Longitudinal trends in CV mortality and major RF in the Czech population in 1985 to Czech MONICA and Czech post-monica study

Longitudinal trends in CV mortality and major RF in the Czech population in 1985 to 2007-8 Czech MONICA and Czech post-MONICA study

Renata Cífková et al. Department of Medicine I, Thomayer University Hospital Department of Medicine II, Charles University Medical School Department of Preventive Cardiology, IKEM Prague, Czech Republic

Death Rates for CVD and Stroke Men, 35-74 yrs Russian Fed. Bulgaria Romania Hungary Poland Argentina Czech Republic China-Rural Colombia China-Urban Scotland Ireland Finland N. Ireland Greece England/Wales Belgium USA Denmark N. Zealand Mexico Germany Portugal Sweden Korea Austria Netherlands Italy Norway Canada Spain Australia France Switzerland Israel Japan

Circulation 2009;119:e21-e181

Death Rates for CVD and Stroke Women, 35-74 yrs Russian Fed. Bulgaria Romania Hungary Colombia China-Rural China-Urban Argentina Poland Czech Republic Mexico Puerto Rico Scotland N.Ireland USA England/Wales New Zealand Greece Korea Ireland Denmark Belgium Portugal Germany Sweden Finland Netherlands Canada Italy Austria Norway Australia Israel Spain Switzerland Japan France

Circulation 2009;119:e21-e181

Standardized mortality Czech Republic, 2008

Females

Males 26.6 %

28.2 %

45.2 %

22.4 %

26.9 %

CVD Malignancies Other

50.7 %

Structure of standardized death, Czech Republic, 2008 Males CVD Malignancy External causes Respiratory d. GIT d. Others

Females CVD Malignancy External causes Respiratory d. GIT d.

Others

Zemřelí ČR 2008

Age-adjusted death rates/100,000 Czech Republic, 1985-2008 Males

1985

2008

%

p

- Total - CVD - CHD - Stroke

1581 844 436 250

967 437 227 87

- 38.8 - 48.2 - 47.9 - 65.2

< 0.001 < 0.001 < 0.001 < 0.001

944 548 223 202

577 292 137 71

- 38.9 - 46.7 - 38.6 - 64.9

< 0.001 < 0.001 < 0.001 < 0.001

Females - Total - CVD - CHD - Stroke

Age-stand. total, CVD, IHD, and stroke mortality (age group 35-74 yrs) Czech Republic 1970-2008 Females

Number of deaths/100,000


Males

Total mortality CVD mortality IHD mortality Stroke mortality

J Hypertens, submitted for publication

CVD mortality, age 35-74 years Males vs Females: p = 0,001

Total mortality, age 35-74 years Males vs Females: p = 0,001 2 000

2 000 y = -37x + 75819 R2 = 0,96

1 800

1 600

1 400



1 600

1 800

1 200 1 000 800 600

y = -17x + 34786 R2 = 0,99

400 200

1 400 1 200 1 000

600

200 0 1985

1990

1995 year

2000

2005

2010

1980

Males Females

CAD mortality, age 35-74 years Males vs Females: p = 0,001

1995 year

2000

2005

2010

2005

2010

500

y = -17x + 33645 R2 = 0,95 Number of deaths/100,000


1990

600

500 400

300 200 y = -6x + 11441 R2 = 0,94

400 300

y = -8x + 15397 R2 = 0,98

200 100 y = -5x + 10255 R2 = 0,98

0 1980

1985

Stroke mortality, age 35-74 years Males vs Females: p = 0,0041

600

100

y = -12x + 24387 R2 = 0,98

400

0 1980

y = -25x + 51128 R2 = 0,97

800

0 1985

1990

1995 year

2000

2005

2010

1980

J Hypertens, submitted for publication

1985

1990

1995 year

2000

Life Expectancy at Birth

1981 - 1985 1986 - 1990 1991 - 1995 1997 2000 2005 2007

Males

Females

67.1 67.7 68.9 70.5 71.7 72.9 73.7

74.1 74.8 75.8 77.5 78.4 79.1 79.9

Factors affecting CHD mortality Risk factors

Treatment

CHD incidence

Case fatality

CHD mortality

Percentage of the Decrease in Death from CHD Attributed to Treatment and Risk Factor Changes

