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To examine the effects of war in Bosnia and Herzegovina on the occurrence of acute coronary syndrome among civilians.The incidences of acute myocardial infarctions (first and recurrent) and unstable angina pectoris were examined among the residents of Mostar and the nine neighboring districts. The study population was the population that lived in the area before the war (182,000 in the 1991 census). Others who immigrated into the area were not taken into consideration. Five consecutive years (1987-1991) before the war and 5 consecutive years (1992-1996) during the war were analyzed.In the 5-year period during the war, 267 men and 161 women suffered from acute myocardial infarctions, compared with 246 men and 119 women in the 5-year period before the war. The wartime increase in acute myocardial infarctions for the combined male-female population was statistically significant (p = 0.025). For women, the wartime increase was statistically significant only for the age group of 60 to 69 years (p = 0.007). The smaller increase among men was not statistically significant (p = 0.354). The increase to a wartime number of 52 cases of recurrent myocardial infarctions from a prewar level of 24 was statistically significant (p = 0.001). The percentage of fatal myocardial infarctions among women, however, was lower during the war (18.6%) than before the war (32.8%) (p = 0.048). During the war, 109 men with unstable angina pectoris were hospitalized, compared with 84 before the war; the cases among women were 76 and 41, respectively. The increase was statistically significant among women (p = 0.001) but not among men (p = 0.072). There was a statistically significant increase (p0.001) in the total number of unstable angina pectoris cases during the war (185 cases, compared with 125 prewar cases).The common population during the war in Bosnia and Herzegovina had increased numbers of acute myocardial infarctions and unstable angina pectoris cases.

Effective intervention strategies aiming to improve cardiorespiratory fitness and to decrease body fatness are needed. However, long-term stability of these traits is not well understood.To assess long-term tracking of cardiorespiratory fitness and body fatness from late adolescence to middle adulthood.The sample consisted of 50 participants (31 boys) from the Zagreb Growth and Development Longitudinal Study who were followed up in adulthood (median age = 43). Fatness was evaluated through BMI and skin-folds, while cardiorespiratory fitness was assessed using a cardiopulmonary exercise test. Inter-age partial correlation coefficients were calculated to evaluate tracking.Body mass index and skin-folds showed moderate tracking from age 15 years to middle adulthood (partial r = 0.55, p0.001 and partial r = 0.52, p0.001, respectively), while tracking of subcutaneous fat distribution was somewhat lower (partial r = 0.38, p0.01). At the same time, the observed tracking of peak oxygen uptake was low-to-moderate (partial r = 0.30, p = 0.03), while ventilatory aerobic and anaerobic thresholds did not show significant tracking.The results of this study indicate that preventive efforts aiming to increase cardiorespiratory fitness should include all adolescents, irrespective of their cardiorespiratory fitness status. Conversely, strategies aiming at obesity prevention should focus on high-risk groups of adolescents.

The aim of this study was to find out and compare characteristics of cardiac patients who, after hospital treatment, participated in cardiac rehabilitation programmes at the Polyclinic for Cardiovascular Prevention and Rehabilitation in Zagreb during 1999 and 2009. The results show an increase in mean patients' age (men: 55.5 to 61.53; p = 0.000 and women: 58.95 to 62.66; p = 0.01), an increase of the proportion of those +/- 65 years by 23% in both genders (men: 17% to 40%; women: 27% to 50%), an increase in the proportion of women (21.16% to 28.22%), a marked increase in the proportion of post - PCI patients with stenting (men: 15.58% to 61.92%; women: 9.68% to 62.20%), reduction of patients with BMI < 25.00 kg/m2 (men: 47.19% to 13.93%; women: 54.84% to 24.41%) and a constantly high proportion of patients with hypercholesterolemia (above 85%). It is obvious that systematic action is required to improve awareness of risk factors and desirable health behaviour.

