Abstract
Acute myocardial infarction (AMI) is a major public health problem. Cold winter weather increases the risk of AMI, but factors influencing susceptibility are poorly known. We conducted an ...individual-level case-crossover study of the associations between winter cold spells and the risk of AMI, with special focus on survival at 28 days and effect modification by age and sex. All 16,071 adult cases of AMI among the residents of the city of Kaunas in Lithuania in 2000–2015 were included in the study. Cold weather was statistically defined using the 5th percentile of frequency distribution of daily mean temperatures over the winter months. According to conditional logistic regression controlling for time-varying and time-invariant confounders, each additional cold spell day during the week preceding AMI increased the risk of AMI by 5% (95% CI 1–9%). For nonfatal and fatal cases, the risk increase per each additional cold spell day was 5% (95% CI 1–9%) and 6% (95% CI − 2–13%), respectively. The effect estimate was greater for men (OR 1.07, 95% CI 1.02–1.12) than for women (OR 1.02, 95% CI 0.97–1.08), but there was no evidence of effect modification by age. Evidence on factors increasing susceptibility is critical for targeted cold weather planning.
Ageing populations experience greater risks associated with health and survival. It increases the relevance of identifying variables associated with mortality. Grip strength (GS) has been identified ...as an important biomarker for all cause and cardiovascular mortality, however, its prognostic value has not been studied in Lithuania. The aim of the present study is to evaluate the relationship of GS to vital status in a representative sample of the Lithuanian 45-72-year-old urban population during the period of 12 years of follow-up and to explore associations of GS with all-cause mortality and mortality from cardiovascular diseases (CVD).
Within the framework of the international study Health, Alcohol and Psychosocial Factors in Eastern Europe (HAPIEE) 7,115 men and women 45-72 years of age were examined in the baseline survey (2006 to 2008). Data from the Official Lithuanian Mortality Register were used to evaluate CVD and all-cause mortality from follow-up till 2020. Cox proportional hazards regression was used, and four models for all-cause and CVD mortality were assessed.
The mean GS was significantly higher among survivors' men and women as compared to individuals deceased from CVD and other causes of death. In survivor men and women groups, minimal values of GS in all terciles were higher as compared to all three deceased groups. In both men and women groups, the lowest GS (1st tercile) was associated with a significantly higher risk of all-cause and CVD mortality as compared to the highest levels of GS (3rd tercile) in three Cox regression models. In both men and women were found to have a 1.34- and 1.35-fold higher risk of all-cause mortality, respectively, at lower GS, but no significant difference in the risk of CVD mortality. When GS was treated in all models as decrement per 1 kg and decrement per 1 SD, in both men and women, the risk of all-cause mortality significantly increased with decreasing of GS.
The mean GS was significantly higher among survivors' men and women as compared to deceased from CVD and other causes of death. Risk of all-cause mortality significantly increased with decreasing of GS.
Empirical evidence on the epidemiology of hypertension, diabetes and hypercholesterolemia is limited in many countries in Central and Eastern Europe. We aimed to estimate the prevalence, awareness, ...treatment and control of hypertension, diabetes and hypercholesterolemia in the Czech Republic, Russia, Poland and Lithuania, and to identify the risk factors for the three chronic conditions.
We analysed cross-sectional data from the HAPIEE study, including adults aged 45-69 years in the Czech Republic, Russia, Poland and Lithuania, collected between 2002 and 2008 (total sample N = 30,882). Among prevalent cases, we estimated awareness, treatment, and control of hypertension, diabetes and hypercholesterolemia by gender and country. Multivariate logistic regression was applied to identify associated risk factors.
