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Background: During the last decade, the beneficial changes in lifestyle and in medical care increased average life expectancy, particularly in patients with chronic diseases such as hypertension and coronary heart disease. Unfortunately this also increased the number of patients, particularly among the elderly, who are susceptible to complications of these conditions such as heart failure. Uncontrolled hypertension is known to be a primary cause of heart failure and is also known to be very prevalent and frequently uncontrolled in the Polish population.Aim: To estimate the prevalence and characteristics of heart failure among patients of 65 years and older seeking medical care in outpatient clinics in Poland.Methods: The study is a cross-country epidemiological project in which 417 physicians from outpatient clinics were asked to register 50 consecutive patients aged 65 years and above seeking medical care for any cause. Information on case history, physical examination (diagnosis of heart failure, NYHA class, heart failure symptoms), laboratory tests (resting ECG, chest X-ray, echocardiogram) and data concerning pharmacology management during the 2 weeks prior to the index visit was obtained.Results: Over 5 months, 19877 eligible patients (7324 men and 12553 women) presented to the 417 participating physicians (90% physicians registered 46-50 patients). Among the patients, 53% were diagnosed with heart failure (3901 men and 6678 women), prevalence did not differ by gender. Among patients with heart failure there were 38% of men in NYHA class III or IV and 34% of women. Coronary heart disease was a predominant cause of heart failure in 87% of men (26% of cases with isolated coronary heart disease, 53% with concomitant hypertension and 8% with other diseases), while percentages for women were 80% (15%, 61% and 4%, respectively). Isolated hypertension was a further cause of heart failure in 8% of men and 13% of women. Cardiac arrhythmia was found in approximately 20% of patients, enlargement of heart size in 32% of patients and peripheral leg edema in 54% of men and 64% of women. These symptoms increased with age. Chest X-ray revealed cardiomegaly in 68% of men and women and increased cardiothoracic ratio (>50%) in approximately 40% of patients. From resting ECGs, cardiac arrhythmia was recorded in 21% of patients with heart failure, with atrial fibrillation as a predominant disorder (19%). Left ventricular hypertrophy on resting ECG was noted in 42% of men and women and old myocardial infarction or cardiac ischemia was diagnosed in 71% of men and 66% of women.Conclusions: (1) Heart failure was diagnosed in over half of outpatients aged 65 and older; in more than a third of these it was NYHA class III and IV. (2) Outpatients with heart failure had a high frequency of co-existing diseases such as arrhythmia, coronary heart disease and hypertension. [ABSTRACT FROM AUTHOR]

Data from two epidemiological studies are used to measure the degree to which two well-known guidelines agree in measuring hyperlipidemia in population samples in the US and Poland. The epidemiological studies are the US Lipid Research Clinics Program Prevalence Study and the Pol-MONICA project in Poland and the guidelines are those adopted by the US National Cholesterol Program (USNCEP) and by the European Atherosclerosis Society (EAS). EAS guidelines were analyzed in two ways: Method 1 used triglycerides and total cholesterol only in classifying persons as hyperlipidemics or non-hyperlipidemics; Method 2 used triglycerides, total cholesterol and nine additional risk factors in the classification process. USNCEP guidelines used total cholesterol, low density lipoprotein cholesterol and the same additional nine risk factors used in EAS Method 2 in classifying hyperlipidemics. Classification differences between the two sets of guidelines were high when EAS Method 1 guidelines were compared with USNCEP guidelines. However, EAS Method 2 which included risk factors, compared favorably with USNCEP guidelines in all three populations under study.