The aim of this paper was to investigate the prevalence of smoking using selected anthropometric variables in a sample of hospitalized coronary heart disease (CHD) patients in Croatia (N = 1,298). A total of 444 subjects (34.6%) were non-smokers, 548 (42.6%) were smokers and 293 (22.8%) were ex-smokers. Men, on average, smoked more cigarettes per day than women (22.62 vs. 19.84 cigarettes, p < 0.001) and they also had bigger index "pack-years" than women (36.96 vs. 33.91, p = 0.024). Men were more often smokers and ex-smokers than women (47.4% vs. 30.8% for smokers and 25.0% vs. 22.8% for ex-smokers, p < 0.001). In this study a high prevalence of smoking was found among CHD patients in Croatia. Unless it is decreased, it can be expected that CHD patients in Croatia will continue to experience adverse effects more often than other CHD patients in the rest of Europe.

Coronary heart disease is a chronic disease with multifactorial etiology. The risk depends on several, already well-known, risk factors such as hypertension, diabetes mellitus, dyslipidemia, smoking, obesity, physical inactivity, stress, etc. Multiple risk factors will increase the risk. The variety of risk factors requires a multidisciplinary approach--a team of different experts guided by a cardiologist who ensures an appropriate rehabilitation program. This should include secondary prevention as an important part of coronary heart disease patient treatment. It is based on the generally accepted medical, professional and scientific principles and long standing international experience. Papers written by experts and published on behalf of the World Health Organization, European Society of Cardiology, European Society of Hypertension, European Association for Cardiovascular Prevention and Rehabilitation, and other societies, define the basic characteristics of cardiac rehabilitation programes: aims, forms, content, indications and ways of implementing it in order to make it comprehensive, and to help regain the patients' temporarily lost ability to return to normal life and work. The cardiac patient will be fully educated to manage his exercise program and secondary prevention for life. Taking into account the situation that we have in our country, in relation to social structure, demography, legislation and types of health insurance, we would recommend that post-acute coronary syndrome patients undergo a cardiac rehabilitation program, which includes secondary prevention. After the education and rehabilitation program, aimed at individual needs, patients will continue under the guidance of his/her GP, consulting the specialist only when needed. In this way, the positive effects of cardiac rehabilitation will be long lasting.

Obesity has become a growing public health problem. The number of obese people in the world is increasing, carrying a number of risks for the development of cardiovascular and other diseases. There are no easy or short-term solutions for this problem. The causes differ and the number of obese and overweight people varies from region to region. The aim of the study was to estimate the distribution of obese and overweight people in Croatia.The study was carried out in 2003 in a sample of 9070 subjects, representative of the population of Croatia. We used three measures of obesity and overweight: body mass index (BMI); waist circumference, and waist/hip ratio (WHR). Overweight is defined as BMI of 25.00-29.99 kg/m2, and obesity as BMI of 30 kg/m2. The other two measures vary according to sex. Waist circumference greater than 102 cm (40 in) in men and greater than 88 cm (35 in) in women is considered to show unfavorable fat distribution, and WHRor = 1 in men andor =0.85 implies an increased risk of heart disease, diabetes, hypertension, and some forms of cancer. Weighted data were analyzed with SPSS statistical software.The analysis of each of the variables yielded the following results: BMI: generally, more than 1 in 5 adults (about 720,000) in Croatia were obese with no sex differences. The highest rate of obesity was found in the inland part of the country and lowest along the Adriatic coast. Overweight was more common than obesity, showing some sex differences [705,000 (43%) men and 625,000 (34%) women]. The greatest number of overweight men lived along the Adriatic cost and in Zagreb, the capital of Croatia, while the greatest number of overweight women lived along the Adriatic coast. The greatest number of overweight young men lived along the Adriatic coast and of young overweight women in the east inland part of Croatia. Waist circumference showed great sex differences: 54% of women (993,000) had waist circumference greater than 88 cm (35 in), and 37% of men (607,000) had waist circumference greater than 102 cm (40 in). The greatest number of men with such waist circumference were found in the inland part, and in the middle and southernmost part of the Adriatic coast. The greatest number of women with waist circumference over 88 cm lived in the continental part of Croatia. WHR showed even greater sex difference: 41.0% of women (754,000) and 18.5% of men (303,000) had unfavorable WHR. The greatest number of men and women with unfavorable WHR lived in the inland and southern parts of Croatia.Obesity and overweight pose major problems in Croatia. There are regional and sex differences, and differences according to the variables observed. In order to get proper insight in the current situation, we recommend that BMI be adjusted for fat distribution and comorbid conditions.