In each country among both men and women, we found high prevalence but low control of hypertension, diabetes, and hypercholesterolemia. Awareness rates of hypertension were the lowest in both men (61.40%) and women (69.21%) in the Czech Republic, while awareness rates of hypercholesterolemia were the highest in both men (46.51%) and women (51.20%) in Poland. Polish participants also had the highest rates of awareness (77.37% in men and 79.53% in women), treatment (71.99% in men and 74.87% in women) and control (30.98% in men and 38.08% in women) of diabetes. The common risk factors for the three chronic conditions were age, gender, education, obesity and alcohol consumption.
Patterns of awareness, treatment and control rates of hypertension, diabetes and hypercholesterolemia differed by country. Efforts should be made in all four countries to control these conditions, including implementation of international guidelines in everyday practice to improve detection and effective management of these conditions.
Cold winter weather increases the risk of stroke, but the evidence is scarce on whether the risk increases during season-specific cold weather in the other seasons. The objective of our study was to ...test the hypothesis of an association between personal cold spells and different types of stroke in the season-specific context, and to formally assess effect modification by age and sex.
We conducted a case-crossover study of all 5396 confirmed 25-64 years old cases with stroke in the city of Kaunas, Lithuania, 2000-2015. We assigned to each case a one-week hazard period and 15 reference periods of the same calendar days of other study years. A personal cold day was defined for each case with a mean temperature below the fifth percentile of the frequency distribution of daily mean temperatures of the hazard and reference periods. Conditional logistic regression was applied to estimate odds ratios (OR) and 95% confidence intervals (95% CI) representing associations between time- and place-specific cold weather and stroke.
There were positive associations between cold weather and stroke in Kaunas, with each additional cold day during the week before the stroke increases the risk by 3% (OR 1.03; 95% CI 1.00-1.07). The association was present for ischemic stroke (OR 1.05; 95% CI 1.01-1.09) but not hemorrhagic stroke (OR 0.98; 95% CI 0.91-1.06). In the summer, the risk of stroke increased by 8% (OR 1.08; 95% CI 1.00-1.16) per each additional cold day during the hazard period. Age and sex did not modify the effect.
Our findings show that personal cold spells increase the risk of stroke, and this pertains to ischemic stroke specifically. Most importantly, cold weather in the summer season may be a previously unrecognized determinant of stroke.
Several lifestyle behaviours, including physical activity, smoking, alcohol consumption, nutrition habits, and social activity have been associated with psychological well-being (PWB). However, their ...effect on PWB prospectively has been less studied. The aim of the present study was to evaluate the influence of lifestyle factors on higher future PWB during the 10-year follow-up of middle-aged and elderly urban population.
In the baseline survey (2006 to 2008), 7115 men and women 45-72 years of age were examined within the framework of the international study Health, Alcohol and Psychosocial Factors in the Eastern Europe (HAPIEE). In the follow-up survey (in 2016), which was performed among all 6210 participants who survived till that year, 4266 individuals participated responding to postal questionnaires. PWB was assessed by a CASP-12 questionnaire. The lifestyle behaviours, including smoking and nutrition habits, alcohol consumption, social and physical activity, were evaluated by the questionnaire. Multivariable logistic regression models were applied for statistical data analysis.
After accounting for several potential confounders, healthy levels of lifestyle behaviours were associated with higher PWB after 10-year follow-up. Never-smokers in men and former smokers in women had higher PWB by 43 and 67% odds respectively in comparison with smokers. Physical activity in women and high social activity both in men in women was positively related to higher PWB. More frequent fresh vegetable and fruit consumption was associated with higher odds of higher PWB (odds ratio 1.57 in men and 1.36 in women, p < 0.05) compared to less frequent consumption of such food groups. Dose-response relationship between increasing number of healthy lifestyle factors and higher PWB was determined both in men and women.
Lifestyle factors such as never smoking and former smoking, high social activity, and more frequent fresh vegetable and fruit consumption increased the odds of higher PWB over 10 years of follow-up in men and women groups. The increase of the protective health behaviour score was directly associated with the odds of higher PWB.
