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
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, 35-74 yrs Circulation 2009;119:e21-e181
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, 35-74 yrs Circulation 2009;119:e21-e181
Standardized mortality Czech Republic, 2008 Males Females 26.6 % 45.2 % 22.4 % 50.7 % 28.2 % 26.9 % CVD Malignancies Other
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 - Total - CVD - CHD - Stroke 1985 2008 % p 1581 844 436 250 967 437 227 87-38.8-48.2-47.9-65.2 < 0.001 < 0.001 < 0.001 < 0.001 Females - Total - CVD - CHD - Stroke 944 548 223 202 577 292 137 71-38.9-46.7-38.6-64.9 < 0.001 < 0.001 < 0.001 < 0.001
Number of deaths/100,000 Number of deaths/100,000 Age-stand. total, CVD, IHD, and stroke mortality (age group 35-74 yrs) Czech Republic 1970-2008 Males Females Total mortality CVD mortality IHD mortality Stroke mortality J Hypertens, submitted for publication
Number of deaths/100,000 Number of deaths/100,000 Number of deaths/100,000 Number of deaths/100,000 Total mortality, age 35-74 years Males vs Females: p = 0,001 CVD mortality, age 35-74 years Males vs Females: p = 0,001 2 000 2 000 1 800 1 600 y = -37x + 75819 R 2 = 0,96 1 800 1 600 1 400 1 400 1 200 1 200 1 000 800 600 400 y = -17x + 34786 R 2 = 0,99 1 000 800 600 400 y = -12x + 24387 R 2 = 0,98 y = -25x + 51128 R 2 = 0,97 200 200 0 1980 1985 1990 1995 2000 2005 2010 year 0 1980 1985 1990 1995 2000 2005 2010 year CAD mortality, age 35-74 years Males vs Females: p = 0,001 Males Females Stroke mortality, age 35-74 years Males vs Females: p = 0,0041 600 600 500 400 y = -17x + 33645 R 2 = 0,95 500 400 300 200 300 200 y = -8x + 15397 R 2 = 0,98 100 0 y = -6x + 11441 R 2 = 0,94 1980 1985 1990 1995 2000 2005 2010 year 100 J Hypertens, submitted for publication 0 y = -5x + 10255 R 2 = 0,98 1980 1985 1990 1995 2000 2005 2010 year
Life Expectancy at Birth 1981-1985 1986-1990 1991-1995 1997 2000 2005 2007 Males 67.1 67.7 68.9 70.5 71.7 72.9 73.7 Females 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 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
Litoměřice WHO MONICA projekt Nové okresy Cheb Praha východ Pardubice Plzeň Benešov Chrudim Kroměříž Jindřichův Hradec
Sample sizes and response rates 1985 1988 1992 1997/8 2000/1 2007/8 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
Methods 1985 1988 1992 1997/98 2000/01 2007/08 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
Systolic BP mmhg Males mmhg Females p < 0.001 p < 0.001 Atherosclerosis (2010), doi:10.1016/j.atherosclerosis.2010.04.007
Diastolic BP mmhg Males mmhg Females p < 0.001 p < 0.001 Atherosclerosis (2010), doi:10.1016/j.atherosclerosis.2010.04.007
Prevalence of hypertension Males Females % % p for linear trend: ns p < 0.001 Atherosclerosis (2010), doi:10.1016/j.atherosclerosis.2010.04.007
BMI Males Females kg/m 2 kg/m 2 p < 0.001 p pro trend: NS Atherosclerosis (2010), doi:10.1016/j.atherosclerosis.2010.04.007
Awareness of hypertension Males % % p for linear trend: 0.001 Females p for linear trend: 0.001 Atherosclerosis (2010), doi:10.1016/j.atherosclerosis.2010.04.007
Antihypertensive medication Males % % p for linear trend: 0.001 Females p for linear trend: 0.001 Atherosclerosis (2010), doi:10.1016/j.atherosclerosis.2010.04.007
Hypertension control BP < 140/90 mmhg of all hypertensives Males % % p for linear trend: 0.001 Females p for linear trend: 0.001 Atherosclerosis (2010), doi:10.1016/j.atherosclerosis.2010.04.007
Hypertension control BP< 140/90 mmhg of all drug-treated hypertensives Males % % p for linear trend: < 0.001 Females p for linear trend: < 0.001 Atherosclerosis (2010), doi:10.1016/j.atherosclerosis.2010.04.007
Antihypertensive medication Czech Republic 1997/98 2000/01 2007/08* 17.3% 51.2% 17.6% 46.7% 27.1% 40.6% 33.6% 35.4% n = 512 n = 615 33.3% n = 573 monotherapy combination of 2 drugs combination of > 3 drugs * Only 6 districts
Total cholesterol mmol/l Males mmol/l Females p < 0.001 p < 0.001 Atherosclerosis (2010), doi:10.1016/j.atherosclerosis.2010.04.007
HDL-cholesterol mmol/l Males p < 0.001 mmol/l Females p for linear trend: n.s Atherosclerosis (2010), doi:10.1016/j.atherosclerosis.2010.04.007