The aim of the study was to determine the number of hospitalized patients with acute coronary syndrome (ACS) in the Zagreb population.Zagreb residents hospitalized in five Zagreb hospitals (Sveti Duh General Hospital, Merkur, Sestre Milosrdnice, Dubrava University Hospitals, and Zagreb University Hospital Center) during 2000 and 2001 with the diagnosis of ACS, were examined. Patients who suffered from acute myocardial infarction with ST elevation (STEMI), patients with acute myocardial infarction without ST elevation (NSTEMI) and patients with unstable angina (UA) were analyzed according to gender and outcome.During 2000, and 2001, 1453 and 1538 Zagreb residents were hospitalized for ACS, respectively, 62% of them men. STEMI was present in 54% of patients hospitalized during 2000 and 56% of those hospitalized during 2001. NSTEMI was present in 19% of patients in 2000 and 23% of patients in 2001, while the respective percentage of UA was 17% and 21%. Among STEMI patients, case fatality was higher in women (20%) than in men (20%) (p = 0.05), whereas no sex difference was observed in NSTEMI (20%) and in UA (about 3%) patients.Women had a higher case fatality. Case fatality was also higher in patients with STEMI than in those with NSTEMI and UA, who had a much lower case fatality. Due to the lack of data, further follow-up is needed because reliable data can help us in the prevention and treatment of ACS.

Kardiovaskularne bolesti (KVB) uzrok su prerane smrti, i u većini razvijenih zemalja, i kod nas. One su velik uzrok onesposobljenosti za rad i u velikoj mjeri povećavaju troškove zdravstvene zaštite. Osnovna patološka promjena u podlozi KVB-a je ateroskleroza, koja se podmuklo razvija godinama. Nagla kardijalna smrt, infarkt miokarda i moždana kap samo su krajnje epizode procesa i obično se javljaju iznenada pa su često mnoge terapijske intervencije samo palijativne. Masovna pojava KVB-a čvrsto je vezana uz način života te fi ziološke čimbenike rizika. Nedvojbeno je dokazano da modifi kacija čimbenika rizika smanjuje morbiditet i mortalitet kod ljudi s prepoznatim ili neprepoznatim KVB-om. Uzrok KVB-a je obično kombinacija nekoliko čimbenika rizika. Prema europskim smjernicama za prevenciju KVB-a u kliničkoj praksi (2003) koje je 2004. godine prihvatilo Hrvatsko kardiološko društvo u suradnji s drugim srodnim društvima, preporučuju se prevencijske smjernice ukupnog KV rizika (sustav SCOR). Neke od kombinacija aterogenih čimbenika rizika od nastanka KVB-a povećavaju ukupni rizik više od drugih ili pojedinačnih. Tako kombinacija hiperglikemije, hipertenzije, hiperlipoproteinemije i centralni tip pretilosti, udruženi s inzulinskom rezistencijom čine metabolički sindrom (sindrom X) koji prema smjernicama ECS-a (Europsko kardiološko društvo) predstavlja osobito visoki kardiovaskularni rizik. Cilj sprečavanja morbiditeta i mortaliteta KVB-a je rana detekcija čimbenika rizika (primarna prevencija) te liječenje pojedinih čimbenika odnosno usporavanje razvoja ateroskleroze (sekundarna prevencija)., Cardiovascular diseases (CVD) represent the major cause of premature death in most developed countries and in Croatia as well. They also largely contribute to a diminished work capacity and escalating healthcare costs. The basic pathology is atherosclerosis that develops insidiously over many years. Sudden cardiac death, myocardial infarction and stroke are only the fi nal episodes in this process. As they usually occur abruptly, many therapeutic interventions are only palliative. The mass occurrence of CVD is strongly related to lifestyle and physiological risk factors. It has been unequivocally proven that the risk factor modifi cation reduces morbidity and mortality in people with established and unestablished CVD. CVD is generally caused by a combination of several risk factors. The European Guidelines on CVD Prevention in Clinical Practice (2003), which were accepted by the Croatian Cardiac Society and some other related societies in 2004, recommend a total CV risk estimation as a guide to preventive strategies (the SCORE system). Some combinations of atherogenic risk factors increase the total risk for the development of CVD more than other combinations or single risk factors. The combination of hyperglycaemia, hypertension, hyperlipoproteinaemia and central obesity, associated with insulin resistance, is known as the metabolic syndrome (syndrome X) that, according to the European guidelines, represents a particularly high CVD risk. The aim in the prevention of CVD morbidity and mortality is an early detection of risk factors (primary prevention) and the treatment of single risk factors along with the slowing down of atherosclerosis (secondary prevention).

