 15% of participants. In almost half of participants the result of MMSE < or = 25 points suggested cognitive impairment. More severe impairment (MMSE < or = 21 points) was found in 15% of examined persons. In participants at age 75 years or older and in those with low education, per cent of persons with cognitive impairement function was higher. Sex and history of previous myocardial infarction were not related to frequency of cognitive impairment. Results indicate the high prevalence of the cognitive impairment in elderly men and women in Polish rural population with low average level of education.

Age Distribution↗

PubMed1998

[Cognitive impairment and cardiovascular disease risk factors. Project CASCADE Kraków. V. Disorders of higher cerebral functions in elderly people (65-78 years old)].

Higher cortical dysfunctions, like dysphasia, dysgnosia and dyspraxia, relatively frequent in the elderly, are related to progressive neurodegenerative or vascular disorders with dementia. The aim of the study was to assess the prevalence and the intensity of higher cerebral dysfunctions in the population over 65 years and to investigate the association between these disorders and the presence of other neurological abnormalities, i.e. extrapyramidal signs, primitive reflexes as well as cognitive impairment assessed by Mini-Mental State Examination (MMSE). There were 92 women and 90 men, aged from 65-78 years included in the study. All patients were interviewed for the presence of vascular risk factors. The battery of 21 detailed test of higher cerebral functions testing speech, calculation, reading, writing, praxia and gnosia were performed in each person. Extra-pyramidal signs and primitive reflexes were also examined. Among the disorders of higher cortical functions, slight dyspraxia was the most frequent (33.7%). Finger dysgnosia, dyscalculia and dysgraphia were found less frequently. 25.4% of studied group abnormally performed at least two tests assessing higher cortical functions and when compared with normal persons, they presented significantly more frequent the extrapyramidal signs (63.9% vs. 46.9%, respectively) and had significantly frequent impaired cognitive functions (p < 0.05). Patients with higher cortical dysfunction, when compared with other persons, had more frequent primitive reflexes (p < 0.05). The results of the study showed that slight disorders of higher cortical functions were found in about 25% of studied population; they were more frequent in people with cognitive impairment, primitive reflexes and extrapyramidal signs.

Aged↗

PubMed1998

[Cognitive impairment and cardiovascular disease risk factors. Project CASCADE Kraków. VI. Magnetic resonance imaging of the aging brain in elderly persons (65-78 years old)].

Magnetic resonance imaging (MRI) is the most sensitive non-invasive method for the detection of brain lesions. The aim of the study was to examine the prevalence of brain abnormalities (white matter lesions, atrophy, and infarction) on MRI in an elderly population. Sample of 174 men and women, aged from 65 to 78 years, was examined. MRI scans were made using a mobile MRI 1.0 Tesla machine (Siemens). Imaging was performed with standard spin-echo sequences (slice thickness 5-6 mm thick and 20% gap): proton density, T1 and T2 images. All MRI scans were read using standardized methodology of assessment of deep white matter lesions, periventricular lesions, cortical atrophy and infarction. Medium subcortical white matter lesions (4-10 mm) were present in 55% participants. Large subcortical white matter lesions (> or = 10 mm) were observed in 27% people, 24% had periventricular white matter lesions (score > or = 3), 83% had cortical atrophy (score > or = 4) and 18% had at least 1 infarct. Frequency of cortical atrophy increased gradually by age group (p < 0.01). The cortical atrophy, deep and periventricular white matter lesions were more frequent only in the oldest group (75-78 years).

Aged↗

PubMed1998

[Cognitive impairment and cardiovascular disease risk factors. Project CASCADE Kradów. VII: Prevalence of apoprotein E isoforms in women and men at age 65-78 years of age].

