Trends in cardiovascular risk factor prevalence among Lithuanian middle-aged adults between 2009 and 2018

Trends and determinants of prevalence, awareness, treatment and control of dyslipidaemia in canton of Geneva, 2005-2019: Potent statins are underused

We assessed 1) trends in prevalence, awareness, treatment and control rates of dyslipidaemia and associated factors, 2) the effect of statin generation/potency on control levels and 3) the effect of ESC lipid guidelines, on lipid management. Data from multiple cross-sectional, population-based surveys conducted between 2005 and 2019 in the canton of Geneva, Switzerland, were used. Prevalence, awareness, treatment and control rates of dyslipidaemia were 46.0% and 34.9% (p < 0.001), 67.0% and 77.3% (p = 0.124), 40.0% and 19.9% (p < 0.001), and 68.0% and 84.0% (p = 0.255), in 2005 and 2019, respectively. After multivariable adjustment, only the decrease in treatment rates was significant. Increasing age, higher BMI, history of hypertension or diabetes were positively associated with prevalence, while female sex was negatively associated. Female sex, history of diabetes or CVD were positively associated with awareness, while increasing age was negatively associated. Increasing age, smoking, higher BMI, history of hypertension, diabetes or CVD were positively associated with treatment, while female sex was negatively associated. Female sex was positively associated with control, while increasing age was negatively associated. Highly potent statins increased from 50.0% to 87.5% and third generation statins from 0% to 47.5% in 2009 and 2015, respectively. Increased statin potency was borderline (p = 0.059) associated with dyslipidaemia control. ESC guidelines had no effect regarding the prescription of more potent or higher generation statins. We conclude that in the canton of Geneva, treatment of diagnosed dyslipidaemia is low, but control is adequate. Women are undertreated but better controlled than men. The most potent hypolipidemic drugs are underused.

Sodium, Potassium and Iodine Intake in an Adult Population of Lithuania

Hypertension is a leading risk factor for cardiovascular events and death. A reduction in salt intake is among the most cost-effective strategies to reduce blood pressure and the risk of cardiovascular diseases. Increasing potassium lowers blood pressure and is associated with lower cardiovascular risk. Adequate iodine intake is important to prevent iodine deficiency disorders. Salt iodization is a key strategy to prevent such deficiency. In Lithuania, no surveys have been performed to directly assess sodium, potassium and iodine consumption. The aim of the present study was to measure sodium, potassium and iodine intake in a randomly selected adult Lithuanian adult population using 24 h urine collections, and to assess knowledge, attitudes and behavior towards salt consumption. Salt and potassium intakes were estimated in 888 randomly selected participants by 24 h urine sodium and potassium excretion and 679 individuals provided suitable 24 h urine samples for the analysis of iodine excretion. Average salt intake was 10.0 (SD 5.3) g/24 h and average potassium intake was 3.3 (SD 1.3) g/24 h. Only 12.5% of participants consumed less than 5 g/24 h of salt. The median value of urinary iodine concentration (UIC) was 95.5 μg/L. Our study showed that average salt intake is twice as high as the maximum level recommended by the World Health Organization while potassium and iodine intakes in Lithuania are below the recommended levels.

Non-persistence to antihypertensive drug therapy in Lithuania

Purpose

Poor persistence to antihypertensive therapy is an important cause of treatment failure. Investigating persistence is especially important in countries with a high cardiovascular mortality, like Lithuania. The aim of this study was to describe the antihypertensive treatment at initiation, to determine the percentage of patients not being persistent with antihypertensive treatment after 1 year and to explore factors associated with non-persistence.

Methods

In this cohort study, data on dispensed prescription medicines from the Lithuanian National Health Insurance Fund (NHIF) were used. All adult patients with a diagnosis of hypertension having first antihypertensive dispensed in 2018 were included. Descriptive statistics was used to determine the number of patients started with monotherapy and combination therapy. Treatment choice by Anatomical Therapeutic Chemical (ATC) and number of active pharmaceutical ingredient (API) was described. Non-persistence was assessed using the anniversary method. Multivariate logistic regression was used to explore factors associated with non-persistence.

Results

A total of 72,088 patients were included into the study, 56% started on monotherapy treatment, with 49% being dispensed an angiotensin converting enzyme inhibitor, and 44% started on combination therapy. Overall, 57% of patients were non-persistent after 1 year. Patients’ gender and prescriber qualification showed no association with non-persistence. Younger patients, patients from rural area, patients started with monotherapy, and patients with no medication change had higher odds to become non-persistent.

