Prevalence and cardiometabolic risk of suspected and untreated hypertension in middle-aged Lithuanian men: insights from a cardiovascular disease prevention programme.

Background and aims: This study aimed to estimate the prevalence of cardiovascular risk factors in middle-aged Lithuanian men categorized according to body mass index and waist circumference results. Methods and results: The data were from the Lithuanian High Cardiovascular Risk primary prevention program between 2009 and 2016. This community-based cross-sectional study comprised 38,412 men aged 40 to 54 years old. We compared the prevalence of arterial hypertension, dyslipidaemia, diabetes mellitus, smoking, and metabolic syndrome in body mass index (BMI) and waist circumference (WC) groups. Regarding the allometric anthropometrics for WC, A Body Shape Indices (ABSIs) were analyzed with respect to mortality risk and smoking status. The most prevalent risk factor in men was dyslipidaemia, followed by arterial hypertension and smoking (86.96%, 47.94%, and 40.52%, respectively). All risk factors except for smoking were more prevalent in men with overweight or obesity as measured by BMI compared to men with normal weight. Similarly, smoking was the only cardiovascular risk factor that was more prevalent among subjects with normal WC compared to those with increased WC or abdominal obesity. Elevated ABSI, which is associated with higher mortality risk, was more prevalent in smokers. Conclusion: The most prevalent cardiovascular risk factor among middle-aged Lithuanian men was dyslipidaemia, with a surprisingly high prevalence in all BMI and WC groups. Smoking was the only risk factor most prevalent in subjects with low or normal weight according to BMI. It was also more prevalent in the normal WC group compared to the increased WC or abdominal obesity groups, but ABSI values associated with higher mortality were more prevalent among smokers than non-smokers.

Aim. To evaluate the association of Family History (FH) of cardiovascular diseases (CVD) in boys aged 12-13 years with the development of structural and functional changes in the left ventricle and stiffness of the main arteries in adulthood (43-46 years old) according to prospective study.Material and methods. For the initial examination, boys were selected whose parents suffered from CVD at a young age or died prematurely from them (risk group). The comparison group was formed from a population sample of boys of a similar age without FH of CVD. The examination included a survey on a standard questionnaire, measurement of anthropometric indicators, blood pressure (BP), pulse counting, determination of the blood lipid spectrum. The intima-media complex thickness (IMT) of the common carotid arteries was measured; echocardiography and applanation tonometry were performed.Results. The group with FH of CVD significantly (p<0.05) differed in childhood in terms of the body mass index (BMI) (18.8 vs 17.6 kg/m2), systolic BP (SBP) (117 vs 107 mm Hg), diastolic BP (DBP) (67 vs 56 mm Hg), average BP (81.8 vs 72.7 mm Hg) and triglycerides (0.79 vs 0.58 mmol/L). In adulthood, increased total cholesterol (TC) level (6.3 vs 5.8 mmol/L; p=0.036) and other indicators of atherogenesis were revealed in the risk group. The risk of fatal outcomes from CVD in the next 10 years in men with a family history of CVD in childhood was significantly higher compared to the control group (1.94 vs. 1.28; p <0.001). The main contribution to the total risk of fatal CVD in middle-aged men was made by TC and smoking. In the group with FH of CVD, higher stiffness of the arteries in adulthood was observed. There were found significant (p=0.002) intergroup differences in the IMT (0.73 vs 0.63 mm). A statistically significant positive relationship between BMI and some structural and functional indicators of the left ventricle and stiffness indicators of the main arteries was revealed. DBP and mean BP in childhood are associated with arterial stiffness in adulthood according to the parameters of central SBP and central DBP. BMI in boys is the most significant predictor for most structural and functional indicators of LV myocardial hypertrophy, in particular, LV myocardial mass (private R2=0.140) and interventricular septum thickness (R2=0.164; p=0.001), and arterial stiffness by central DBP parameter (R2=0.043; p=0.024) in adulthood. The risk of increased IMT development in males in adulthood with FH of CVD is 6.1 times higher than that of their peers without FH.Conclusion. FH of CVD revealed in childhood in males is a risk factor for the development of early atherosclerosis and, due to its ease of detection, can be used as one of the criteria for the formation of high-risk groups for the purpose of primary prevention.