There is a growing evidence on the relations between apoprotein E (apo E), in particular apoE4, cardiovascular disease and Alzheimer's disease. However, little is known on the prevalence of apoE in Polish population. The goal of this paper was to assess the frequency of apoE phenotypes and isoforms in the sample of elderly people. Studied group were 90 men and 92 women, residents of Polish rural province (Tarnobrzeg Voivodship) at age 65-78 years. Identification of apoE isoforms was done using the immunoblotting method. The most frequent phenotype was apoE3/3, which was found in 70% of men and 73% of women. Phenotype apoE3/2 was identified in 20% men and 15% women. Both in men and in women phenotypes apoE4/2 and apoE4/3 were more rare-in total 10% and 12% participants, respectively. There was nobody with phenotype apoE4/4. In women there was also nobody with phenotype apoE4/2, but in men phenotype apoE4/2 was found in 4% of participants. No person was found with phenotype apoE2/2. Frequency of homozygotes apoE4/4 was low in studied population and could little contribute to the epidemy of cardiovascular disease and dementia in the elderly. However, the 10% frequency of heterozygotes with isoform apoE4 could have more impact.

Aged↗

PubMed1997

Changes over time in blood lipids and their correlates in Polish rural and urban populations: the Poland-United States Collaborative Study in cardiopulmonary disease epidemiology.

PURPOSE: The purpose of this manuscript is to examine changes in blood lipid levels and related factors between 1983 and 1987 in two selected Polish populations, to evaluate these changes and their association with other coronary heart disease (CHD) risk factors, and to examine the nutrient intake changes for consistency with observed lipid changes. METHODS: Men and women, aged 35-64 were screened from Warsaw and rural Tarnobrzeg province, Poland-the Pol-MONICA screening sites. An independent random sample of 5132 screened in 1983-84 and a second independent random sample of 2596 screened in 1987-88 were compared. A 25% cohort of the 1983-84 sample was also rescreened in 1987-88 (n = 1236) and 24-hour dietary recall information on this cohort was used to evaluate nutrient intake changes and their relationship to the lipid changes. RESULTS: For the random samples, the total cholesterol increased by 5.1 mg/dL (rural) and by 7.9 mg/dL (urban) for women; there were no significant changes among men. Low-density lipoprotein cholesterol (LDL-C) increased for all site and gender subgroups by 5.4-8.7 mg/dL. Among rural men and women, high-density lipoprotein cholesterol (HDL-C) decreased by 3.4 and 3.3 mg/dL, respectively, whereas it increased by 3.3 mg/dL among urban women and did not change among urban men. Total triglycerides (TG) increased by 9.5 mg/dL for rural men, with no significant change for rural women. For urban men and women, TG decreased by 29.5 and 21.8 mg/dL respectively. In the cohort, changes in dietary intake (decreases in energy from fat, Keys index and increases in the polyunsaturated to saturated fats ratio) were related to a decrease in TC at both sites and to a decrease or smaller increase in LDL-C for rural men. CONCLUSIONS: The observed changes were generally unfavorable, with a decrease in the proportion of persons with desirable lipid levels. At both sites nutritional changes were favorable, including a drop in total energy intake. Less pronounced were changes in percentages of total energy from fats, where the only significant decrease was for rural women; however, improvements in dietary fat composition and declines in cholesterol consumption were found. These favorable changes in diet were not strong enough or were not in effect long enough to counter the unfavorable changes in blood lipids.

Adult↗

PubMed1997

Thrombin generation markers and coronary heart disease risk factors in a Polish population sample.