Conclusions

The majority of patients were initiated with treatment following hypertension management guidelines, but it is of concern that over half of the patients were non-persistent to antihypertensive therapy in the first year.

High Prevalence of Atrial Fibrillation in a Lithuanian Stroke Patient Cohort

Background and Objectives: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with a five-fold increased risk for acute ischemic stroke (AIS). We aimed to estimate the prevalence of AF in a Lithuanian cohort of stroke patients, and its impact on patients regarding case fatality, functional outcome, and health-related quality of life (HRQoL) at 90 days. Materials and Methods: A single-center prospective study was carried out for four non-consecutive months between December 2018 and July 2019 in one of the two comprehensive stroke centers in Eastern Lithuania. A telephone-based follow-up was conveyed at 90 days using the modified Rankin Scale (mRS) and EuroQoL five-dimensional three-level descriptive system (EQ-5D-3L) with a self-rated visual analog scale (EQ-VAS). One-year case fatality was investigated. Results: We included 238 AIS patients with a mean age of 71.4 ± 11.9 years of whom 45.0% were female. A striking 97 (40.8%) AIS patients had a concomitant AF, in 68 (70.1%) of whom the AF was pre-existing. The AIS patients with AF were at a significantly higher risk for a large vessel occlusion (LVO; odds ratio 2.72 [95% CI 1.38−5.49], p = 0.004), and had a more severe neurological impairment at presentation (median NIHSS score (interquartile range): 9 (6−16) vs. 6 (3−9), p < 0.001). The LVO status was only detected in those who had received computed tomography angiography. Fifty-five (80.9%) patients with pre-existing AF received insufficient anticoagulation at stroke onset. All patients received a 12-lead ECG, however, in-hospital 24-h Holter monitoring was only performed in 3.4% of AIS patients without pre-existing AF. Although multivariate analyses found no statistically significant difference in one-year stroke patient survival and favorable functional status (mRS 0−2) at 90 days, when adjusted for age, gender, reperfusion treatment, baseline functional status, and baseline NIHSS, stroke patients with AF had a significantly poorer self-perceived HRQoL, indicated by a lower EQ-VAS score (regression coefficient ± standard error: β = −11.776 ± 4.850, p = 0.017). Conclusions: In our single-center prospective observational study in Lithuania, we found that 40.8% of AIS patients had a concomitant AF, were at a higher risk for an LVO, and had a significantly poorer self-perceived HRQoL at 90 days. Despite the high AF prevalence, diagnostic tools for subclinical AF were greatly underutilized.

The impact of a comprehensive national policy on improving acute stroke patient care in Lithuania

Introduction:

Reperfusion therapy (RT) is a mainstay treatment for acute ischemic stroke (AIS). We aimed to evaluate the impact of a comprehensive national policy (CNP) to improve access to RT for AIS patients across Lithuania.

Patients and methods:

Aggregated anonymized data on AIS cases treated in Lithuanian hospitals between 2006 and 2019 were retrospectively obtained from the Institute of Hygiene and the Stroke Integrated Care Management Committee. Through an interrupted time series analysis, we examined the trends in AIS hospital admissions, RT, and in-hospital case fatality rates prior to the enactment of CNP in 2014, changes immediately after the intervention, and differences in trends between the pre- and post-intervention periods. Mean yearly door-to-needle times were calculated post-intervention.

Results:

114,436 cases were treated for AIS in Lithuanian hospitals before, and 65,084 after the government intervention. We observed a significant decreasing post-intervention trend change in AIS hospital admission rate per 100,000 population (regression coefficient ± standard error: β = –16.47 ± 3.95, p = 0.002) and an increasing trend change in the proportion of AIS patients who received reperfusion treatment: intravenous thrombolysis (β = 1.42 ± 0.96, p < 0.001) and endovascular therapy (β = 0.85 ± 0.05, p < 0.001). The proportion of patients treated in stroke centers increased immediately after the intervention (β = 4.95 ± 1.14, p = 0.001), but the long-term post-intervention trend did not change. In addition, there was a significant decreasing trend in all cause in-hospital case fatality rate within primary and comprehensive stroke centers after the intervention (β = –0.60 ± 0.18, p = 0.008) despite its prompt initial immediate increase (β = 1.68 ± 0.73, p = 0.043). The mean countrywide door-to-needle time decreased from 68 min in 2014 to 43 min in 2019.

Conclusion:

The comprehensive national stroke patient care policy could be associated with an immediate increase in stroke center treatment rate, increased access to RT, and improved stroke care performance measures.

