Česká republika patří mezi země s vysokou úmrtností na KVO, která od roku 1985 významně klesá. Aplikce validovaného mortalitního modelu IMPACT ukázala, že více než polovinu významného poklesu úmrtnosti na ICHS lze v ČR připsat změnám (poklesu) hlavních KV rizikových faktorů; zlepšení léčby se podílelo cca 43 %. Tyto výsledky podtrhují význam primární prevence a léčby založené na důkazech. Navrhovaný projekt je populační studie u reprezentativního náhodného vzorku populace ČR s cílem analyzovat longitudinální trendy hlavních KV rizikových faktorů. Poprvé bude v naší obecné populaci stanovena prevalence diabetu a primárního aldosteronismu. Projekt je unikátní v tom, že propojuje údaje z předchozí studie z roku 1997/98 s údaji o morbiditě (Národní onkologický registr) a mortalitě (ÚZIS) a stanovuje tak prediktivní hodnotu hlavních KV rizikových faktorů. Je příkladem mezioborové spolupráce analyzující společné rizikové faktory pro rozvoj KV, metabolických a maligních onemocnění.; The Czech Republic (CR) is a country with high CV mortality decreasing since 1985. Using the validated IMPACT mortality model, more than half of the substantial fall in CHD mortality in the CR was attributable to reduction in major CV risk factors; improvement in treatments accounted for an approx. 43%. The results highlight the value of primary prevention and evidence-based treatment. The proposed project is a population study in a representative random sample of the CR aiming to analyze longitudinal trends in major CV risk factors and chronic kidney disease. Prevalence of diabetes and primary aldosteronism will be determined for the first time in our general population. The project proposal is unique in linking data from a previous survey conducted in 1997/98 to morbidity (National Cancer Registry) and mortality data (Institute of Health Information and Statistics of the CR) thus evaluating the predictive value of major CV risk factors; it is an example of interdisciplinary cooperation analyzing shared risk factors for the development of CV, metabolic, and malignant disease.

• MeSH
• chronická renální insuficience epidemiologie   MeSH
• diabetes mellitus epidemiologie   MeSH
• hyperaldosteronismus epidemiologie   MeSH
• kardiovaskulární nemoci etiologie   mortalita   MeSH
• lidé MeSH
• morbidita trendy   MeSH
• mortalita trendy   MeSH
• nádory mortalita   MeSH
• rizikové faktory kardiovaskulárních chorob MeSH
• Check Tag
• lidé MeSH

• Konspekt
• Patologie. Klinická medicína
• NLK Obory
• kardiologie
• epidemiologie
• NLK Publikační typ
• závěrečné zprávy o řešení grantu AZV MZ ČR

Advanced glycation end products (AGEs) are involved in several pathophysiologic processes in vascular diseases, including progressive loss of elasticity of the vessel wall (arterial stiffness). Circulating soluble receptors for AGEs (sRAGE) act as a decoy and counterbalanced the harmful properties of AGEs as the natural protective factor. We compared the role of circulating or skin-deposed AGEs and sRAGE regarding the natural course of arterial stiffening. In a prospective cohort study, we longitudinally followed 536 general population-based subjects (subsample of Czech post-MONICA study). Aortic pulse-wave velocity (PWV) was measured twice (at baseline and after ~8 years of follow-up) using a SphygmoCor device (AtCor Medical Ltd), and the intraindividual change in PWV per year (∆PWV/year) was calculated. Concentrations of sRAGE and carboxymethyl lysine (circulating AGEs) were assessed at the follow-up visit by ELISA, while skin AGEs were measured using the autofluorescence-based device AGE Reader. Using multiple regressions, we found significant association between ∆PWV/year as a dependent variable, and both, sRAGE and skin AGEs as independent ones (each on its own model). However, the closest associations to ∆PWV/year were found for the ratio of these two factors (skin AGEs/sRAGE) [β coeff = 0.0747 (SE 0.0189), p < 0.0001]. In a categorized manner, subjects with skin AGEs/sRAGE ratio ≥ 3.3 showed about twofold higher risk having ΔPWV/year ≥ 0.2 m/s [adjusted odds ratio was 2.09 (95% CI: 1.35-3.22), p = 0.001]. In contrast, neither circulating AGEs nor circulating AGEs/sRAGE showed any significant relation to ΔPWV/year. In conclusion, skin AGEs/sRAGE ratio seems to be a more sensitive biomarker of vascular aging than these single factors themselves or circulation status of AGEs.