The authors present the results of first screening of random sample of population aged 35-64 years of two Warsaw districts (Praga South and Praga North). The screening was performed within framework of the international WHO-MONICA Project in 1984. 1309 men and 1337 women were screened (response rate 72.7% and 74.3%). Standardized mean values of plasma triglycerides concentration were found significantly higher and those of plasma HDL-cholesterol concentration significantly lower in male than in female sample. In men there was also higher the prevalence of hypertriglyceridemia, and hypoalphalipoproteinemia. Standardized mean values of plasma total cholesterol concentration and prevalence of hypercholesterolemia did not differ significantly between men and women. The mean values of lipid concentration and prevalence of lipid metabolism disturbances increased with age in men whereas in men such trend was not observed. The influence of selected factors on lipids and lipoproteins plasma concentration was evaluated by means of multivariate regression analysis. Quetelet index, cigarettes smoking and level of education were the most strongly associated with a lipid pattern which increases risk of cardiovascular diseases both in men and women.

The results of a number of Polish epidemiological studies raised the importance of hypertension in the Polish population. In view of a high frequency and insufficient control of it. The detection rate of hypertension in the Warsaw population was not exceeding 59% in men and 73% in women, and treatment was undertaken in 42% and 64% of them respectively. The effectiveness of pharmacological control was 5.9% in men and 10.3% in women. The study was carried out in a representative population sample of 1309 men and 1337 women living in right-bank Warsaw districts aged 35-64 years. Hypertension was found in 515 men and 457 women. Only 132 men and 188 women were currently treated. Drugs were recorded which were taken in the last 14 days, and were grouped into pharmacological classes. The most frequently taken drugs were those blocking the sympathetic system activity (78%) and diuretics (34%). Monotherapy was used by 38.5% of patients, 32.5% took two drugs, and 7.5% took three drugs. Drug consumption was expressed in DDD for comparing the obtained data with those reported from other centres.

In years 1984-1986 582 men and 338 women have been registered with clinical diagnosis of cerebral stroke. The respective numbers in the Tarnobrzeg province were 340 and 263. Preliminary diagnosis of cerebral stroke was confirmed according to criteria of registration in 82% of men or women from Warsaw and in 81% of men and 84% of women in the Tarnobrzeg province . Standardized incidence due to cerebral stroke was significantly higher in every of analysed years in the Warsaw population both among men and women in compare with that in the Tarnobrzeg province . In both population studied the incidence was significantly higher among men than among women. Standardized fatality during 28 days from the start of sickness was higher in the Tarnobrzeg province population than in the Warsaw population so far as both men and women are concerned. In both populations among men and women the most frequently diagnosis was acute disease of cerebral vessels.

In 1984 a group of 1309 men and 1337 women aged 35-64 years were studied in the population of Warsaw. The standardized mean systolic blood pressure was 143.4 mm Hg in men and 144.0 mm Hg in women (p less than 0.05), the mean values for the diastolic pressure were 89.7 mm Hg in men and 85.8 mm Hg in women (p less than 0.05). The standardized per cent values of borderline hypertension were 23.4% for men and 21.9% for women (p less than 0.05), according to WHO criteria the prevalence of hypertension was 35.8% in men and 28.0% in women (p less than 0.05). Only 55% of hypertensive men and 73% of hypertensive women knew that they had had hypertension, and 42% of male patients and 64% of female patients had had any treatment for hypertension. In the present study a correlation was demonstrated between hypertension and socioeconomic class (significantly higher blood pressure was found in people at lower educational level), besides that higher pressure was noted in married men and in women working artisans in relation to hose doing clerical work. The proportion of hypertensive subjects increased with increasing cholesterol level and with increasing overweight. A negative correlation was showed between hypertension and cigarette smoking. Ischaemic heart disease was significantly more frequent in hypertensive subjects as in normotensive ones.

Comparison of the parameters of obesity between two populations, urban from Warsaw and agricultural-industrial from Tarnobrzeg province revealed that skinfolds thickness, Quetelet index and body fat index, and per cent of overweight were statistically significantly higher in men from urban population. In the group of women these parameters were also statistically higher in Warsaw population with the exception of triceps skinfold and Quetelet index--differences of no statistical significance. There were also differences in the set of variables which correlate with the parameters of obesity between these two tested populations.

