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

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1 Longitudinal trends in CV mortality and major RF in the Czech population in 1985 to 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

2 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 Death Rates for CVD and Stroke Men, yrs Circulation 2009;119:e21-e181

3 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 Death Rates for CVD and Stroke Women, yrs Circulation 2009;119:e21-e181

4 Standardized mortality Czech Republic, 2008 Males Females 26.6 % 45.2 % 22.4 % 50.7 % 28.2 % 26.9 % CVD Malignancies Other

5 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

6 Age-adjusted death rates/100,000 Czech Republic, Males - Total - CVD - CHD - Stroke % p < < < < Females - Total - CVD - CHD - Stroke < < < < 0.001

7 Number of deaths/100,000 Number of deaths/100,000 Age-stand. total, CVD, IHD, and stroke mortality (age group yrs) Czech Republic Males Females Total mortality CVD mortality IHD mortality Stroke mortality J Hypertens, submitted for publication

8 Number of deaths/100,000 Number of deaths/100,000 Number of deaths/100,000 Number of deaths/100,000 Total mortality, age years Males vs Females: p = 0,001 CVD mortality, age years Males vs Females: p = 0, y = -37x R 2 = 0, y = -17x R 2 = 0, y = -12x R 2 = 0,98 y = -25x R 2 = 0, year year CAD mortality, age years Males vs Females: p = 0,001 Males Females Stroke mortality, age years Males vs Females: p = 0, y = -17x R 2 = 0, y = -8x R 2 = 0, y = -6x R 2 = 0, year 100 J Hypertens, submitted for publication 0 y = -5x R 2 = 0, year

9 Life Expectancy at Birth Males Females

10 Factors affecting CHD mortality Risk factors Treatment CHD incidence Case fatality CHD mortality

11 Percentage of the Decrease in Death from CHD Attributed to Treatment and Risk Factor Changes NEJM 2007;356:

12 Lifestyle and CVD risk factors Lifestyle Diet (rich in calories, saturated fats, cholesterol) Smoking Low physical activity Increased alcohol consumption Biochemical or physiological characteristics (modifiable) Hypertension Elevated total (LDL-) cholesterol Decreased HDL-cholesterol Elevated triglycerides 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

13 Litoměřice WHO MONICA projekt Nové okresy Cheb Praha východ Pardubice Plzeň Benešov Chrudim Kroměříž Jindřichův Hradec

14 Sample sizes and response rates /8 2000/1 2007/8 Total Males Resp *** Females Resp *** *** p < for trend

15 Methods / / /08 Physician-completed questionnaire (CVD history) Body weight, height, BP Total cholesterol, HDL-cholesterol Physician-completed questionnaire (CVD history incl. family history) Body weight, height, BP, waist/hip ratio Total cholesterol, HDL-cholesterol Triglycerides Fasting glycemia

16 Systolic BP mmhg Males mmhg Females p < p < Atherosclerosis (2010), doi: /j.atherosclerosis

17 Diastolic BP mmhg Males mmhg Females p < p < Atherosclerosis (2010), doi: /j.atherosclerosis

18 Prevalence of hypertension Males Females % % p for linear trend: ns p < Atherosclerosis (2010), doi: /j.atherosclerosis

19 BMI Males Females kg/m 2 kg/m 2 p < p pro trend: NS Atherosclerosis (2010), doi: /j.atherosclerosis

20 Awareness of hypertension Males % % p for linear trend: Females p for linear trend: Atherosclerosis (2010), doi: /j.atherosclerosis

21 Antihypertensive medication Males % % p for linear trend: Females p for linear trend: Atherosclerosis (2010), doi: /j.atherosclerosis

22 Hypertension control BP < 140/90 mmhg of all hypertensives Males % % p for linear trend: Females p for linear trend: Atherosclerosis (2010), doi: /j.atherosclerosis

23 Hypertension control BP< 140/90 mmhg of all drug-treated hypertensives Males % % p for linear trend: < Females p for linear trend: < Atherosclerosis (2010), doi: /j.atherosclerosis

24 Antihypertensive medication Czech Republic 1997/ / /08* 17.3% 51.2% 17.6% 46.7% 27.1% 40.6% 33.6% 35.4% n = 512 n = % n = 573 monotherapy combination of 2 drugs combination of > 3 drugs * Only 6 districts

25 Total cholesterol mmol/l Males mmol/l Females p < p < Atherosclerosis (2010), doi: /j.atherosclerosis

26 HDL-cholesterol mmol/l Males p < mmol/l Females p for linear trend: n.s Atherosclerosis (2010), doi: /j.atherosclerosis

27 Non-HDL-cholesterol /2008 Males Females / / /08 p for trend 4.85 ± ± ± ± ± ± 1.10 < ± ± ± ± ± ± 1.12 < Atherosclerosis (2010), doi: /j.atherosclerosis

28 Lipid-lowering drugs 1997/98 n = 130 (3.95%) 2000/01 n = 171 (5.1%) 2007/08 n = 386 (10.7%) 13% 3% 3% 27.5% 4% 1.6% 4.7% 15.5% 81% 68.5% fibrates statins other combinations 78.0% Atherosclerosis (2010), doi: /j.atherosclerosis