Cardiovascular diseases mortality and alcohol control policy in Lithuania: exploring a possible link

Background

Lithuania possesses one of the highest alcohol per capita consumption and has previously implemented alcohol control policies to reduce the alcohol-attributable burden. The aim of this study was to investigate Lithuanian cardiovascular disease (CVD) mortality rate trends between 2001 and 2018 and to explore a possible link between CVD mortality rate and alcohol control policy implementation.

Methods

Lithuanian population mortality and alcohol consumption data for 2001–2018 were obtained from Statistics Lithuania and The State Register of Death Cases and Their Causes, Institute of Hygiene. Sex-specific CVD mortality rates were directly standardized to the European standard population by five-year age groups and categorized according to the ICD-10 codes for all CVDs (I00-I99), ischemic heart disease (IHD) (I20-I25), cerebrovascular diseases (I60-I69) and alcoholic cardiomyopathy (ACM) (I42.6). Joinpoint regression analyses were performed to identify points of inflection to explore their alignment with five selected alcohol policy enactments.

Results

Overall, the 2001–2018 yearly mortality rates for all CVDs significantly decreased on average by − 1.6% (95% CI -2.0, − 1.2%) among men and − 2.1% (95% CI -2.5, − 1.8%) among women. Yearly changes in all CVDs, IHD, cerebrovascular diseases and ACM mortality rates were insignificant prior to their respective critical year points in 2006, 2005, 2008 and 2007, but significantly decreased afterwards by an average of − 2.4% (95% CI -2.7, − 2.0%), − 1.6% (95% CI -2.1, − 1.1%), − 1.2% (95 CI -1.7, − 0.6%) and − 4.5% (95% CI -7.3, − 1.6%) among men, and by − 2.7% (95% CI -3.0, − 2.3%), − 2.0% (95% CI -2.6, − 1.4%), − 1.8% (95% CI 2.4, − 1.3%) and − 6.6% (95% CI -10.7, − 2.2%) among women, respectively. The changes in the mortality rate trends for all CVDs, IHD, cerebrovascular diseases and especially ACM coincided with alcohol policies enacted on the January 1, 2008, January 1, 2009, April 1, 2014 and March 1, 2017.

Conclusions

Yearly mortality rates for all CVDs, IHD, cerebrovascular diseases and ACM have declined in Lithuania between 2001 and 2018, and declining trends were more prominent in women than in men. Among the ICD-10 CVD categories investigated, the points of inflection identified for the ACM mortality rate trend coincided best with the selected alcohol policy enactment dates.

Arterial stiffness in regards to kidney function in middle-aged subjects with metabolic syndrome: Lithuanian high-risk cohort

OBJECTIVE

The current study aimed to check whether early vascular aging, measured as carotid-femoral pulse wave velocity (cfPWV), is related to kidney function, measured as creatinine-based estimated glomerular filtration (eGFR) and urinary albumin-to-creatinine ratio (UACR), in middle-aged subjects with metabolic syndrome.

METHODS

Participants were recruited from Lithuanian high-risk cohort (LitHiR). The cohort consists of middle-aged individuals with high cardiovascular risk but without overt cardiovascular disease. Participants underwent baseline and second visit hemodynamics measurement, including aortic mean arterial pressure (MAP), cfPWV, crPWV, carotid-intima media thickness measurement (CIMT) and biochemical analysis and all fulfilled NCEP/ATPIII criteria for metabolic syndrome diagnosis. First of all, we had determined correlations among hemodynamic measurement and eGFR together with albuminuria, expressed as UACR. Then we compared subjects who experienced significant eGFR decline with the remaining population and determining factors influencing this.

RESULTS

A total of 689 subject data were eligible for analysis. We observed relationship between cfPWV and MAP, crPWV, glucose, BMI, C-reactive protein, waist circumference except kidney function measured as eGFR at the baseline and at the second visit. eGFR was not associated with MAP or albuminuria. Baseline but not second visit UACR significantly positively correlated with cfPWV (r-spearman = 0.146, P = 0.003) and MAP (r-spearman = 0.142, P = 0.005). eGFR decline was mainly observed in subjects with higher baseline eGFR and was independently influenced by increase in cfPWV.

CONCLUSION

In middle-aged subjects with prevalent metabolic syndrome eGFR decline is related to aortic and not peripheral arterial stiffening. Better baseline kidney function could be possibly an effect of glomerular hyperfiltration, and it allows us to conclude that this phenomenon indicates early vascular damage and it should be addressed seriously in metabolic syndrome patients with normal kidney function.