• MeSH
• biologické markery MeSH
• lidé MeSH
• produkty pokročilé glykace * MeSH
• prospektivní studie MeSH
• receptor pro konečné produkty pokročilé glykace MeSH
• stárnutí * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: The potential antiatherogenic role of bilirubin is generally acknowledged, so the aim of this study was to determine serum bilirubin concentrations and the prevalence of Gilbert syndrome (GS) in the Czech general population with particular reference to its relationship to the risk of myocardial infarction (MI). Methods and Results: Biochemical markers were analyzed in 2 independent Czech post-MONICA studies (in total, n=3,311), and in 741 male MI patients. TheUGT1A1promoter gene variant (rs81753472) was analyzed in these MI patients and in the first control population cohort (n=717). Medians of serum bilirubin concentrations in the 2 Czech general population cohorts were 9.6 and 9.8 mumol/L (10.7 and 11.3 mumol/L in males, and 8.3 and 8.8 mumol/L in females; P<0.01). The prevalence of GS was 8.9%, twice as high in males compared with females (11.6 vs. 6.1%; P<0.01). TheUGT1A1(TA)7/7promoter repeats significantly influenced serum bilirubin concentrations in the controls, but not in the MI patients. Serum bilirubin concentrations were significantly lower in MI patients (7.7 vs. 10.7 mumol/L; P<0.01), with almost 5-fold lower prevalence of GS. CONCLUSIONS: Serum bilirubin concentrations and the prevalence of GS were determined in the Czech general population. Significantly lower serum bilirubin concentrations were observed in male MI patients.

• MeSH
• bilirubin * krev   MeSH
• dospělí MeSH
• genotyp MeSH
• Gilbertova nemoc * epidemiologie   genetika   krev   MeSH
• glukuronosyltransferasa genetika   MeSH
• infarkt myokardu * epidemiologie   genetika   krev   MeSH
• lidé středního věku MeSH
• lidé MeSH
• polymorfismus genetický MeSH
• prevalence MeSH
• promotorové oblasti (genetika) MeSH
• prospektivní studie MeSH
• průřezové studie MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• sexuální faktory MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Geografické názvy
• Česká republika MeSH

Circulating levels of soluble receptor for advanced glycation end-products (sRAGE) have been suggested to have a protective role in neutralizing advanced glycation end-products (AGEs) and their pathological effects on vessel walls. We aimed to investigate the association between the circulating concentration of sRAGE and the dynamics of arterial wall stiffening as a manifestation of vascular aging in the general population. In a prospective cohort study, we longitudinally followed 530 general-population-based subjects (subsample of Czech post-MONICA study). Aortic pulse wave velocity (PWV) was measured twice (at baseline and after ~8 years of follow-up) using a SphygmoCor device (AtCor Medical Ltd), and the intraindividual change in PWV per year (∆PWV/year) was calculated. Concentrations of sRAGE were assessed at baseline by ELISA (R&D Systems). The average ∆PWV/year significantly decreased across the sRAGE quintiles (p = 0.048), and a drop by one sRAGE quintile was associated with an ~21% increase in the relative risk of accelerated age-dependent stiffening (∆PWV/year ≥ 0.2 m/s). Subjects in the bottom quintile of sRAGE (<889.74 pg/mL) had a fully adjusted odds ratio of accelerated stiffening of 1.72 (95% CI: 1.06-2.79), p = 0.028, while those with high sRAGE concentrations (≥1695.2 pg/mL) showed the opposite effect [odds ratio 0.55 (95% CI: 0.33-0.90), p = 0.017]. In conclusion, the circulating status of sRAGE independently influenced the individual progression of arterial stiffness over time. This finding strongly supports the hypothesis that high sRAGE has a protective role against vascular aging.

• MeSH
• analýza pulzové vlny MeSH
• dospělí MeSH
• krevní tlak fyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• longitudinální studie MeSH
• prospektivní studie MeSH
• receptor pro konečné produkty pokročilé glykace krev   MeSH
• senioři MeSH
• stárnutí metabolismus   MeSH
• tuhost cévní stěny fyziologie   MeSH
• věkové faktory MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Východisko: Asymptomatické osoby se zvýšeným kardiovaskulárním rizikem představují jednu z priorit kardiovaskulární prevence, v praxi ale často opomíjenou. Naším cílem bylo objektivizovat, jak vysokorizikové osoby dosahují léčebných cílů v primární péči. Metoda: Analýza zahrnovala náhodný vzorek obecné populace, vyšetřený v rámci populačního průzkumu postMONICA v letech 2016–2017. Probandi byli kategorizováni podle svého individuálního kardiovaskulárního rizika na základě principů 6. společných evropských doporučení a porovnána byla jejich skutečná kontrola rizikového profilu s teoretickými doporučenými cíli kardiovaskulární prevence. Výsledky: Celkem bylo do analýzy zařazeno 898 subjektů ve věku 25–75 let (47 % mužů). Mezi nimi, 16,7 % subjektů bylo klasifikováno do kategorie “velmi vysoké riziko“, 36,8 % jako “vysoké riziko“, zatímco zbylých 46,5 % jako jen mírně zvýšené nebo nízké celkové individuální riziko. Z hlediska adherence k doporučeným principům, ve skupině s “velmi vysokým rizikem“ abstinovalo od tabáku v jakékoliv podobě jen 58,7 %, náležitou fyzickou aktivitu (≥ 150 min alespoň mírné aktivity týdně) nahlásilo 38 %, doporučenou tělesnou konstituci (BMI 20–25 kg/m2) vykazovalo 16,7 %, náležitý krevní tlak (< 140/90 mm Hg) 39,3 % a cílové hodnoty LDLcholesterolu (< 1,8 mmol/l) dosáhlo jen 8,7 % subjektů. V kategorii “vysokého rizika“ byla adherence k těmto cílům následující: 83,9 % (abstinence od tabáku), 32,7 % (fyzická aktivita), 17 % (tělesná konstituce), 58,2 % (krevní tlak) a 30,8 % (LDLcholesterol < 2,5 mmol/l). Přijatelnější byla v obou rizikových kategoriích kontrola glukózového metabolismu (HbA1c < 53 mmol/mol u diabetiků), tj. 75 % a 81 %, respektive. Závěr: Celková adherence k doporučeným principům kardiovaskulární prevence vysokorizikových osob je v primární péči velmi daleko od svého optima a markantní je toto zejména u subjektů s velmi vysokým rizikem.

