Background: Severe hypercholesterolemia is associated with an increase in the risk of developing atherosclerotic cardiovascular disease. The aim of this analysis was to assess longitudinal trends in severe dyslipidemia (defined as total cholesterol > 8 mmol/L or LDL-cholesterol > 5 mmol/L) in a representative population sample of the Czech Republic and to analyze the longitudinal trends in the basic characteristics of individuals with severe dyslipidemia. Methods: Seven independent cross-sectional surveys were organized in the Czech Republic to screen for major cardiovascular risk factors (from 1985 to 2015-2018). A total of 20,443 randomly selected individuals aged 25-64 years were examined. Results: The overall prevalence of severe dyslipidemia was 6.6%, with a significant downward trend from the fifth survey onwards (2000/2001). Over the study period of 30+ years, the individuals with severe dyslipidemia became older, increased in BMI, and did not change their smoking habits. Total cholesterol and non-HDL-cholesterol decreased significantly in both sexes throughout the duration of the study. Conclusions: Despite a significant improvement in lipids in the Czech Republic from 1985, substantially contributing to the decline in cardiovascular mortality, the number of individuals with severe dyslipidemia remained high, and in most cases, they were newly detected during our screening examinations and were thus untreated.
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Hypertension is the most common cardiovascular disease which substantially increases cardiovascular morbidity and mortality. Despite the broad availability of antihypertensive medication, control of hypertension is not satisfactory worldwide. OBJECTIVE: The study aim was to assess longitudinal trends in blood pressure, prevalence, awareness, treatment, and control of hypertension in a representative population sample of the Czechia from 1985 to 2016/2017, focusing on sex differences. METHODS: A total of 7,606 men and 8,050 women aged 25-64 years were screened for major CV risk factors in seven independent cross-sectional surveys run consistently in the same six country districts of the Czechia between 1985 and 2016/2017. The population samples were randomly selected. RESULTS: Over a study period of 31/32 years, there was a significant decline in systolic and diastolic blood pressure in both sexes, whereas the prevalence of hypertension decreased only in women. There was an increase in hypertension awareness in both sexes over the entire study period with consistently higher rates in women. The proportion of individuals treated with antihypertensive drugs increased significantly in both sexes throughout the study, again with consistently higher rates in women. Control of hypertension increased significantly over the study period with consistently higher rates in women. The age-adjusted trends in blood pressure, prevalence, awareness, and treatment of hypertension were significantly different in men and women, always in favor of women. The age-adjusted trends in control of hypertension in treated patients were equally poor in both sexes. CONCLUSION: There are significant differences in longitudinal trends in blood pressure, prevalence, awareness, treatment, and control of hypertension between men and women, always in favor of women except for the control of hypertension in treated patients, where it is equally poor in both sexes.
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Compared with Western Europe, the decline in cardiovascular (CV) mortality has been delayed in former communist countries in Europe, including the Czech Republic. We have assessed longitudinal trends in major CV risk factors in the Czech Republic from 1985 to 2016/17, covering the transition from the totalitarian regime to democracy. METHODS: There were 7 independent cross-sectional surveys for major CV risk factors conducted in the Czech Republic in the same 6 country districts within the WHO MONICA Project (1985, 1988, 1992) and the Czech post-MONICA study (1997/98, 2000/01, 2007/08 and 2016/2017), including a total of 7,606 males and 8,050 females. The population samples were randomly selected (1%, aged 25-64 years). RESULTS: Over the period of 31/32 years, there was a significant decrease in the prevalence of smoking in males (from 45.0% to 23.9%; p < 0.001) and no change in females. BMI increased only in males. Systolic and diastolic blood pressure decreased significantly in both genders, while the prevalence of hypertension declined only in females. Awareness of hypertension, the proportion of individuals treated by antihypertensive drugs and consequently hypertension control improved in both genders. A substantial decrease in total cholesterol was seen in both sexes (males: from 6.21 ± 1.29 to 5.30 ± 1.05 mmol/L; p < 0.001; females: from 6.18 ± 1.26 to 5.31 ± 1.00 mmol/L; p < 0.001). CONCLUSIONS: The significant improvement in most CV risk factors between 1985 and 2016/17 substantially contributed to the remarkable decrease in CV mortality in the Czech Republic.
- MeSH
- antihypertenziva terapeutické užití MeSH
- dospělí MeSH
- hypercholesterolemie epidemiologie MeSH
- hypertenze farmakoterapie epidemiologie MeSH
- index tělesné hmotnosti MeSH
- kardiovaskulární nemoci epidemiologie etiologie MeSH
- kouření cigaret epidemiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- morbidita trendy MeSH
- mortalita trendy MeSH
- obezita epidemiologie MeSH
- politika MeSH
- průřezové studie MeSH
- rizikové faktory MeSH
- sociální změna MeSH
- zdraví - znalosti, postoje, praxe MeSH
- zdravotnické přehledy MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
OBJECTIVES: There is no agreement on optimal blood pressure (BP) level during the acute phase of stroke, because studies on the relation between BP and stroke outcome have shown contradicting results. The aim of this study was to compare the relationship of admission, maximal, discharge BP and its components during hospitalization for the first-ever acute ischemic stroke with total mortality after stroke. METHODS: In 532 consecutive patients (mean age 66 ± 10 years, 59% of men) hospitalized for their first-ever ischemic stroke, the association between BP and total mortality during a median follow-up of 66 weeks (interquartile range 33-119 weeks) was analyzed. RESULTS: In multivariate analysis, both admission mean BP (MBP) and discharge SBP quartiles were independent predictors of mortality and outperformed other parameters of BP. After multivariate adjustments, patients with admission MBP below 100 mmHg had a higher risk of death than those with MBP between 100-110 and 110-121 mmHg, whereas the risk of mortality did not differ from the group with admission MBP above 122 mmHg. Similarly, patients with discharge SBP below 120 mmHg had an increased risk of death as compared to groups with SBP between 120-130 and 130-141 mmHg, whereas the risk of death was similar to that with discharge SBP above 141 mmHg. CONCLUSION: Among patients hospitalized for their first-ever ischemic stroke, the risk of all-cause death is significantly increased in those with admission MBP below 100 mmHg and discharge SBP below 120 mmHg, even after adjustments for other confounders.
