Tamošiūnas, Abdonas

Background/Objectives: Epidemiological studies over the first decades of the 21st century have reported a decrease in cardiovascular disease (CVD) morbidity and mortality. Changes in coronary care for acute myocardial infarction (AMI) over these years, including the COVID-19 pandemic period, have been less studied in Eastern and Central Europe. The study aimed to assess changes in coronary care—the time of medical assistance and treatment—for AMI patients over 2000–2023 in urban Kaunas residents aged 25–64. Methods: The data source was study cases from the Kaunas Ischemic Heart Disease Registry (Registry)—Kaunas city residents aged 25–64 years included in the Registry according to MONICA project protocol evaluation methodologies. Data were analyzed by sex and age group (25–54 and 55–64 years). Descriptive statistics (chi-square and z-score values) were used to evaluate the data; the significance level was p < 0.05. A logistic regression analysis was performed to assess the odds ratios of death within 28 days across six time periods. Results: The proportion of AMI patients hospitalized up to 2 h from the onset of pain accounted for about one-fifth of all hospitalized patients in 2000–2016, while in 2017–2023, it significantly decreased. In 2017–2023, compared with 2000–2004 and 2009–2016, significantly fewer men who developed AMI were hospitalized within the first 2 h of emergency presentation (p < 0.05). Over the whole study period, fewer women with AMI were hospitalized within the first 2 h of pain as compared to men (p < 0.05). There were no significant differences in time from pain onset to hospitalization between the age groups. At the same time, from 2009 to 2012, more young AMI patients were hospitalized within the first 2 h (p < 0.05). Percutaneous coronary angioplasty (PTCA) with stenting (PCI) increased 30 times from 2000–2004 to 2020–2023. PCI has been the most available treatment for men with AMI since 2009 and stayed stable from 2013 (66.0%) until 2023 (72.1%). Women with AMI tended to get less PCI, PTCA, and coronary artery bypass grafting (CABG) than men. The pre-pandemic and COVID-19 periods did not differ in the proportions of reperfusion treatment methods used in both men and women. Thrombolysis was very rare, and since 2017, it has not been used in Kaunas because PCI has become more accessible. PCI (2000–2016) and CABG (2009–2016) were more prevalent among the 25–54-year-old AMI patients (p < 0.05). From 2017 to 2023, there were no differences between age groups in the reperfusion procedures used, nor were there differences in treatment between these groups during the pre-pandemic (2017–2019) and peri-COVID-19 pandemic (2020–2023) periods. Conclusions: In Kaunas, the treatment of patients with AMI has improved significantly over the past 20 years. The use of PCI has increased greatly, and the rate of CABG surgery stayed stable, while only every fifth patient has been admitted to the hospital in a timely manner. Men were more likely to receive PCI, and older patients were more likely to undergo CABG. Compared to the period of 2000–2004, the chance of dying within 28 days after AMI was significantly lower in 2017.