Background Arterial hypertension (AH), defined as elevated systolic blood pressure (SBP) ≥ 140 mmHg and/or diastolic blood pressure (DBP) ≥ 90 mmHg, is a treatable and highly prevalent risk factor for cardiovascular, cerebrovascular, and chronic kidney diseases globally (1, 2). Elevated blood pressure is responsible for an estimated 7.7 to 10.4 million annual deaths worldwide (3). Despite the wide treatment options available, high blood pressure remains a serious chronic condition that requires appropriate treatment and intensive cardiovascular risk factor management. A research study found that approximately one-third of nearly 42 million study subjects were unaware of having AH and, therefore, were not receiving antihypertensive treatment (4). Purpose The aim of the study was to evaluate untreated arterial hypertension and concomitant cardiovascular risk factor prevalence in the Lithuanian population aged 50-54 years old in the 2009-2022 period. Design: LITHIR is a nationwide primary prevention program financed by the Ministry of Health that has been implemented since 2006 and is designed to identify patients at high risk of CVD. A retrospective study involving 66,468 participants was carried out after gathering and analyzing LITHIR data. Participants who were not enrolled in any treatment but had previous hypertension diagnosis or an abnormal BP measurement (>140 and/or 90 mmHg) during evaluation in a primary health care center were considered as untreated AH. More than 94% of primary healthcare centers participate in the program, covering 44.5% of the studied population in 2023. Therefore, the data reliably reflects the general middle-aged Lithuanian population. Results Untreated hypertension prevalence steadily increased in the 50-54-year-old Lithuanian population from 15.81% in 2009 to 21.51% in 2022 (p < 0.001). Untreated hypertension was significantly more prevalent in the male group compared to women, with a mean difference of 8.35% (22.38% vs. 14.03%; p < 0.001). A total of 11,240 individuals were identified as having untreated hypertension. An unbalanced diet was the most prevalent cardiovascular risk factor in the analyzed group, reaching 59%. Insufficient physical activity, smoking, and increased LDL-C (>3.5 mmol/l) concentration amounted to 51.7%, 29.2%, and 60%, respectively. Despite substantial dyslipidemia prevalence, normal glucose concentration in venous blood was measured in 78.9% of the population. Conclusion(s) The study found that the prevalence of untreated hypertension was steadily growing in the middle-aged Lithuanian population, when the majority of patients with untreated hypertension were male. The most prevalent cardiovascular risk factors in the studied population were inadequate diet and smoking, although normal glucose concentration was obtained in most cases.Untreated hypertension 50-54 years old

Introduction: Family history is an established risk factor for both cardiovascular disease (CVD) and diabetes; however, no study has presented population-based prevalence estimates of family histories of CVD and diabetes and examined their joint impact on prevalence of diabetes, CVD, cardiometabolic risk factors, and mortality risk. Methods: We analyzed data from a representative sample of the US adult population including 29,440 participants from the National Health and Nutrition Examination Survey (2007–2018) and assessed self-reported first-degree family history of diabetes and CVD (premature heart disease before age of 50 years) as well as meeting criteria and/or having risk factors for CVD and diabetes. Results: Participants with joint family history exhibit 6.5 greater odds for having both diseases and are diagnosed with diabetes 6.6 years earlier than participants without family history. Healthy participants without prevalent CVD or diabetes but with joint family history exhibit a greater prevalence of diabetes risk factors compared to no family history counterparts. Joint family history is associated with an increase in all-cause mortality, but with no interactive effect. Conclusion: Over 44% of the US adult population has a family history of CVD and/or diabetes that is comparable in risk to common cardiometabolic risk factors. This wide presence of high-risk family history and its simplicity of ascertainment suggests that clinical and public health efforts should collect and act on joint family history of CVD and diabetes to improve population efforts in the prevention and early detection of these common chronic diseases.