NEJM 2007;356:2388-98

Lifestyle and CVD risk factors Lifestyle

Biochemical or physiological characteristics (modifiable)

Diet Hypertension (rich in calories, saturated fats, cholesterol) Elevated total (LDL-) cholesterol Smoking Decreased HDL-cholesterol Low physical activity Elevated triglycerides Increased alcohol consumption Impaired fasting glucose /diabetes Overweight/obesity Thrombogenic factors Markers of chronic inflammation

Personal characteristics (non-modifiable) Age Gender Family history of premature CVD Personal history of CVD Genetic markers

WHO MONICA projekt Litoměřice

Nové okresy

Cheb

Pardubice

Praha východ Plzeň

Chrudim Benešov Jindřichův Hradec

Kroměříž

Sample sizes and response rates 1985

1988

1992

1997/8

Total

2570

2768

2343

1990

2055

2246

Males Resp.

1253 81.5

1357 85.5

1134 73.2

969 63.2

1003 62.0

1102 62.7***

Females Resp.

1317 85.0

1411 88.4

1209 76.7

1021 66.4

1052 63.8

1144 63.1***

*** p < 0.001 for trend

2000/1 2007/8

Methods 1985 1988 1992

Physician-completed questionnaire (CVD history) Body weight, height, BP Total cholesterol, HDL-cholesterol

1997/98 2000/01 2007/08

Physician-completed questionnaire (CVD history incl. family history) Body weight, height, BP, waist/hip ratio Total cholesterol, HDL-cholesterol Triglycerides Fasting glycemia

Systolic BP Males

Females

mmHg

mmHg p < 0.001

p < 0.001

Atherosclerosis (2010), doi:10.1016/j.atherosclerosis.2010.04.007

Diastolic BP Males

Females

mmHg

mmHg p < 0.001

p < 0.001


Prevalence of hypertension Males %

Females %

p for linear trend: ns

p < 0.001


BMI Males

Females

kg/m2

kg/m2

p < 0.001

p pro trend: NS


Awareness of hypertension Males

Females %

% p for linear trend: 0.001

p for linear trend: 0.001


Antihypertensive medication Males %

Females %




Hypertension control BP < 140/90 mmHg of all hypertensives Males

Females %

% p for linear trend: 0.001



Hypertension control BP< 140/90 mmHg of all drug-treated hypertensives Males

Females %

% p for linear trend: < 0.001

p for linear trend: < 0.001


Antihypertensive medication Czech Republic 1997/98 17.3%

33.6%

51.2%

2000/01 17.6%

2007/08* 46.7%

40.6%

33.3%

35.4%

n = 512

27.1%

n = 615 monotherapy combination of 2 drugs combination of > 3 drugs

n = 573

* Only 6 districts

Total cholesterol Males

Females

mmol/l

mmol/l p < 0.001

p < 0.001


HDL-cholesterol Males

Females

mmol/l

mmol/l p < 0.001

p for linear trend: n.s


Non-HDL-cholesterol 1985 – 2007/2008

1985 1988 1992 1997/98 2000/01 2007/08 p for trend

Males

Females

4.85 ± 1.35 4.96 ± 1.26 4.65 ± 1.33 4.36 ± 1.16 4.63 ± 1.11 3.97 ± 1.10

4.61 ± 1.29 4.66 ± 1.25 4.44 ± 1.32 4.03 ± 1.24 4.33 ± 1.18 3.65 ± 1.12

< 0.001

< 0.001


Lipid-lowering drugs 1997/98

2000/01

2007/08

n = 130 (3.95%)

n = 171 (5.1%)

n = 386 (10.7%)

13%

3% 3%

81%

27.5%

4%

68.5%

4.7% 15.5%

1.6%

78.0%

fibrates statins other combinations Atherosclerosis (2010), doi:10.1016/j.atherosclerosis.2010.04.007

Dyslipidemia* by age groups Czech Republic 2007/2008 Males Females p < 0.001

% 90

p < 0.001

%

87,1

84,8 77,3

80 70 60

58,5

50

25 - 34

35 - 44

45 - 54

55 - 64 age groups

age groups

* Total chol. > 5.0 or HDL-chol. < 1.0 or LDL-chol. > 3.0 or TG > 2 mmol/L or use of lipid-lowering drugs

Smoking Males

Females

%

% p < 0.001

p for trend: n.s.