Lėtinės neinfekcinės ligos šiais laikais kelia vieną didžiausių iššūkių tiek visuomenės sveikatai, tiek sveikatos priežiūros sistemų tvarumui. Jų paplitimas, sudėtinga etiologija ir ilgalaikės pasekmės paciento gyvenimo kokybei lemia būtinybę nuosekliai tobulinti šių ligų valdymą, ypač pirminės sveikatos priežiūros grandyje. Šiame leidinyje sistemiškai nagrinėjami pagrindiniai lėtinių ligų valdymo aspektai, apimantys epidemiologiją, patogenezę, klinikinę praktiką, sveikatos priežiūros organizavimą ir pacientų priežiūros tęstinumą. Analizuojamos tiek konkrečių ligų bei jų rizikos veiksnių problemos, tiek kompleksinės situacijos, susijusios su dauginėmis lėtinėmis ligomis, pacientų patirties valdymu, gyvensenos medicina, psichikos sveikata bei ilgalaike priežiūra. Akcentuojama integruotos, į pacientą orientuotos priežiūros svarba, tarpdisciplininio bendradarbiavimo reikšmė bei įvairių sveikatos priežiūros specialistų indėlis į visapusišką paciento gerovę. Šio vadovėlio turinys atspindi šiuolaikinės medicinos kryptį - pereiti nuo siauro, į ligą orientuoto požiūrio prie holistinio, žmogų vertinančio kaip visumą. Todėl ypatingas dėmesys skiriamas ne tik gydymui, bet ir prevencijai, sveikatos stiprinimui, paciento lūkesčių valdymui bei efektyviai komunikacijai tarp paciento ir sveikatos priežiūros specialistų. Šis universitetinis vadovėlis skiriamas medicinos, slaugos ir kitų sveikatos mokslų studentams, rezidentams bei praktikuojantiems pirminės sveikatos priežiūros specialistams. Manau, kad jis taps svarbiu studijų ir profesinės veiklos šaltiniu, padedančiu gilinti teorines žinias ir taikyti jas praktiškai, gerinant lėtinėmis ligomis sergančių pacientų priežiūros kokybę. [...]

Global reporting of obesity is commonly based on comparisons over multiple decades1 and lacks a granular and systematic analysis of its dynamics. We used 4,050 population-based studies with measured height and weight data on 232 million participants to assess the worldwide dynamics of obesity from 1980 to 2024. The rise in obesity decelerated in school-aged children and adolescents throughout the 1990s in many high-income countries, and subsequently plateaued in most at age-standardized prevalences spanning 20 percentage points, from 3-4% for girls in Japan, Denmark and France to 23% for boys in the USA. There were indications of a small decline in obesity in children and adolescents in some high-income western countries (for example, Italy, Portugal and France) since the 2000s. Similar trends were seen in some countries in Central and Eastern Europe. In adults, the rise in obesity slowed down in high-income western countries about a decade after children, followed by a plateau or possibly a small reversal of the rise in some countries (for example, Spain). In most low-income and middle-income countries, the annual absolute change in prevalence has remained stable or increased over time, even though prevalence has surpassed that of high-income countries. These highly varied dynamics suggest that the social, economic and technological trends that influence the availability, affordability and use of different foods may have helped control the rise in obesity in high-income countries, but require policy interventions in low-income and middle-income countries.

Background and Objectives. Over the past two decades, 28-day acute myocardial infarction (AMI) case-fatality rates have declined globally due to improved treatment and secondary prevention. This study aimed to evaluate AMI case-fatality levels and trends in the Kaunas population aged 25–64 from 2000 to 2023. Materials and Methods. Data were obtained from the population-based Kaunas Ischemic Heart Disease Registry, operating under the WHO MONICA standards. The study included adults with AMI or coronary heart disease death registered within 28 days from the onset of AMI. Case-fatality was defined as the proportion of AMI deaths among all AMI cases. Trends were assessed using JoinPoint regression. Results. From 2000 to 2023, 28-day AMI case-fatality in males showed no significant change, while in females it increased by 2.5% per year (p = 0.002). In-hospital AMI case-fatality remained stable in both sexes. Males had higher average AMI case-fatality rates than females in both age groups (25–54 and 55–64). Only females aged 55–64 showed a significant rise in AMI case-fatality (3.0%/year, p = 0.002). A trend change point was identified in 2006 for males (no significant trend) and in 2010 for females, after which the AMI case-fatality rates increased. Among males, in-hospital AMI case-fatality decreased significantly from 2015 to 2023 (14.7%/year). Conclusions. Over the two decades, 28-day AMI case-fatality among 25–64-year-old-persons remained unchanged in males but increased in females. In-hospital AMI case-fatality showed no major change in either sex. Males consistently had higher AMI case-fatality rates with age. While aging did not affect AMI case-fatality trends in males, rates rose significantly among older females.