Prevalence of cardiovascular risk factors in middle-aged Lithuanian women in different body mass index and waist circumference groups

O verweight and obesity have become increasingly com- mon; worldwide, at least 1.1 billion adults are overweight and 312 million are obese, when overweight and obesity are defined conventionally as having a body mass index (BMI) of Ͼ25 kg/m 2 and Ͼ30 kg/m 2 , respectively. 1,2In the general population, overweight and obesity are associated with increased risk of developing cardiovascular disease, 3,4 and thus it is not surprising that in cohorts of patients with prevalent ischemic heart disease or acute coronary events, well over 50% are overweight or obese. 5,6Despite the association between obesity and cardiovascular risk in the general population, a multitude of studies have described an inverse correlation between BMI and mortality in patients with coronary artery disease (CAD), including post-coronary revascularization patients and those with acute myocardial infarction (MI); the association between elevated BMI and improved survival has been termed the obesity paradox. 7,8 Article p 482In this issue of Circulation, Zeller et al 9 further investigate the obesity paradox in a cohort of 2229 consecutive patients presenting with acute MI in the Côte d'Or region of France.In assessing the impact of obesity on mortality after MI, the group uses both BMI, a traditional index of obesity, as well as waist circumference, an alternate anthropometric index that is more specific for abdominal obesity.Approximately one-half of the subjects in the study were overweight (BMI 25 to 29.9 kg/m 2 ), one-quarter were obese (BMI Ͼ30 kg/m 2 ) and onehalf had increased waist circumference, which was defined as Ͼ102 cm in men and Ͼ88 cm in women.Left ventricular ejection fraction, type of MI, and acute treatment strategy did not generally differ by BMI or waist circumference values.Of note, BMI was inversely correlated with age and plasma N-terminal pro B-type natriuretic peptide, whereas waist circumference was positively correlated with age and did not correlate with N-terminal pro B-type natriuretic peptide.Consistent with prior studies, survival analysis showed that the risk of death decreased with increasing BMI tertile.In a waist-matched analysis of 832 subjects, BMI was a signifi-

Hypertension (HT) is the most attributable and modifiable risk factor for spontaneous intracerebral hemorrhage (SICH). However, epidemiological data on blood pressure (BP) control before SICH and its relationship to patient lifestyles are lacking. This study prospectively enrolled patients with acute SICH from six stroke centers in Tochigi, Japan. BP control and patient lifestyles were investigated using a questionnaire conducted on patients and their families. A total of 365 patients were analyzed, 270 (74.0%) of whom had HT and 198 (54.2%) untreated HT. The prevalence of untreated HT was much higher in younger patients and decreased with age (79.0%, 71.8%, 62.2%, 44.8%, and 31.0% in those aged <50, 50-59, 60-69, 70-79, and ≥80 years, respectively). Patients with untreated HT were significantly less likely have a family doctor and attended fewer annual health checkups than did those with treated or no HT. Untreated HT with awareness was much higher in younger and middle-age men than in women, whereas untreated HT without awareness was much higher in younger women than in men. Among patients who received antihypertensives, the prevalence of well-controlled HT was also very low, especially in younger patients (20.0% and 23.5% in those aged <50, and 50-59 years, respectively). In-hospital mortality was much higher in younger patients (age <70 years) with untreated than with treated or no HT. Untreated and uncontrolled HT were highly detected and seemed to be important targets for the primary prevention of Japanese SICH. Different strategies to improve BP control are warranted for each generation and sex.

