Health Factors and Risk of All-Cause, Cardiovascular, and Coronary Heart Disease Mortality: Findings from the MONICA and HAPIEE Studies in Lithuania

Abstract

AimsThis study investigated the trends and levels of the prevalence of health factors, and the association of all-cause and cardiovascular (CVD) mortality with healthy levels of combined risk factors among Lithuanian urban population.MethodsData from five general population surveys in Kaunas, Lithuania, conducted between 1983 and 2008 were used. Healthy factors measured at baseline include non-smoking, normal weight, normal arterial blood pressure, normal level of total serum cholesterol, normal physical activity and normal level of fasting glucose. Among 9,209 men and women aged 45–64 (7,648 were free from coronary heart disease (CHD) and stroke at baseline), 1,219 death cases from any cause, 589 deaths from CVD, and 342 deaths from CHD occurred during follow up. Cox proportional hazards regression was used to estimate the association between health factors and mortality from all causes, CVD and CHD.ResultsBetween 1983 and 2008, the proportion of subjects with 6 healthy levels of risk factors was higher in 2006–2008 than in 1983–1984 (0.6% vs. 0.2%; p = 0.09), although there was a significant increase in fasting glucose and a decline in intermediate physical activity. Men and women with normal or intermediate levels of risk factors had significantly lower all-cause, CVD and CHD mortality risk than persons with high levels of risk factors. Subjects with 5–6 healthy factors had hazard ratio (HR) of CVD mortality 0.35 (95% confidence interval (CI) 0.15–0.83) compared to average risk in the whole population. The hazard ratio for CVD mortality risk was significant in men (HR 0.34, 95% CI 0.12–0.97) but not in women (HR 0.38, 95% CI 0.09–1.67).ConclusionsAn inverse association of most healthy levels of cardiovascular risk factors with risk of all-cause and CVD mortality was observed in this urban population-based cohort. A greater number of cardiovascular health factors were related with significantly lower risk of CVD mortality, particularly among men.

Differences in utilization rates between commercial and administrative databases: implications for future health-economic and cross-national studies

“…Interestingly, the differences seen for the statins between the various databases (Table 3) were much greater than seen in previous studies across Europe [1,19], which shows the value of additional research. Not surprisingly, there was convergence in utilization rates between the databases once the reimbursement restrictions were lifted for the statins (Tables 1 and 2) in view of the prevalence of CHD in Lithuania [15]. The lack of any major difference in the utilization of the renin-angiotensin inhibitors between the different databases with no prescribing restrictions in Lithuania (Tables 1 and 4), and similar utilization patterns to Western European countries in 2007 [10,26], further demonstrates that prescribing restrictions can appreciably influence subsequent utilization rates [21,28] and, as a result, demonstrating the need to accurately document ongoing reforms in any CNC study.…”

“…Prescribing restrictions and high co-payments for statins in Lithuania limited their reimbursed utilization in 2007 to just 0.8 defined daily doses per 1000 inhabitants per day (DIDs) versus for instance 114.7 in Scotland with no such restrictions [6], despite the prevalence of coronary vascular disease higher in Lithuania than among Western European countries [15]. In addition, prescribing restrictions and high co-payments limited the reimbursed utilization of proton pump inhibitors (PPIs) in Lithuania in 2007 to just 2.3 DIDs in 2007 compared with for instance 76.9 in Scotland with no such restrictions [6].…”

Trends in Mortality From Ischemic Heart Disease and Cerebrovascular Disease in Europe

“…22 A prospective study found that a low-risk cardiovascular profile was present in only 1% of middle-aged urban adults in Kaunas, Lithuania (1994-2010), with a worsening trend in body mass index, fasting glucose, and healthy diet. 23 Cyprus has very few mortality figures recorded on the WHO database. The few data available, however, show substantial increases in both CVD and IHD, with the exception of female CVD mortality, which demonstrates declining death rates.…”

Health promotion for older people in Lithuania: Between bureaucratic and financial constraints

“…Most importantly, over the past decades, mortality due to preventable causes, such as unhealthy lifestyle, was higher in Lithuania than in Western European countries [8]. Important concerns are the risk factors such as smoking, overweight and obesity, unhealthy nutrition habits, as well as physical inactivity [9]. To a great extent, this is attributed to the lack of inter--sectoral public health interventions, particularly in relation to public health and lifestyle changes [3].…”