Thrombosis plays a major role in the development of atherosclerosis and its acute vascular complications. Epidemiological studies have shown that elevated levels of plasma fibrinogen are associated with an increased risk of coronary heart disease (CHD). It is not clear whether this association is linked to hemostatic functions of fibrinogen which serves as a substrate for thrombin. Generation of thrombin in vivo can be evaluated by measurement of its specific markers in plasma, i.e. thrombin-antithrombin III complex (TAT) and prothrombin fragment 1 + 2 (F1 + 2). We determined plasma levels of TAT and F1 + 2 in a population sample of southeastern Poland and evaluated relations of these markers with plasma fibrinogen, factor VII coagulant activity (FVIIc), and other known CHD risk factors. The population studied consisted of 215 men and 251 women, aged 43-75 years. Final analysis was performed on 195 men and 222 women. The distribution of plasma TAT and F1 + 2 concentrations were highly skewed with the higher median values for women than for men. Log values of TAT correlated with log values of F1 + 2 in men (r = 0.27, p < 0.01) and in women (r = 0.15, p < 0.05). In the regression analysis both markers were positively related to age in women but not in men. After adjustment to age there was a positive relation between TAT and fibrinogen in both sexes. In women, but not in men, F1 + 2 showed a positive association with FVIIc. Total plasma cholesterol was negatively related to TAT in women only. There was no association between thrombin generation markers and plasma triglycerides, HDL-cholesterol, LDL-cholesterol, blood pressure, cigarette smoking and body mass index (BMI). The association of plasma fibrinogen and FVIIc with thrombin generation markers points to an important role of the hemostatic system in the pathogenesis of atherosclerosis and coronary heart disease in humans.

Adult↗

PubMed1996

Poland and United States Collaborative Study on Cardiovascular Epidemiology. A comparison of HDL cholesterol and its subfractions in populations covered by the United States Atherosclerosis Risk in Communities Study and the Pol-MONICA Project.

HDL cholesterol (HDL-C) levels are inversely related to coronary heart disease (CHD) risk, and HDL-C distributions vary among countries. Poland is one of the few developed countries in which CHD rates are increasing at the same time that US rates have been falling, but whether these differences are explained by differences in risk factors such as HDL-C has not been determined. To examine this possibility, levels of HDL-C and its subfractions were compared in US and Polish urban and rural men and women aged 45 to 64 years. Age-adjusted HDL-C means were 0.20 mmol/L higher in urban Polish men and 0.37 mmol/L higher in rural Polish men than in their US counterparts (P < .0001); means in urban Polish women were 0.06 mmol/L higher (P < .05) and in rural Polish women 0.09 mmol/L higher (P < .001) than in their US counterparts. Adjustment for age, education, alcohol intake, smoking, BMI, heart rate, and menopause status (in women) had little effect on differences. Means of HDL2 and HDL3 levels showed similar between-country differences, although differences were minimal for HDL2 in urban men and women, and HDL3 means did not differ between rural women. BMI was inversely related to HDL-C and both subfractions in all gender-country-site strata (P < .001), and alcohol was directly related to HDL-C (P < .001) in all strata except Polish women. Cigarette smoking was negatively related to HDL-C and both subfractions in all US samples except HDL2 in urban men, whereas in Polish samples, significant associations were found only in urban women for HDL-C and in rural and urban women for HDL3. Age, heart rate, and education showed inconsistent or no association with HDL-C and its subfractions in either country. This profile of HDL-C and its subfractions in Polish samples contrasts sharply with the opposite trend in CHD mortality rates, which suggests either that other risk factors may account for the trends or that the relationship between HDL-C and CHD may differ between the two countries.

Age Factors↗

PubMed1996

[Myocardial infarction and complications. Longitudinal observation of a population of 280,000 women and men--Project POL-MONICA Krakow. I. Genesis and objectives of the WHO MONICA Project].

The WHO MONICA Project is a multicentre collaborative study coordinated by The World Health Organization. The aim is to measure trends in cardiovascular disease mortality and morbidity and to assess the extent, to which these trends are related to changes in risk factor levels and in medical care measured at the same time in defined communities in different countries. There are 38 participating research centres from 21 countries from 4 continents, including two Polish centres: POL-MONICA Warszawa and POL-MONICA Kraków. Population studied in POL-MONICA Warszawa Project consisted of residents of two districts of Warsaw capital. The interest of the research of the POL-MONICA Kraków focuses on problems of the myocardial infarction in semi-rural population and the population observed consisted of men and women at age 25-64 years residents of one Polish province-Tarnobrzeg Voivodship.

Adult↗

PubMed1996

[Myocardial infarction--threats and medical care. Longitudinal observations in a population of 280,000 women and men--Project POL-MONICA Krakow. II. Risk factors and mortality due to ischemic heart disease in men ages 35-64].