29 Dyslipidemia* by age groups Czech Republic 2007/2008 Males Females % p < % p < ,8 87, , , 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 age groups

30 Smoking Males % % p < Females p for trend: n.s. Atherosclerosis (2010), doi: /j.atherosclerosis

31 BMI Males Females kg/m 2 kg/m 2 p < p for trend: NS

32 BMI in the Czech Republic Males p for trend in obesity: < Females p for trend in obesity: n.s BMI > 30.0 kg/m 2 BMI kg/m 2 BMI < 25.0 kg/m 2

33 % BMI by education level Males - 9 Czech districts, n.s. p < n.s. < > 30 BMI (kg/m 2 )

34 BMI by education level Females - 9 Czech districts, % p < *** *** p < n.s. p < *** < > 30 BMI (kg/m 2 )

35 Education in the Czech Republic Males Females % Basic Secondary University

36 Conclusions Total and CV mortality is decreasing in the Czech Republic. The decrease is due to decreasing stroke and CHD mortality rates.

37 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 years

38 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 years

39 10-year risk of death from CVD in the Czech population

40 10-year risk of death from CVD in the Czech population

41

42 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.

43

44 Prevalence, % Prevalence metabolického syndromu Česká republika, *** * *** * p < 0,05 *** p < 0,001 p pro trend: 0,001 *** *** Věkové skupiny

45 prevalence (%) Prevalence metabolického syndromu Česká republika p pro trend: muži: n.s. ženy: < 0,05 roky

46 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

47 BMI dle věkových dekád muži - 9 okresů ČR 2000/2001 % p < 0, ,4 28,2 19,5 14 n.s ,2 44,9 p < 0, ,2 22,8 11,6 0 < ,9 > 30 BMI (kg/m 2 )

48 Prevalence of diabetes by age groups, Czech Republic, 9 districts Males Females % % Total Total p for trend < 0.001

49 Prevalence of IFG by age groups, Czech Republic, 9 districts Males % 9.2 % Total Females Total p for trend < 0.001

50 Prevalence of hypertension and diabetes by age groups, Czech Republic, 9 districts Males % 16.1 % Total 18 Females Total p for trend < 0.001

51 BMI dle vzdělání muži - 9 okresů ČR 2000/2001 % 60 ns * p < 0, , ,8 48,6 48,5 32,5 * * 25,4 25,5 ZŠ SŠ VŠ 10 0 < ,9 > 30 BMI (kg/m 2 )

52 % BMI dle vzdělání ženy - 9 okresů ČR 2000/2001 *** 58,4 *** p < 0, ns 45,7 30,9 31,6 33,6 30,9 37,5 *** 20,8 10,7 ZŠ SŠ VŠ 0 < ,9 > 30 BMI (kg/m 2 )

53 Znalost, léčba a kontrola hypertenze NHANES II NHANES III NHANES III Fáze 1 Fáze Znalost 51 % 73 % 68.4 % Léčba 31 % 55 % 53.6 % Kontrola 10 % 29 % 27.4 %

54 Kontrola hypertenze v různých zemích < 140/90 mmhg < 160/95 mmhg Kanada 16 % Indie 9 % Korea 5 % Čína 3 % Zaire 2,5 % Austrálie 19 %

55 Kontrola hypertenze v evropských zemích < 140/90 mmhg (%) < 160/95 mmhg (%) Belgie 25 Česká republika 17,8 Anglie 6 Francie 33 Itálie 9 Polsko 4 Rusko 5,7 Španělsko 16,3 Finsko 23,5 Německo 22,5 Skotsko 17,5

56 Dyslipidemie* podle věkových skupin Muži Ženy % p < % p < ,7 87,2 92, ,7 94, , , věk. skupiny věk. skupiny * Celk. chol. > 5.0 nebo HDL-chol. < 1.0 nebo LDL-chol. > 3.0 nebo TG > 2 mmol/l nebo užívání hypolipidemik

57 Prevalence obezity a nadváhy v populačním vzorku ČR 9 okresů ČR 2000/ ,5 % muži 24,6% 28,1 % ženy 39,6 % 45,9 % BMI (kg/m 2 ) < ,9 > 30 32,4 %

58 BMI dle věkových dekád ženy - 9 okresů ČR 2000/2001 % p < 0,001 69,8 n.s. p < 0,001 49,5 47,4 41,5 34,8 30,5 28,3 28,8 21,5 22,1 17,8 8,8 < ,9 > 30 BMI (kg/m 2 )

59 BMI dle vzdělání muži - 9 okresů ČR 2000/2001 % 60 ns * p < 0, , ,8 48,6 48,5 32,5 * * 25,4 25,5 ZŠ SŠ VŠ 10 0 < ,9 > 30 BMI (kg/m 2 )

60 BMI dle vzdělání ženy - 9 okresů ČR 2000/2001 % *** *** p < 0, , ,7 30,9 31,6 ns 33,6 30,9 37,5 *** 20,8 10,7 ZŠ SŠ VŠ 0 < ,9 > 30 BMI (kg/m 2 )