The aim of this study was to determine the association between the daily number of cases of ischemic stroke (IS) and hemorrhagic stroke (HS) in patients aged 25–64 years and the El Niño-Southern ...Oscillation (ENSO) events during 2000–2015. As an indicator of the effect of the ENSO, the monthly NIÑO 3.4 index (Equatorial Pacific Sea Surface Temperature) was used. During the 5844-day study period, 5600 cases of stroke (3170 (56.61%) in men and 2430 (43.39%) in women) were analyzed. Of these, 4354 (77.8%) cases were IS, and 1041 (18.6%) cases were HS. In 3496 (62.2%) cases, stroke occurred in the age group of 55–64 years. In the analysis, we used the following categories of the ENSO events: strong La Niña, moderate La Niña, moderate El Niño, and strong El Niño. The effect of the ENSO was examined by using the multivariate Poisson regression adjusting for weather variables. The highest risk of both strokes (BS) was observed on days of strong and moderate La Niña (rate ratio (
RR
) 1.27, 95%
CI
1.13–1.42) and
RR
= 1.15 (1.07–1.23), respectively), while the risk for IS was the highest on days of moderate El Niño (
RR
= 1.11(1.02–1.20)). A lower risk for BS was found on days of strong El Niño (
RR
= 0.77(0.62–0.97)). We found that ENSO events affected the occurrence of BS and IS in all age groups, and the strongest effect was observed among females. The results of this study provide new evidence that ENSO events may affect the risk of stroke, especially the risk of IS.
Abstract
It is unclear whether the dose–response relationship between lung function and all-cause and cardiovascular mortality in the Central and Eastern European populations differ from that ...reported in the Western European and American populations. We used the prospective population-based HAPIEE cohort that includes randomly selected people with a mean age of 59 ± 7.3 years from population registers in Czech, Polish, Russian and Lithuanian urban centres. The baseline survey in 2002–2005 included 36,106 persons of whom 24,944 met the inclusion criteria. Cox proportional hazards models were used to estimate the dose–response relationship between lung function defined as FEV1 divided by height cubed and all-cause and cardiovascular mortality over 11–16 years of follow-up. Mortality rate increased in a dose–response manner from highest to lower FEV1/height
3
deciles. Adjusted hazard ratios (HR) of all-cause mortality for persons in the 8th best, the 5th and the worst deciles were 1.27 (95% CI 1.08‒1.49), 1.37 (1.18–1.60) and 2.15 (1.86‒2.48), respectively; for cardiovascular mortality, the respective HRs were 1.84 (1.29–2.63), 2.35 (1.67–3.28) and 3.46 (2.50‒4.78). Patterns were similar across countries, with some statistically insignificant variation. FEV1/height
3
is a strong predictor of all-cause and cardiovascular mortality, across full distribution of values, including persons with preserved lung function.
The impact of weather on morbidity from stroke has been analysed in previous studies. As the risk of stroke was mostly associated with changing weather, the changes in the daily stroke occurrence may ...be associated with changes in atmospheric circulation. The aim of our study was to detect and evaluate the association between daily numbers of ischaemic strokes (ISs) and haemorrhagic strokes (HSs) and the teleconnection pattern.
The study was performed in Kaunas, Lithuania, from 2000 to 2010. The daily numbers of ISs, subarachnoid haemorrhages (SAHs), and intracerebral haemorrhages (ICHs) were obtained from the Kaunas Stroke Register. We evaluated the association between these types of stroke and the teleconnection pattern by applying Poisson regression and adjusting for the linear trend, month, and other weather variables.