The objective of paper was to assess to which extent hypertension, hypercholesterolemia, obesity and smoking are related to the risk of dying due to ischaemic heart disease (IHD) and to which extent changes in IHD risk factors could explain changes in IHD mortality in Polish men. The study was done in population of men at age 35-64 years, inhabitants of one Polish province (Tarnobrzeg Voivodship), which was subjected to POL-MONICA Kraków Project. The risk of IHD death and predicted changes in IHD mortality were assessed by logistic regression model using the risk factors measurements obtained at 3 screening surveys of independent random samples of studied population. Surveys were carried out in 1983-84, 1987-88 i 1992-93 and 2502 men were examined in total. 97% were followed for 12 years and 69 died of IHD. Higher risk of IHD death was found in men who had hypercholesterolemia, hypertension and who were smokers. Odds ratio adjusted to age and other risk factors was 1.87 for hypercholesterolemia, 2.38 for hypertension and 1.73 for smoking. There was no significant relation between obesity and risk of IHD death. In the studied population there was an increase in the prevalence of hypercholesterolemia and decrease in the prevalence of hypertension. There was no significant changes in the prevalance of obesity and smoking. Compared to 1983-84, predicted increase in IHD mortality calculated from changes in risk factors was 7.7% in 1987-88 and 0.2% in 1992-93. Predicted changes were smaller than observed, which were 40.1% and 39.3% increase respectively. In conclusion, despite of confirmed strong relationship between risk factors studied and risk of IHD death, combined effect of spontaneous changes in the risk factors was to small to explain observed changes in IHD mortality in the studied population.

Adult↗

PubMed1996

[Myocardial infarction--symptoms and procedures. Longitudinal observation of a population of 280,000 women and men--Project POL-MONICA Krakow. V. Atypical symptoms and prognosis in myocardial infarction].

There is some evidence in Poland, that percent of hospitalized coronary heart disease events with no typical pain for myocardial infarction (MI) increased. The purpose of the paper was to assess in the observational study whether the lack of typical pain in MI effects the risk of death in the acute phase. There were 1815 events, registered in POL-MONICA Kraków Project, with clinical diagnosis of MI or acute coronary heart disease, which were classified as "definite MI" or "possible MI" according to the criteria of The WHO MONICA Project, which were included to the analysis. Typical pain occurred in 1693 (93%) events and atypical symptoms in 122 (7%) events. Shock and left ventricular failure (LVF) were observed more frequently in patients with atypical symptoms who also were treated more frequently with diuretics, inotropic agents, antiarrythmics and more frequently received thrombolytic treatment. Patients with atypical symptoms had higher risk of death. Relative risk was 3.65 (95% confidence interval: 2.45-5.44). After adjustment for age, sex, shock, LVF and diabetes relative risk decreased to 1.67 (95% confidence interval: 1.10-2.54) and after inclusion of treatment to the analysis relative risk decreased to 1.58 (95% confidence interval: 1.04-2.39). The results suggest that lack of typical pain in MI can be related to worse prognosis and it should lead to more careful consideration of the treatment.

Adult↗

PubMed1996

[Myocardial infarction--symptoms and procedures. Longitudinal observation of a population of 280,000 women and men--Project POL-MONICA in Krakow. VI: Enzymatic diagnosis and myocardial infarction].