Background: Asymptomatic high-risk individuals represent one of the highest priorities of cardiovascular prevention, in clinical practice frequently overlooked. We analyzed the real adherence to recommended principles of cardiovascular prevention in primary care subjects. Methods: Our analysis is based on random general population sample, examined in the frame of post-MONICA survey in 2016/17. Each subject was categorized with regard to its individual cardiovascular risk (based on Sixth Joint European Guidelines) and the real adherence to recommended targets was ascertained. Results: In total 898 subjects aged 25–75 years (47% males) were analyzed. Of them, 16.7% were classified into “very high risk“ and 36.8% into “high risk“ subgroup; remaining 46.5% were only at moderate or low risk. Regarding adherence to recommended principles, in “very high risk“ category only 58.7% abstain from any form of tobacco, 38% reported appropriate physical activity (≥150 minutes of at least moderate activity weekly), 16.7% had recommended body constitution (BMI 20–25kg/m2), 39.3% appropriate blood pressure (<14 0/9 0mm Hg) and only 8.7% reached LDL target (<1.8mmol/l). In “high risk” category was the adherence to these targets as follows: 83.9% (tobacco abstinence), 32.7% (physical activity), 17% (body constitution), 58.2 % (blood pressure) and 30.8 % (LDL < 2.5 mmol/l). More acceptable was in both risk categories the therapeutic control of glucose metabolism (HbA1c < 53 mmol/mol in diabetics), i. e. 75 % and 81 %, respectively. Conclusions: Global adherence of high-risk subjects to recommended principles of cardiovascular prevention is in primary care far from being optimal, notably in “very high risk“ category.

• MeSH
• adherence pacienta * MeSH
• dospělí MeSH
• kardiovaskulární nemoci * prevence a kontrola   MeSH
• klinická studie jako téma MeSH
• lidé středního věku MeSH
• lidé MeSH
• primární prevence MeSH
• primární zdravotní péče 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
• práce podpořená grantem MeSH

BACKGROUND: Cardiovascular disease (CVD) followed by cancer are the two leading causes of death worldwide. SCORE charts have been recommended in Europe to identify individuals at increased CVD risk. However, the SCORE ability to identify individuals at increased risk of cancer has not yet been evaluated. The aim of this study was to determine the SCORE chart calibration in a country with changing CVD epidemiology, and its discrimination ability to identify individuals at increased risk of cancer over 20-years. METHODS: The present analysis includes data from two cross-sectional independent surveys within the Czech post-MONICA study (randomly selected representative population samples of the Czech Republic, aged 25-64 years); 3209 individuals in 1997/98 and 3612 in 2006-2009. RESULTS: The SCORE had reasonable discrimination to predict 10-year CVD mortality, but significantly overestimated the risk across all risk categories. During the 20-year follow up, high and very high-risk categories were associated with an increased risk of cancer morbidity (in particular colorectal, other gastrointestinal, lung and malignant skin) and cancer mortality, as compared to low risk category. CONCLUSIONS: The present study shows that periodical calibration testing of SCORE charts is needed in countries with changing CVD epidemiology. Furthermore, we show that in middle-aged individuals, identified by SCORE charts as being at high or very high risk for CVD, cancer morbidity and cancer mortality is increased. Rigorous cancer screening may be appropriate in this group, especially in countries with falling CVD mortality, where relative proportion of cancer mortality is increasing.