BMI Males

Females

kg/m2

kg/m2

p < 0.001

p for trend: NS

BMI in the Czech Republic Males 19.7

p for trend in obesity: < 0.001 25.3

19.9

25.2

p for trend in obesity: n.s.

Females 28.0

1985

33.6

29.5

30.0

1988

25.5

26.5

1992

30.1

27.8

1997 BMI > 30.0 kg/m2 BMI 25.0–29.9 kg/m2 BMI < 25.0 kg/m2

2000

2007

BMI by education level Males - 9 Czech districts, 2006-2009 %

n.s. p < 0.001

n.s.

< 25

25-29.9

> 30 BMI (kg/m2)

BMI by education level Females - 9 Czech districts, 2006-2009 % p < 0.001

*** p < 0.001

*** p < 0.001

n.s.

< 25

25-29.9

***

> 30 BMI (kg/m2)

Education in the Czech Republic Males

Females

%

Basic

Secondary

University

Conclusions Total and CV mortality is decreasing in the Czech Republic.

The decrease is due to decreasing stroke and CHD mortality rates.

Conclusions (2) In a random Czech population sample  mean SBP and DBP decreased  the prevalence of hypertension in females decreased  the number of individuals using antihypertensive agents increased

 hypertension control improved over a period of 22-23 years

Conclusions (3) In a random Czech population sample  the proportion of male smokers decreased (by a third),

with no change in the prevalence of female smokers (25%)

 total and non-HDL-cholesterol decreased in both genders; there was a rise in individuals using lipid-lowering drugs  there was an increase in male BMI over a period of 22-23 years

10-year risk of death from CVD in the Czech population

10-year risk of death from CVD in the Czech population

Acknowledgment To all my coworkers from Department of Preventive Cardiology, IKEM Atherosclerosis Research Laboratory, IKEM Financial support Internal Grant Agency, Ministry of Health, CR KRKA ČR, s.r.o.

Servier, s.r.o.

Prevalence metabolického syndromu

Prevalence, %

Česká republika, 2006-2009

* ***

* p < 0,05 *** p < 0,001 p pro trend: 0,001

***

***

***

Věkové skupiny

Prevalence metabolického syndromu Česká republika

prevalence (%)

p pro trend: muži: n.s. ženy: < 0,05

roky

Další vyšetření kreatinin v séru, mikroalbuminurie

EKG, echokardiografické vyšetření, UZ vyšetření karotických tepen, kotníkové tlaky, vyšetření pulzové vlny Spolupráce na řešení projektu II. int. klinika 1.LF UK a VFN, Praha II. int. klinika LF Plzeň

BMI dle věkových dekád muži - 9 okresů ČR 2000/2001 25 - 34

%

35 - 44

45 - 54

55 - 64

80 70 60 50

n.s.

p < 0,001

49 44,4

44

p < 0,001

45,2 44,9

41

40 30 20

35,2 28,2 22,8

19,5 14

11,6

10 0

< 25

25-29,9

> 30 BMI (kg/m2)

Prevalence of diabetes by age groups, 2000 – 2001 Czech Republic, 9 districts Males

Females

%

%

21.4

25

25

18.3 20

20

11.8

15

10.6

15

8.5 10

10

3.6 5

3.1

1.4

4.7

6.2

5 0

0 25-34

35-44

45-54

55-64

Total

25-34

p for trend < 0.001

35-44

45-54

55-64

Total

Prevalence of IFG

by age groups, 2000 – 2001 Czech Republic, 9 districts Males %

%

9.2

10 9 8 7 6 5 4 3 2 1

Females 10 9

7.7 6.3 4.6 2.0

8 7 6 5 4 3 2 1

4.6 2.8

2.7

2.4

0.3

0

0 25-34

35-44

45-54

55-64

Total

25-34

p for trend < 0.001

35-44

45-54

55-64

Total

Prevalence of hypertension and diabetes by age groups, 2000–2001 Czech Republic, 9 districts Males %