Different combinations of serum enzymes activity determinations are used in the diagnostics of myocardial infarction. The goal of the present paper was: 1) to assess the frequency of determinations of asparagine aminotransferase (AspAT) and to compare it with the frequency of determinations of creatinine phosphokinase (CPK) in patients hospitalized due to ischaemic heart disease in district hospitals, and 2) to assess to what extent the parallel determination of both enzymes effected to diagnostic classification of events according to The WHO MONICA Project. The analysis was done in 7406 hospitalized events registered with the clinical diagnosis of ischaemic heart disease (1810 myocardial infarctions, 402 acute coronary heart disease and 5194 other forms of ischaemic heart disease), registered in POL-MONICA Kraków Project in 1988-1993. Serum activity of AspAT was determined in over 90% events with either myocardial infarction or acute coronary heart disease. Number of determinations of CPK increased since 1990 and then, fluctuated from 15% to 36%. In 718 hospitalized events with clinical diagnosis of ischaemic heart disease, for whom both CPK and AspAT were determined, there was 96% observed agreement between diagnostic classification of events based on complains, ecg and alternatively: 1) both AspAT and CPK and 2) CPK only. Potential agreement beyond chance-kappa was 0.94 (almost perfect agreement). The parameters of the agreement were worse when AspAT only was used in the second option. The results indicate that efforts to increase the number of determinations of CPK in myocardial infarction diagnostics should be undertaken. At least for a part of events with myocardial infarction diagnosis confirmed by ecg and CPK tests, determination of AspAT is not necessary.

Adult↗

PubMed1996

[Myocardial infarction--risks and procedures. Longitudinal observation of a population of 280,000 women and men--Project POL-MONI CA Krakow. III: Epidemiology and treatment of myocardial infarction].

There has been a large amount of progress in the methods of prevention and treatment of ischaemic heart disease (IHD), but the effect of these changes on mortality due to IHD has not been assessed. This paper presents the complex analysis of 10-year trends of incidence, case fatality and mortality due to myocardial infarction (MI) and changes in medical care in the acute phase of MI in residents of one province of Poland-Tarnobrzeg Voivodship, which was the target population of the POL-MONICA Kraków Project (over 280,000 men and women at age 25-64 years). In men, the incidence of MI, which was 335/100,000 in 1984, increased in 1986 to 463/1,000,000 and then was stable until 1993 when it felt to 362/100,000. Mortality from MI, which was 149/100,000 in 1984, increased to 212/100,000 in 1986 and then was stable until 1992, before falling to 173/100,000 in 1993. There were large fluctuations in the incidence and mortality from MI in women i.e. from 58/100,000 to 116/100,000 and from 21/100,000 to 55/100,000 respectively. In 1993 the incidence was 82/100,000 and mortality was 32/100,000. After adding sudden deaths and other fatal events attributed to IHD the mortality figures increased over the ten years of observation by an average of 29% in men and by 28% in women. The average total MI case fatality was 47% in men and 40% in women, with 86% of all deaths due to MI occurring out of hospital. Case-fatality of MI managed in hospital was 11% on average.

Adrenergic beta-Antagonists↗

PubMed1996

[Myocardial infarction--risks and procedures. Longitudinal observation of a population of 280,000 women and men--Project POL-MONICA Krakow. I V: Prognosis of non-invasive treatment in myocardial infarction within 28 days since its onset].

The objective of a paper was to assess in the observational study the early determinants of outcome in patients with acute myocardial infarction (MI)) in one province of Poland (Tarnobrzeg Voivodship). The studied group were 1858 hospitalized men and women registered in POL-MONICA Kraków study with clinical diagnosis of myocardial infarction or acute coronary heart disease, who fulfilled the criteria for definite or possible myocardial infarction according to The WHO MONICA Project. The main out-come measure was death before the end of 28th day after the onset. Patients with shock were at the highest risk to die-relative risk (RR) = 21.47, 95% confidence interval (CI) = 12.86-35.83. The other characteristics, which increased risk independently were: left ventricular failure (LVF) (RR = 2.51, 95% CI = 1.54-4.10) and age (RR = 1.03, 95% CI = 1.01-1.05) per one year. Male sex and diabetes were not related to the risk of death. After adjustment to age, sex, shock, LVF and diabetes, lower risk was found in patients treated with antiplatelet agents (RR = 0.41, 95% CI = 0.29-0.59), with beta-blockers (RR = 0.48, 95% CI = 0.31-0.75) and with nitrates (RR = 0.62, 95% CI = 0.39-0.98), which were used in 66.2%, 33.1% and 97% of events respectively. Higher risk was found in patients treated with diuretics.

Adrenergic beta-Antagonists↗