In years 1984-1986 3639 men and 1885 women were registered with suspected myocardial infarction from right-side Warsaw, simultaneously 2371 men and 917 women with the same suspected disease were registered from the Tarnobrzeg province population. The myocardial infarction diagnosis was confirmed in 54% of men and 43% of women from the Warsaw population as well as in 77% of men and 66% of women from Tarnobrzeg province population. In Warsaw the standardized incidence due to myocardial infarction increased during years of study from 466 to 588/100,000 among men and from 178 to 206/100,000 among women. The analogous increase among the Tarnobrzeg province population was 302 to 559/100,000 among men and 64 to 195 among women. Fatality during 28 days from the onset of the disease did not show any relationship with year of study and corresponded yearly among men to 45% and among women to 37% in Warsaw and to 42% among men and 33% among women in the Tarnobrzeg province . High fatality was noted during first 24 hours of hospitalization (Warsaw: 36% among men and 26% among women, Tarnobrzeg: 39% among men and 32% among women). The highest fatality was noted in the youngest of analysed groups.

In the paper presented, the relationship was analysed between the educational level and the level of risk of ischaemic heart disease (IHD) in a random sample of the Warsaw population aged 35-64 years. Men with a lower educational level (elementary or basic vocational) were found to have a significantly higher means for systolic blood pressure level, for plasma high-density lipoprotein (HDL) cholesterol concentration, for the numbers of cigarettes smoked daily, and for the probability of IHD development according to the multivariate logistic function of Farchi and Menotti, and also significantly greater prevalences of cigarette smoking, hypertension and overweight. And for men, a negative relationship was noted between educational level and plasma low-density lipoprotein (LDL) cholesterol concentration. Women with a lower educational level had a higher mean plasma triglyceride concentration, higher values of systolic and systolic blood pressures, a greater probability of IHD development, and higher prevalences of hypertension, obesity and ischaemic heart disease symptoms. And for women, a negative relationship with educational level was noted for plasma LDL-cholesterol concentration and for the mean value of the overall risk score according to Rose.

The coefficients and trends of mortality in years 1976-1987, based on data of Central Statistical Office, has been estimated in population of men and women aged 25 to 64 years, inhabitants of the Warsaw city region or the county region of Tarnobrzeg province . The trend of decrease of general mortality due to diseases of circulatory system has been statistically significant one similarly as that of mortality due to other heart diseases or ischaemic heart disease in men (group aged 25-34 or 35-44 years) in the Tarnobrzeg province . The analogously significant trend of mortality due to diseases of circulatory system or ischemic heart diseases in men aged 35-44 years has been stated in the Warsaw inhabitants. In the group of women an increase of general mortality has been noted in the youngest age group in Warsaw. In Warsaw and the Tarnobrzeg province in 1987 deaths due to diseases of circulatory system represented 33.2% and 39.9%, respectively, of total death pool among subjects aged 25 to 64 years. The respective percentages in the group of women were 29.1% and 39.4%.

The aim of the study was to determine the distribution of blood pressure and to evaluate the prevalence of hypertension in the Polish and Slovak populations. This report is a continuation of searching for causes of different ischaemic heart disease death rates observed in both compared populations. The studied male population aged 45-54 years consists of 2944 men from Warsaw (response rate 88.4%) and of 698 men from Bratislava's factories (response rate 64.5%). The mean of systolic and diastolic blood pressure in the 45-49 years group was significantly higher in Warsaw than in Bratislava although the prevalence of hypertension was similar in both populations in this age-group. In the older group the mean systolic blood pressure was similar in both populations but the mean diastolic pressure and the prevalence of hypertension were higher in Bratislava. The prevalence of hypertension was found to be similar to the rates observed in some other industrialized countries. The authors conclude that the finding of high proportions of hypertension in both populations proves that hypertension control is unsatisfactory, which has been confirmed by the results of additional investigations carried out in Warsaw.