Non-HDL-cholesterol 1985 2007/2008 Males Females 1985 1988 1992 1997/98 2000/01 2007/08 p for trend 4.85 ± 1.35 4.96 ± 1.26 4.65 ± 1.33 4.36 ± 1.16 4.63 ± 1.11 3.97 ± 1.10 < 0.001 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 Atherosclerosis (2010), doi:10.1016/j.atherosclerosis.2010.04.007
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:10.1016/j.atherosclerosis.2010.04.007
Dyslipidemia* by age groups Czech Republic 2007/2008 Males Females % p < 0.001 % p < 0.001 90 84,8 87,1 80 77,3 70 60 58,5 50 25-34 35-44 45-54 55-64 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
Smoking Males % % p < 0.001 Females p for trend: n.s. Atherosclerosis (2010), doi:10.1016/j.atherosclerosis.2010.04.007
BMI Males Females kg/m 2 kg/m 2 p < 0.001 p for trend: NS
BMI in the Czech Republic Males p for trend in obesity: < 0.001 19.7 25.3 19.9 25.2 29.5 33.6 Females p for trend in obesity: n.s. 28.0 30.0 25.5 26.5 27.8 30.1 1985 1988 1992 1997 2000 2007 BMI > 30.0 kg/m 2 BMI 25.0 29.9 kg/m 2 BMI < 25.0 kg/m 2
% BMI by education level Males - 9 Czech districts, 2006-2009 n.s. p < 0.001 n.s. < 25 25-29.9 > 30 BMI (kg/m 2 )
BMI by education level Females - 9 Czech districts, 2006-2009 % p < 0.001 *** *** p < 0.001 n.s. p < 0.001 *** < 25 25-29.9 > 30 BMI (kg/m 2 )
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, % Prevalence metabolického syndromu Česká republika, 2006-2009 *** * *** * p < 0,05 *** p < 0,001 p pro trend: 0,001 *** *** Věkové skupiny
prevalence (%) Prevalence metabolického syndromu Česká republika 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 % 80 25-34 35-44 45-54 55-64 70 60 50 40 30 20 10 p < 0,001 44 44,4 28,2 19,5 14 n.s. 49 45,2 44,9 p < 0,001 41 35,2 22,8 11,6 0 < 25 25-29,9 > 30 BMI (kg/m 2 )
Prevalence of diabetes by age groups, 2000 2001 Czech Republic, 9 districts Males Females % % 21.4 25 20 20 25 18.3 15 10 5 1.4 3.6 11.8 10.6 15 10 5 3.1 4.7 6.2 8.5 0 25-34 35-44 45-54 55-64 Total 0 25-34 35-44 45-54 55-64 Total p for trend < 0.001
Prevalence of IFG by age groups, 2000 2001 Czech Republic, 9 districts 10 9 8 7 6 5 4 3 2 1 0 Males % 9.2 % 7.7 6.3 4.6 2.0 2 1 0 25-34 35-44 45-54 55-64 Total 10 9 8 7 6 5 4 3 Females 4.6 2.8 2.4 2.7 0.3 25-34 35-44 45-54 55-64 Total p for trend < 0.001
Prevalence of hypertension and diabetes by age groups, 2000 2001 Czech Republic, 9 districts 18 16 14 12 10 8 6 4 2 0 Males % 16.1 % 7.5 7.1 0.3 1.3 16 14 12 10 8 6 4 2 0 25-34 35-44 45-54 55-64 Total 18 Females 15.7 5.7 3.5 1.6 0 25-34 35-44 45-54 55-64 Total p for trend < 0.001
BMI dle vzdělání muži - 9 okresů ČR 2000/2001 % 60 ns * p < 0,05 50 40 30 20 23,7 26 26 43,8 48,6 48,5 32,5 * * 25,4 25,5 ZŠ SŠ VŠ 10 0 < 25 25-29,9 > 30 BMI (kg/m 2 )
% 80 70 60 BMI dle vzdělání ženy - 9 okresů ČR 2000/2001 *** 58,4 *** p < 0,001 50 40 30 20 10 ns 45,7 30,9 31,6 33,6 30,9 37,5 *** 20,8 10,7 ZŠ SŠ VŠ 0 < 25 25-29,9 > 30 BMI (kg/m 2 )
Znalost, léčba a kontrola hypertenze NHANES II NHANES III NHANES III 1976-80 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 16 % Indie 9 % Korea 5 % Čína 3 % Zaire 2,5 % Austrálie 19 %
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
Dyslipidemie* podle věkových skupin Muži Ženy % p < 0.001 % p < 0.001 100 90 84,7 87,2 92,4 100 90 80 82,7 94,7 80 70 66,6 70 60 61,9 60 50 40 45 50 30 25-34 35-44 45-54 55-64 25-34 35-44 45-54 55-64 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
Prevalence obezity a nadváhy v populačním vzorku ČR 9 okresů ČR 2000/2001 29,5 % muži 24,6% 28,1 % ženy 39,6 % 45,9 % BMI (kg/m 2 ) < 25 25 29,9 > 30 32,4 %
BMI dle věkových dekád ženy - 9 okresů ČR 2000/2001 % 80 70 60 50 40 30 20 10 0 25-34 35-44 45-54 55-64 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 < 25 25-29,9 > 30 BMI (kg/m 2 )
BMI dle vzdělání muži - 9 okresů ČR 2000/2001 % 60 ns * p < 0,05 50 40 30 20 23,7 26 26 43,8 48,6 48,5 32,5 * * 25,4 25,5 ZŠ SŠ VŠ 10 0 < 25 25-29,9 > 30 BMI (kg/m 2 )
BMI dle vzdělání ženy - 9 okresů ČR 2000/2001 % 80 70 *** *** p < 0,001 60 58,4 50 40 30 20 10 45,7 30,9 31,6 ns 33,6 30,9 37,5 *** 20,8 10,7 ZŠ SŠ VŠ 0 < 25 25-29,9 > 30 BMI (kg/m 2 )