Background/Objectives: There is growing interest among researchers in improved biological risk factor indices or combinations of indices, which have emerged as a major focus in evaluating the risk of cardiovascular disease (CVD). This study aimed to identify latent profiles based on the clustering of biological factors and to explore associations between lifestyle factors and CVD outcomes across the identified latent profiles. Methods: This epidemiological health survey was performed during 2023–2024. A random sample of Kaunas inhabitants aged 25–69 years, stratified by sex and age, was randomly selected from the Lithuanian population register. The 3426 individuals were screened. Latent profile analysis was performed using Latent Gold 6.1 and IBM SPSS Statistics 30. Multinomial logistic regression and multivariable binary logistic regression were used to evaluate the associations between biological risk factor profiles, lifestyle factors, and CVD outcome. Results: Three biological risk factor profiles were identified: low-risk profile (42.6%) was considered the healthiest, having the lowest levels of body mass index (BMI), fasting glucose, systolic blood pressure (SBP), and the highest level of high-density lipoprotein (HDL) cholesterol. Medium-risk profile (50.4%), having intermediate indicators of those factors. The high-risk profile (7.0%) was characterized by the lowest HDL cholesterol and the highest values of triglycerides, fasting glucose, SBP, and BMI. Conclusions: Compared to the low-risk profile, medium- and high-risk biological profiles were independently associated with higher odds of CVD, according to sociodemographic and lifestyle factors. The study suggests that integrating multiple biological risk factors rather than a single risk factor in clinical practice may enhance diagnostic accuracy.

Background and Objectives: Stroke remains a major contributor to global morbidity and mortality, with substantial geographic variation in incidence and outcomes. Although declining trends in stroke incidence and mortality have been documented in several Western European populations, countries in Eastern Europe have historically experienced a disproportionately high cardiovascular disease burden. Comprehensive long-term evaluations assessing simultaneous trends in stroke attack rates, mortality, and case-fatality in Lithuania are limited. This study aimed to investigate 24-year trends (2000–2023) in stroke epidemiology among working-age residents of Kaunas city. Materials and Methods: Data were derived from the Kaunas population-based stroke registry and included individuals aged 25–64 years. Age-standardized attack rates, mortality rates, and case-fatality rates per 100,000 population were calculated using the World Health Organization standard population. Temporal trends were assessed using Joinpoint regression analysis to estimate annual percentage changes (APCs) with corresponding 95% confidence intervals (CIs). Analyses were stratified by sex, age group (25–54 and 55–64 years), and stroke subtype (ischemic and hemorrhagic). Results: During 2000–2023, overall stroke attack rates declined significantly in both sexes, with a more pronounced reduction observed among females. Stroke mortality decreased significantly among females over the entire study period, whereas no significant overall change was observed among males, largely due to increases during 2010–2021 that attenuated earlier and subsequent improvements. Case-fatality rates demonstrated no significant overall long-term trend in either sex but exhibited marked temporal variability, including significant increases during 2010–2021 followed by substantial declines after 2021. Age-stratified analyses confirmed significant reductions in attack rates across both age groups. Ischemic stroke incidence declined significantly in both sexes, while hemorrhagic stroke mortality decreased significantly among males and females. The period 2021–2023 was characterized by pronounced reductions in mortality and case-fatality across multiple subgroups. Conclusions: Over the past two decades, the stroke burden among working-age residents of Kaunas has declined substantially, particularly among females. Despite period-specific deteriorations, recent improvements underscore the impact of advances in stroke prevention and acute care. Sustained risk factor control and continued healthcare system development remain essential to maintain favourable trends.