Introduction While family history of cardiovascular disease (CVD) is a well-established non-modifiable risk factor of CVD, it remains unclear which modifiable CVD risk factors may further increase risk in subjects with a family history. Recent research suggests that cardiometabolic risk markers may be particularly relevant. Purpose To assess interactions between a family history of CVD and established as well as less established cardiometabolic risk factors in relation to risk of CVD in a cohort of 60-year-old men and women. Methods The cardiometabolic factors considered were hypercholesterolemia, LDL- and HDL cholesterol, ApoB, ApoA1, ApoB/ApoA1 ratio, Lp(a), uric acid, PCSK9, BMI, waist circumference, hypertension, and diabetes. Family history of CVD was defined as having at least one first-degree relative affected by coronary heart disease or stroke before the age of 70 (mother) or 65 (father/sibling). After excluding prevalent CVD, 3875 participants remained for analysis. The participants were followed from baseline, 1997-1998, for incident fatal or non-fatal CVD events until they reached approximately 75 years of age and 85 years of age, respectively. Using Cox proportional hazards model, we calculated hazard ratios (HR) and 95% confidence intervals (CI) for: 1) each of the cardiometabolic factors in absence of family history of CVD; 2) family history of CVD in absence of the exposure to each of the cardiometabolic factors, and 3) the combination of a family history of CVD and the respective cardiometabolic factor. Interactions were assessed by modelling cross-product terms (p multiplicative) and calculating relative excess risk due to interaction (RERI). All models were adjusted for classical CVD risk factors. Results The prevalence of a family history of CVD was 27.4%. Results based on the shorter follow-up revealed a statistically significant interaction (p multiplicative 0.023) for the co-presence of elevated serum levels of PCSK9 (&amp;gt;75th percentile) and family history. The HR (95% CI) for the combination of elevated PCSK9 and family history was 1.43 (1.34-2.24) whereas for increased PCSK9 alone it was 1.21 (0.99-1.47) and for a family history alone it was 1.20 (1.00-1.73). The corresponding results based on the longer follow-up were less pronounced (p multiplicative 0.056). The RERI was not statistically significant. For the other cardiometabolic factors we observed no significant interaction with a family history, regardless of length of follow-up. Conclusion(s) Of the cardiometabolic factors under study, we found that elevated PCSK9 was a significantly stronger risk factor for suffering a CVD event before the age of 75 in individuals with a family history of CVD compared to individuals without such a family history. This finding supports CVD preventive guidelines highlighting the need to closely monitor subjects with a family history of CVD for cholesterol-related risk markers.

Objective: To determine the prevalence of cardiovascular disease risk factors in adolescents from public and private schools of a Brazilian state capital. Design and method: Cross-sectional study with a representative sample of adolescents aged 14 to 18 years, enrolled in public and private schools in Goiânia, Goiás state, Brazil. The data collection included a standard questionnaire (gender, age, ethnicity, smoking, alcohol consumption in the last 30 days, socioeconomic status, and family history of cardiovascular disease); the International Physical Activity Questionnaire (IPAQ); and a physical assessment (weight, height, waist circumference, and blood pressure). The prevalence ratio was used as the measure of association, estimated by Poisson regression. Results: The sample was composed of 862 adolescents with a mean age of 15.4 ± 1.1 years and with a predominance of females (52.8%). Alcohol consumption in the last 30 days (72.2%) and physical inactivity (66.8%) were the most prevalent cardiovascular risk factors. The most prevalent variables in female adolescents were socioeconomic class C (53.6%; p = 0.022), alcohol consumption in the last 30 days (75.4%; p = 0.025) and physical inactivity (66.8%, p = 0.000). In male adolescents, the most prevalent variables were abnormal blood pressure (24.3%; p = 0.000), abnormal waist circumference (17.2%; p = 0.011), and overweight (24.6%; p = 0.001). The prevalence of a family history of cardiovascular disease was 39.5%. Most adolescents (60.3%) had three or more risk factors, and only 1.1% did not present any cardiovascular risk factor. Conclusions: The prevalence of cardiovascular disease risk factors, particularly the occurrence of multiple risk factors, was high in the population studied.