The relation of developing coronary artery disease risk factors to the taking a post were assessed. 5438 males aged 40-59 underwent the study. Significantly greater mean body mass, total cholesterol level, diastolic blood pressure and risk coefficient by Rose were stated in the group of office workers, whereas in the group of factory workers the percentage of overweighted men and smokers was significantly more frequently observed.

The differences in mortality and incidence rates of ischaemic heart disease between the Polish and the Czechoslovak population prompted undertaking a study on the differences in risk factors. The presented paper deals with the problem of lipid disturbances. The study in Warsaw covered 2944 males aged 49-54 years from 14 Warsaw factories (response rate--88.4%) whereas the study in Bratislava covered 698 males in the same age group from four Bratislava factories (response rate--64.5%). The mean value of the total cholesterol and triglycerides level as well as the prevalence of elevated cholesterol of triglycerides was found to be higher in Bratislava than in the Warsaw population (p < 0.05). Hyperlipoproteidaemia was found in 24.6% of the studied males in Warsaw and in 43.8% of the Bratislava population (p < 0.05). Pure hypertriglyceridaemia prevailed in both populations. Phenotyping of hyperlipoproteinaemia according to Fredricksen additionally performed in Warsaw indicated the predominance of type IV; types, I, III and V were not found in the studied male group.

The present study, based on the World Health Organization (WHO) MONICA Project design, covers two Warsaw districts inhabited by 274442 people, aged 25-64. In the studied population over the years 1976-1985, no significant time-trends were found of cardiovascular disease (CVD), ischemic heart disease (IHD), myocardial infarction (MI) and cerebrovascular mortality, whereas the hypertension mortality trends increased significantly. The MI attack rate in 1984/85 in men aged 25-64 was 466/100,000 and that of women 173/100,000. Within the last 14-15 years the age-standardized MI attack rates increased by 35% in men aged 35-64 and by 65% in women. The 28-day case fatality was 40% in men and 35% in women. Fatality was highest the first day after the onset of symptoms, and only 66% of men and 72% of women survived the first 3 days after onset. No significant differences in age-standardized mean values of plasma total cholesterol, low-density lipoprotein (LDL)-cholesterol and systolic blood pressure (BP) were found between men and women. Mean values of high-density lipoprotein-cholesterol (HDL) and of the Quatelet index were higher in the female population, whereas the triglyceride level, diastolic BP, and the number of cigarettes smoked daily were higher in the male population. In men, the plasma total cholesterol, LDL-cholesterol and HDL-cholesterol values did not change with age, but the tryglyceride values decreased; in women, the plasma total cholesterol, LDL-cholesterol and triglyceride values increased with age. Mean values of systolic and diastolic BP increased with age in both sexes, whereas the number of cigarettes smoked daily decreased.

5426 males aged 40-59 of 14 Warsaw factories underwent the study to evaluate the relationship between coronary artery disease risk factors and education levels. Greater mean body mass, total cholesterol level and greater mean value of Rose's coefficient were significantly more frequently observed in men with secondary and university education. Persons with technical or elementary education have been significantly more frequently smoking cigarettes and overweighted.

The purpose of the study was to determine the prevalence of such ischaemic heart disease (IHD) risk factors as cigarette smoking and overweight, and the degree of IHD risk in the Polish and Slovak populations. The investigated population consisted of men aged 45-54 years; 2944 of them were from industrial plants in Warsaw, with response rate of 88.4%, and 698 from plants in Bratislava (response rate: 64.5%). 60.4% of the Warsaw group were cigarette smokers, with average daily consumption of 12.7 cigarettes; the respective values in the Bratislava group were lower (46.4%; 9.2 cigarettes). The mean body weight and the prevalence of overweight were higher in Bratislava (79.6 kg; 25.6%) than in Warsaw (77.9 kg; 20.8%). The IHD risk evaluated according to the multilogistic function was higher in Bratislava. It is concluded that the difference in the IHD death rate found in these cities could to a high extent be explained by the difference in the prevalence of risk factors.