Background and Objectives: Depression has emerged in recent years as a significant global health issue, drawing considerable research interest and attention. The development of depression could be impacted by a range of environmental factors. Aim: To investigate the relationship between depressive symptoms and various indoor environmental factors, such as microclimate, odors, mold, and room ventilation, in association with some sociodemographic and lifestyle factors. Materials and Methods: This epidemiological health survey of the study “Chronic diseases and their risk factors in the adult population” was performed during 2023–2024 in Kaunas city (Lithuania) following the methodology of the WHO MONICA study. A random sample of Kaunas inhabitants aged 25–69 years, stratified by sex and age, was randomly selected from the Lithuanian population register. The 3426 individuals were screened. The associations of various indoor environmental factors with depressive symptoms were investigated using binary logistic regression analysis. Results: Depressive symptoms were associated with sociodemographic, lifestyle, and indoor environmental factors. Poor microclimate conditions, unpleasant household odors, mold exposure, and insufficient room ventilation were associated with increased odds of depressive symptoms. The significance of these associations varied across sex, age, marital status, socioeconomic status, and physical activity of responders. Additional multivariable logistic regression analyses, including interaction terms between each indoor environmental factor and the stratification variables (sex, age groups, marital status, family economic situation, and physical activity), were performed. Significant interaction was found only between family status and room ventilation (p = 0.007). This indicates that the association between ventilation and depressive symptoms differed by family status. Conclusions: This study contributes to the cross-disciplinary understanding of the role of indoor environmental quality, sociodemographic, and lifestyle factors in the development of depression, adding to the evidence on the role of other factors in depression inequalities.

Current European Cardiovascular Disease (CVD) prevention guidelines recommend 10-year risk assessment using the SCORE2 model to identify individuals eligible for preventive treatment. Risk can be estimated using conventional risk charts or online calculators, though these methods may differ in precision and treatment classification.

Background/Objectives: The Lancet Commission proposes a new obesity definition that combines body mass index (BMI) with anthropometric measurements to distinguish adipose tissue excess more effectively. This study aims to determine the prevalence of obesity based on the new definition and to examine cardiometabolic risk factors and lifestyle habits across different obesity phenotypes in the urban population of Lithuania. Methods: This study was conducted among residents of Kaunas city from 2020 to 2024. A total of 3426 adults aged 25–69 years (57.1% of the random sample) were participated. Three individuals were excluded due to missing anthropometric data. Participants were categorized into three phenotypes: (1) no obesity (BMI < 30 kg/m2 and no or one elevated anthropometric measure, (2) anthropometric-only obesity (BMI < 30 kg/m2 and at least 2 elevated anthropometric measures), and (3) BMI-plus-anthropometric obesity (BMI ≥ 30 kg/m2 plus at least one elevated anthropometric measure or BMI ≥ 40 kg/m2). Standardized anthropometric, biochemical, and clinical measurements were collected, along with self-reported dietary habits and leisure-time physical activity. Results: Anthropometric-only obesity was highly prevalent, affecting 36.1% of males and 22.7% of females (p < 0.05). The prevalence of BMI-plus-anthropometric obesity was 24.1% among males and 21.4% among females. Individuals with anthropometric-only obesity had significantly higher odds of metabolic syndrome (OR 8.64; 95% CI 6.97–10.71), diabetes (OR 3.01; 95% CI 1.72–5.25), coronary heart disease (OR 1.48; 95% CI 1.12–1.97), and several lipid abnormalities compared with those without obesity. The highest cardiometabolic risk was observed in the BMI-plus-anthropometric obesity group. Greater adiposity was associated with higher intake of red meat, junk foods, and sugary drinks, while physical activity levels declined across obesity categories. Conclusions: Anthropometric-only obesity is a common and metabolically adverse phenotype that cannot be detected using BMI alone. A new obesity definition enhances identification of high-risk individuals and supports targeted prevention strategies.

Lifestyle factors - such as dietary habits, physical activity, smoking, and sleep quality - are modifiable determinants that not only directly affect cardiovascular risk but also shape an individual’s self-rated health and mental wellbeing. However, the interrelationships among these domains remain inadequately understood. The aim of this study is a comprehensive assessment of complex factors - self-rated health, mental wellbeing, and lifestyle factors and their association with morbidity of ischemic heart disease (IHD).