BackgroundNurses as the largest group of health workers have a very stressful job which can cause number of diseases specially increase cardiovascular risk factors. This study aims to investigate the overall epidemiology of cardiovascular disease (CVD) risk factors among nurses.MethodWe searched all four main databases such as Scopus, PubMed, Embase and Web of Sciences from the beginning of 2000 to March 2022 with appropriate Mesh Terms. We also searched Google scholar. Then we applied inclusion and exclusion criteria and after selection the studies the Newcastle-Ottawa Scale (NOS) was used to assess the methodological quality of included studies. Comprehensive Meta-analysis and R software was used for analysis.ResultsFinally, 22 articles with a total number of 117922 nurses were included. Among all risk factors, sedentary lifestyle and lack of regular physical activity with a prevalence of 46.3% (CI 95%, 26.6–67.2) was regarded as the main prevalent risk factor among nurses. The mean systolic blood pressure (SBP) measured in the study population was 121.31 (CI 95%, 114.73–127.90) and the mean diastolic blood pressure (DBP) was 78.08 (CI 95%, 74.90–81.25). Also family history of cardiovascular disease (41.9%; 95% IC: 29.8–55.1%), being overweight (33.3%; 95% IC: 24.7–43.2%), and alcohol consumption (24.6%; 95% IC: 16.4–35.2%) was found among the participants.ConclusionStudy results revealed that sedentary lifestyle was the main prevalent CVD risk factor among nurses followed by family history of cardiovascular disease, being overweight and alcohol consumption. Furthermore, among nurses with shift works almost all risk factors got higher score representing the worse condition in comparison with day workers’ nurses. This study enables learning the associated risk factors of CVD among nurses to facilitate interventional programs with a view to reduce the exposure of nursing staff particularly those who work in shifts to cardiovascular risk factors.1. What was already known?In general, many studies have emphasized the impact of the nursing profession on the incidence of some cardiovascular patients. Also, different shifts of nurses can have a double effect.2. What are the new findings?In this study, the mean for sedentary lifestyle was reported to be 46.3% which represented the most prevalent risk factor for cardiovascular risk factors among study population.3. What is their significance?This study enables learning the associated risk factors of CVD among nurses to facilitate interventional programs with a view to reduce the exposure of nursing staff particularly those who work in shifts to cardiovascular risk factors. This information can comprise essential tools for health human resource management contributing to advance nursing.

Nurses as the largest group of health workers have a very stressful job which can cause number of diseases specially increase cardiovascular risk factors. This study aims to investigate the overall epidemiology of cardiovascular disease (CVD) risk factors among nurses. We searched all four main databases such as Scopus, PubMed, Embase and Web of Sciences from the beginning of 2000 to March 2022 with appropriate Mesh Terms. We also searched Google scholar. Then we applied inclusion and exclusion criteria and after selection the studies the Newcastle-Ottawa Scale (NOS) was used to assess the methodological quality of included studies. Comprehensive Meta-analysis and R software was used for analysis. Finally, 22 articles with a total number of 117922 nurses were included. Among all risk factors, sedentary lifestyle and lack of regular physical activity with a prevalence of 46.3% (CI 95%, 26.6-67.2) was regarded as the main prevalent risk factor among nurses. The mean systolic blood pressure (SBP) measured in the study population was 121.31 (CI 95%, 114.73-127.90) and the mean diastolic blood pressure (DBP) was 78.08 (CI 95%, 74.90-81.25). Also family history of cardiovascular disease (41.9%; 95% IC: 29.8-55.1%), being overweight (33.3%; 95% IC: 24.7-43.2%), and alcohol consumption (24.6%; 95% IC: 16.4-35.2%) was found among the participants. Study results revealed that sedentary lifestyle was the main prevalent CVD risk factor among nurses followed by family history of cardiovascular disease, being overweight and alcohol consumption. Furthermore, among nurses with shift works almost all risk factors got higher score representing the worse condition in comparison with day workers' nurses. This study enables learning the associated risk factors of CVD among nurses to facilitate interventional programs with a view to reduce the exposure of nursing staff particularly those who work in shifts to cardiovascular risk factors. In general, many studies have emphasized the impact of the nursing profession on the incidence of some cardiovascular patients. Also, different shifts of nurses can have a double effect. In this study, the mean for sedentary lifestyle was reported to be 46.3% which represented the most prevalent risk factor for cardiovascular risk factors among study population. This study enables learning the associated risk factors of CVD among nurses to facilitate interventional programs with a view to reduce the exposure of nursing staff particularly those who work in shifts to cardiovascular risk factors. This information can comprise essential tools for health human resource management contributing to advance nursing.