Females %

16.1

18 16

16

14

14

12

12

7.5

10

7.1

10

8

8

6

6

4

0.3

1.3

2

0

0

35-44

5.7 3.5

4

2 25-34

15.7

18

45-54

55-64

Total

0 25-34

p for trend < 0.001

1.6

35-44

45-54

55-64

Total

BMI dle vzdělání muži - 9 okresů ČR 2000/2001 % 60

ns

50

48,6 48,5

* p < 0,05

43,8

*

40

*

32,5

30 23,7

26

26

25,4 25,5

ZŠ SŠ VŠ

20 10 0

< 25

25 - 29,9

> 30

BMI (kg/m2)

BMI dle vzdělání ženy - 9 okresů ČR 2000/2001 % 80 70

*** p < 0,001

*** 58,4

60 50

45,7

ns 37,5

40 30,9

***

31,6 33,6 30,9

30

ZŠ SŠ VŠ

20,8

20 10,7

10 0

< 25

25 - 29,9

> 30 BMI (kg/m2)

Znalost, léčba a kontrola hypertenze NHANES II 1976-80

NHANES III NHANES III Fáze 1 Fáze 2 1988-91 1991-94

Znalost

51 %

73 %

68.4 %

Léčba

31 %

55 %

53.6 %

Kontrola

10 %

29 %

27.4 %

Kontrola hypertenze v různých zemích < 140/90 mmHg

< 160/95 mmHg

Kanada Indie Korea Čína Zaire

Austrálie 19 %

16 % 9% 5% 3% 2,5 %

Kontrola hypertenze v evropských zemích < 140/90 mmHg (%)

Belgie Česká republika Anglie Francie Itálie Polsko Rusko Španělsko

25 17,8 6 33 9 4 5,7 16,3

< 160/95 mmHg (%)

Finsko 23,5 Německo 22,5 Skotsko 17,5

Dyslipidemie* podle věkových skupin Muži

Ženy p < 0.001

% 100

100 92,4

90

84,7

87,2

94,7

90

82,7

80

80 70

p < 0.001

%

70

61,9

60

66,6

50 60

45

40

50

30

25 - 34

35 - 44

45 - 54

55 - 64 věk. skupiny

25 - 34

35 - 44

45 - 54

55 - 64 věk. skupiny

* Celk. chol. > 5.0 nebo HDL-chol. < 1.0 nebo LDL-chol. > 3.0 nebo TG > 2 mmol/L nebo užívání hypolipidemik

Prevalence obezity a nadváhy v populačním vzorku ČR 9 okresů ČR 2000/2001

muži 29,5 %

45,9 %

24,6%

ženy 39,6 %

28,1 %

BMI (kg/m2) < 25 25 – 29,9 > 30

32,4 %

BMI dle věkových dekád ženy - 9 okresů ČR 2000/2001 25 - 34

% 80

35 - 44

45 - 54

55 - 64

p < 0,001 69,8

70 60 50

p < 0,001

n.s. 49,5

47,4 41,5

40

34,8 30,5 17,8

20

28,8

28,3

30

22,1

21,5 8,8

10 0

< 25

25-29,9

> 30 BMI (kg/m2)

BMI dle vzdělání muži - 9 okresů ČR 2000/2001 % 60

ns

* p < 0,05

48,6 48,5

50 43,8

*

40

*

32,5

30 23,7

26

26

25,4 25,5

ZŠ SŠ VŠ

20 10 0

< 25

25 - 29,9

> 30

BMI (kg/m2)

BMI dle vzdělání ženy - 9 okresů ČR 2000/2001 % 80 70

*** p < 0,001

*** 58,4

60 50

45,7

40 30,9

ns 31,6 33,6 30,9

37,5

***

30

ZŠ SŠ VŠ

20,8

20 10,7

10 0

< 25

25 - 29,9

> 30 BMI (kg/m2)

Longitudinal trends in CV mortality and major RF in the Czech population in 1985 to Czech MONICA and Czech post-monica study

Recommend Documents