The article emphasizes clinical and prognostic significance of non-linear measures of the heart rate variability (HRV). It was applied on the group of patients with stable coronary heart disease (CHD) and arterial hypertension (AH) before and after 6 months treatment by amlodipine besylate (5 mg daily). Two different methods were applied: Hurst exponent (H) and detrended fluctuation analysis (DFA). Hurst exponent of the R-R series was determined by the range rescaled analysis technique. DFA was used to quantify fractal long-range-correlation properties of heart rate variability. It was found that the short-term fractal scaling exponent (/spl alpha//sub 1/) is significantly lower in patients with CHD, as well as Hurst exponent. But, after 6 months treatment with calcium channel blocker amlodipine besylate the results of HRV are normalize.

Dynamic analysis techniques may quantify abnormalities in heart rate behaviour based on nonlinear and fractal analysis. To investigate the clinical and prognostic significance of the fractal dimension and de-trended fluctuation analysis, a group of patients with stable angina pectoris without previous myocardial infarction and an age-matched healthy control group were studied. The fractal dimension of the R-R series was determined by the range-rescaled analysis technique. To quantify the fractal long-range correlation properties of heart rate variability, the de-trended fluctuation analysis technique was used The short-term fractal scaling exponent (/spl alpha//sub 1/) was significantly lower in patients with stable angina pectoris (0.95/spl plusmn/0.05 vs. 1.08/spl plusmn/0.06; p

The article emphasizes clinical and prognostic significance of non-linear measures of the heart rate variability, applied on the group of patients with coronary heart disease (CHD) and age-matched healthy control group. Three different methods were applied: Hurst exponent (H), Detrended Fluctuation Analysis (DFA) and approximate entropy (ApEn). Hurst exponent of the R-R series was determined by the range rescaled analysis technique. DFA was used to quantify fractal long-range-correlation properties of heart rate variability. Approximate entropy measures the unpredictability of fluctuations in a time series. It was found that the short-term fractal scaling exponent (/spl alpha//sub 1/) is significantly lower in patients with CHD (0.93 /spl plusmn/ 0.07 vs. 1.09 /spl plusmn/ 0.04; p < 0.001). The patients with CHD had lower Hurst exponent in each program of exercise test separately, as well as approximate entropy than healthy control group (P < 0.001).

The results of inteligent data analysis based on an inductive machine learning (IML) approach of the coronary heart disease (CHD) data collected in regular medical practice are presented.

Linear dependence between risk factors and the ischemic ST segment depression during exercise ECG test in patients with coronary heart disease (CHD) are studied.