Cardiometabolic Risk Assessment in Children and Young Adults with Hemophilia

Background: Cardiovascular (CV) risk factors tend to cluster in persons with family history of cardiovascular diseases (CVDs) with variable distribution and penetrance. Screening adult Nigerians with immutable family history of CVD for other conventional CV risk factors is an important primary care challenge that is often neglected especially in resource-constrained settings. Aim: This study was designed to determine the frequency of cardiovascular risk factors in adult Nigerians with family history of non-communicable cardiovascular disease in a primary care clinic of a tertiary hospital in a resource-constrained environment of Eastern Nigeria. Materials and Methods: A descriptive facility-based study carried out on 440 consecutive adult Nigerians with family history of at least one of the major non-communicable CVDs in Nigeria who were screened for CV risk factors. Basic demographic variables, cardio-metabolic and behavioural risk factors were obtained using a pretested, structured and researcher-administered questionnaire. The conventional CV risk factors studied were hypertension, obesity, diabetes mellitus, physical activity, alcohol and tobacco use. Family history of CVD refers to previous information on any major CVDs such as hypertension, heart failure, myocardial infarction and stroke in any of the first, second and third degree generation family members who were dead or alive made by a health professional. Results: The three most frequent cardiovascular risk factors were physical inactivity (81.6%), asymptomatic hypertension (26.4%) and obesity (18.9%). Others included alcohol use (17.5%), diabetes mellitus (7.7%) and tobacco use (5.7%). Conclusion: This study has shown that CV risk factors exist among the study population with three most common being physical inactivity, asymptomatic hypertension and obesity. Screening adult Nigerians with family history of CVD for cardio-metabolic and behavioural CV risk factors should form baseline evaluation for these patients during clinical encounter in primary care.

This study aimed to examine how the muscularity of the abdomen at the umbilicus level differs between sedentary middle-aged and young men. Magnetic resonance imaging was applied to determine the cross-sectional areas of skeletal muscle, subcutaneous fat, and interperitoneal tissue in 43 middle-aged (40 58yrs) and 38 young (21-29 yrs) men. The cross-sectional area of the skeletal muscle was analyzed as the sum of those of the rectus abdominis, abdominal oblique, lower back, and iliopsoas skeletal muscle groups. The middle-aged men showed greater waist circumference and whole abdominal cross-sectional area than the young men. In addition, the cross-sectional areas of subcutaneous fat and interperitoneal tissue were greater in the middle-aged men than in the young men. However, the total cross-sectional area of the skeletal muscle was similar between the two groups, although its percentage to the whole abdominal cross-sectional area was higher in the young men compared to the middle-aged men. Among the four skeletal muscle groups analyzed, the percentage of the cross-sectional areas in abdominal oblique muscles to that of total skeletal muscle was higher in the middle-aged men than in the young men and that of the lower back muscles was the reverse. These results were similar even when cross-sectional area data were analyzed using a subsample (33 middle-aged and 23 young men) matched for body height and mass. Thus, the present study indicated that the total muscularity of the abdomen at the umbilicus level was similar between the middle-aged and young men, but the relative distributions of lower back and abdominal oblique muscles varied between the two generations.

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