- MeSH
- cévní mozková příhoda komplikace mortalita patofyziologie MeSH
- dospělí MeSH
- hospitalizace MeSH
- hypotenze komplikace MeSH
- krevní tlak fyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- měření krevního tlaku MeSH
- multivariační analýza MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
OBJECTIVE: Recurrent strokes are associated with higher mortality, greater disability, and increased healthcare costs compared with first-ever stroke. Lifestyle measures and drug treatment in secondary prevention decrease the risk of recurrence while improving the quality of life of patients. The objective of this study was to determine the prevalence of hypertension and other cardiovascular risk factors in stroke survivors and population controls. METHODS AND RESULTS: A total of 424 poststroke survivors (aged 66.0 ± 10.4 years) were examined 6-36 months after their first ischemic stroke. Controls of similar age and from the same geographic region were selected from the database of the Czech post-Multinational MONItoring of trends and determinants in CArdiovascular disease Study. Hypertension was found to be the most prevalent risk factor affecting 91.5% of stroke survivors and 71.8% of controls. Use of antihypertensive drugs was reported in 79.5% of stroke survivors and 56.7% of controls. However, blood pressure lower than 140/90 mmHg was achieved in only 49.5% of hypertensive stroke survivors. More than 60% of stroke survivors used statins but low-density lipoprotein-cholesterol lower than 2.5 mmol/l was achieved in only 47.4 and 37% of male and female poststroke survivors, respectively. About a third of poststroke patients continue to smoke, and obesity is a major problem, particularly in women (prevalence 47%), who also have a high prevalence of diabetes. CONCLUSION: We found a high prevalence and poor control of major cardiovascular risk factors in patients surviving their first-ever ischemic stroke, thus showing poor implementation of guidelines for secondary prevention in clinical practice.
- MeSH
- antihypertenziva terapeutické užití MeSH
- cévní mozková příhoda epidemiologie prevence a kontrola MeSH
- diabetes mellitus epidemiologie MeSH
- dospělí MeSH
- hypertenze farmakoterapie epidemiologie patofyziologie MeSH
- kouření epidemiologie MeSH
- krevní tlak fyziologie MeSH
- kvalita života MeSH
- LDL-cholesterol krev MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- obezita epidemiologie MeSH
- prevalence MeSH
- přežívající statistika a číselné údaje MeSH
- recidiva MeSH
- rizikové faktory MeSH
- sekundární prevence MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- statiny terapeutické užití MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
BACKGROUND: Although obesity is a risk factor for stroke and achieving normal weight is advocated to decrease stroke risk, the risk associated with obesity and weight loss after stroke has not been well established. The aim of this study was to assess the association of obesity at the time of stroke admission and weight loss after stroke with total mortality. METHODS: We analyzed 736 consecutive patients (mean age, 66 ± 11 years; 58% men) hospitalized for their first ischemic stroke. Body weight at hospital admission and at the outpatient visit during follow-up was used in the analysis. RESULTS: After multivariate adjustment, obesity at admission was associated with lower mortality risk as compared with normal weight (hazard ratio [HR], .50, P = .03). At the outpatient visit, with a median follow-up time of 16 months, 21% of patients had lost more than 3 kg of weight. Stroke severity, heart failure, transient ischemic attack, and depression after stroke were independently associated with significant weight loss. Weight loss of more than 3 kg was associated with increased mortality risk (HR, 5.87; P = .001) independently of other factors. Similar results were seen when weight loss was defined as losing more than 3% of baseline weight (HR, 4.97; P = .004). Weight gain of more than 5% of the baseline weight tended to be associated with better survival when compared with no weight change (log-rank test, P = .07). CONCLUSIONS: Normal weight at hospital admission and weight loss after ischemic stroke are independently associated with increased mortality. Overweight and obesity at baseline do not decrease the risk associated with weight loss.
- MeSH
- cévní mozková příhoda komplikace mortalita patofyziologie MeSH
- hmotnostní úbytek fyziologie MeSH
- index tělesné hmotnosti MeSH
- lidé středního věku MeSH
- lidé MeSH
- obezita komplikace patofyziologie MeSH
- rizikové faktory MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- MeSH
- cévní mozková příhoda * prevence a kontrola terapie MeSH
- hypertenze * farmakoterapie MeSH
- krevní tlak účinky léků MeSH
- lidé MeSH
- měření krevního tlaku MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