During the study period, we analysed 4038 cases (2226 men and 1812 women) of stroke. Of these, 3245 (80.4%) cases were ISs, 533 (13.2%) cases were ICHs, and 260 (6.4%) cases were SAHs. An increased risk of SAH was associated with a change in mean daily atmospheric pressure over 3.9 hPa (RR = 1.49, 95% CI 1.14-1.96), and a stronger El Niño event had a protective effect against SAHs (RR = 0.34, 95% CI 0.16-0.69). The risk of HS was positively associated with East Atlantic/West Russia indices (RR = 1.13, 95% CI 1.04-1.23). The risk of IS was negatively associated with the Arctic Oscillation index on the same day and on the previous day (RR = 0.97, p < 0.033). During November-March, the risk of HS was associated with a positive North Atlantic Oscillation (NAO) (RR = 1.29, 95% CI 1.03-1.62), and the risk of IS was negatively associated with the NAO index (RR = 0.92, 95% CI 0.85-0.99).
The results of our study provide new evidence that the North Atlantic Oscillation, Arctic Oscillation, East Atlantic/West Russia, and El Niño-Southern Oscillation pattern may affect the risk of stroke. The impact of these teleconnections is not identical for various types of stroke. Emergency services should be aware that specific weather conditions are more likely to prompt calls for more severe strokes.
The purpose of this prospective cohort study was to examine whether the level of cognitive function at the baseline expressed as a cognitive function composite score and score of specific domains ...predict the risk of first cardiovascular disease (CVD) events in middle-aged and older populations.
Seven thousand eighty-seven participants, men and women aged 45-72 years, were assessed in the baseline survey of the Health Alcohol Psychosocial Factors in Eastern Europe (HAPIEE) study in 2006-2008 in the city of Kaunas, Lithuania. During 10 years of follow-up, the risk of first non-fatal events of CVD and death from CVD (excluding those participants with a documented history of CVD and/or ischemic heart disease (IHD) diagnosed at the baseline survey) was evaluated. Cox proportional hazards regression models were applied to examine how cognitive function predicts the first events of CVD.
During the follow-up, there were 156 deaths from CVD (49 women and 107 men) and 464 first non-fatal CVD events (195 women and 269 men) registered. The total number of first CVD events was 620 (11.5%). After adjustment for sociodemographic factors, biological and lifestyle risk factors and illnesses, a decrease per 1 standard deviation in different cognitive function scores significantly increased the risk of a first event of CVD (immediate verbal recall score - by 17% in men and 32% in women; delayed verbal recall score - by 17% in men and 24% in women; and a composite score of cognitive function - by 15% in men and 29% in women). Kaplan-Meier survival curves for the probability of a first cardiovascular event according to the categories of a composite score of cognitive function, revealed that a lowered cognitive function predicts a higher probability of the events compared to normal cognitive function (p < 0.05).
The findings of this follow-up study suggest that men and women with lower cognitive functions have an increased risk for a first event of CVD compared to participants with a higher level of cognitive functions.
Background
The study aimed to examine whether after confounding by possible socio-demographic and other risk factors, psychological well-being is independently associated with reduced all-cause and ...cardiovascular mortality.
Methods
Initial data were collected within the framework of the international project HAPIEE in 2006–2008. A random sample of 7115 individuals aged 45–72 years was screened. Deaths were evaluated by death register of Kaunas city (Lithuania) in a follow-up study till 2016. Psychological well-being was evaluated by a CASP-12 questionnaire. Socio-demographic, lifestyle, biologic factors and depressive symptoms were evaluated.
Results
Age-adjusted survival curves revealed that psychological well-being predicts longevity in men and women (
p
< 0.001). After adjustment for many possible confounders psychological well-being was independently associated with all-cause mortality in men (HR 0.77; 95% CI 0.62–0.94) and women (HR 0.73; 95% CI 0.56–0.96). However, psychological well-being association with cardiovascular mortality attained statistical significance only in the women’s group (HR 0.53; 95% CI 0.33–0.87), but not in men (HR 0.98; 95% CI 0.72–1.33).
Conclusions
Psychological well-being is an important predictor of longevity, controlling well-recognized risk factors such as age, education, cardiovascular diseases, social status, marital status, lifestyle and biological factors and depressive symptoms. Positive psychological well-being should be taken into account when screening older people to prevent negative health outcomes.
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