• MeSH
• dospělí MeSH
• hodnocení rizik MeSH
• kardiovaskulární nemoci * epidemiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory * epidemiologie   MeSH
• průřezové studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH
• Evropa MeSH

The purpose: To evaluate longitudinal trends in the prevalence of hyperuricaemia and chronic kidney disease (CKD) in Czech adults with and without arterial hypertension (HT).Materials and methods: Two independent cross-sectional surveys were performed in 2006-2009 and 2015-2018, each screening involving 1% population random sample of the general population of nine districts of the Czech Republic aged 25-64 years, stratified by age and gender. Hyperuricaemia was defined as serum uric acid ≥ 420 μmol/l in men, and ≥ 360 μmol/l in women. CKD was defined as estimated glomerular filtration rate < 60 ml/min/1.73 m2 and/or albumin/creatinine ratio ≥ 3 mg/mmol.Results: Final analyses included 3504 individuals examined in 2006-2009, and 2309 in 2015-2018. The overall prevalence of hyperuricaemia increased from 16.4% to 25.2% in men (p < 0.001), and from 7.6% to 10.9% in women (p < 0.001), whereas the overall prevalence of CKD declined from 6.8% to 3.6% in men (p = 0.001), and from 7.6% to 4.8% in women (p < 0.001). There was no interaction between HT and hyperuricaemia in either gender; the increase in hyperuricaemia prevalence was observed both in hypertensive and normotensive adults and was accompanied by the increased prevalence of abdominal obesity. Contrarily, there was an interaction between HT and CKD in both men (p < 0.001) and women (p = 0.011); the CKD prevalence declined only in hypertensive individuals, specifically in those using antihypertensive medication and was accompanied by the increased use of renin-angiotensin-aldosterone system (RAS) inhibitors and calcium channel blockers (CCBs).Conclusions: Over the period of 10 years, the overall prevalence of hyperuricaemia increased, while the prevalence of CKD decreased. An increase in the prevalence of hyperuricaemia was observed both in hypertensive and normotensive individuals and was accompanied by an increase in the prevalence of abdominal obesity. A decline in the prevalence of CKD was only observed in hypertensive individuals and was accompanied by the increased use of RAS inhibitors and CCBs.

• MeSH
• chronická renální insuficience komplikace   epidemiologie   patofyziologie   MeSH
• dospělí MeSH
• hypertenze komplikace   patofyziologie   MeSH
• hyperurikemie komplikace   epidemiologie   patofyziologie   MeSH
• krevní tlak MeSH
• lidé středního věku MeSH
• lidé MeSH
• longitudinální studie MeSH
• prevalence MeSH
• průřezové studie 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

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 an ongoing controversy about the magnitude of the difference between unattended automated office blood pressure (AOBP) and conventional office blood pressure (BP). The aim of our study was to compare unattended AOBP with both auscultatory BP and oscillometric attended AOBP in an epidemiological setting. METHODS: In 2588 participants of the Czech post-MoNItoring of CArdiovascular Disease study (a randomly selected 1% representative population sample aged 25-64 years, mean age 48 ± 11 years, 47.5% males), BP was measured using an AOBP device unattended, auscultatory mercury sphygmomanometer and an oscillometric attended AOBP device. RESULTS: On average, auscultatory BP was 10.6/5.6 mmHg higher than unattended AOBP. Similarly, oscillometric attended AOBP was 9.9/3.4 mmHg higher than unattended AOBP, while the mean difference between attended oscillometric AOBP and auscultatory BP was 0.8/2.1 mmHg. Unattended systolic AOBP of 127 mmHg corresponded to SBP of 140 mmHg measured by a conventional sphygmomanometer. The prevalence of hypertension varied depending on the measurement technique and ranged from 31.5 to 40.1%. Reasonable agreement in hypertension diagnosis was observed with unattended AOBP cut-off at least 130/85 mmHg when compared with both auscultatory (McNemar P = 0.07, kappa 0.819) and attended oscillometric AOBP (McNemar P = 0.46, kappa 0.852) thresholds of at least 140/90 mmHg. CONCLUSION: Unattended automated office SBP is on average 10 mmHg lower than the office auscultatory or attended AOBP values. In epidemiological settings, a threshold of unattended AOBP at least 130/85 mmHg should make comparison of hypertension prevalence possible with studies using auscultatory techniques and cut-off values of 140/90 mmHg.

• MeSH
• dospělí MeSH
• hypertenze diagnóza   epidemiologie   patofyziologie   MeSH
• krevní tlak fyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• měření krevního tlaku metody   MeSH
• prevalence MeSH
• sfygmomanometry 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
• srovnávací studie MeSH

• MeSH
• anamnéza MeSH
• hypertenze * MeSH
• krevní tlak MeSH
• lidé MeSH
• prevalence MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• dopisy MeSH
• komentáře MeSH
• práce podpořená grantem MeSH