Šileikienė, Lolita

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).

Galvos smegenų insultas (GSI) išlieka viena iš dažniausių mirties ir negalios priežasčių pasaulyje [1]. Patikimi duomenys apie insulto sergamumo ir mirtingumo tendencijas yra svarbūs kuriant veiksmingas prevencijos strategijas ir paskirstant sveikatos priežiūros išteklius [2]. Šio populiacinio tyrimo tikslai buvo nustatyti 24 metų laikotarpio GSI sergamumo, mirštamumo ir mirtingumo tendencijas tarp darbingo amžiaus (25–64 metų) Kauno miesto gyventojų 2000–2023 metais ir įvertinti COVID-19 pandemijos įtaką. [...].

Įvadas Pasaulio sveikatos organizacijos (PSO) duomenimis, lėtinės ligos sudarė 74 proc. visų mirties priežasčių [1]. Širdies ir kraujagyslių ligos (ŠKL) yra viena iš pagrindinių lėtinių ligų nuo kurių miršta pasaulio gyventojai dėl spartaus gyventojų senėjimo, sveikatos bei socialinių-ekonominių problemų [2, 3]. Europos regione ŠKL taip pat išlieka pirmaujančia mirčių priežastimi tiek vyrų, tiek moterų grupėse ir bendrai siekia beveik 4,1 mln. (Europos Sąjungoje (ES) - 1,7 mln.) mirties atvejų per metus arba beveik trečdalį visų mirčių [4]. ŠKL kasmet ES kainuoja 282 mlrd. Eur, iš kurių 27 proc. (77 mlrd. Eur) sudarė išeminės širdies ligos (IŠL) gydymo išlaidos [5]. PSO duomenimis IŠL sudarė didžiąją dalį visų mirčių pasaulyje [6]. PSO duomenų analizė parodė, kad Jungtinėje Karalystėje, JAV, Brazilijoje, Kazachstane ir Ukrainoje IŠL buvo dažniausia mirties priežastis, o mirtingumas nuo IŠL pastarųjų trijų dešimtmečių eigoje palaipsniui mažėjo [7]. Kai kuriose šalyse, ypač Rytų Europoje, standartizuotas pagal amžių mirtingumas nuo IŠL buvo daug didesnis nei Vakarų ar Šiaurės Europos šalyse [8]. Šie skirtumai siejami su skirtingu šalių išsivystymo lygiu ir ŠKL rizikos veiksnių didesniu paplitimu bei jų valdymu mažiau išsivysčiusiose šalyse. Lietuvoje mirtys nuo ŠKL 2024 metais tarp visų mirties priežasčių sudarė pusę visų mirties atvejų (44,6 proc. vyrų ir 56,8 proc. moterų) [9]. Lietuvoje mirtingumas nuo IŠL vis dar vienas aukščiausių Europoje [10]. Pagrindinė mirties priežastis Lietuvoje 2021 metais buvo IŠL, kuri lėmė beveik trečdalį visų mirties atvejų [10]. [...].

Background and Aims Reliable data on stroke trends are critical for guiding public health interventions. The present study aimed to evaluate long-term trends in morbidity, mortality, and case-fatality rates of stroke among 25–64-year-old residents of Kaunas city, Lithuania, during 2000–2023, with attention to potential impacts of the COVID-19 pandemic.

Methods Stroke events among Kaunas residents aged 25-64 years from 2000 to 2023 were identified and validated according to standardized criteria. Joinpoint regression analysis was applied to estimate time-trends in age-standardized stroke morbidity, mortality, and case-fatality rates, calculating annual percentage changes (APC) with 95% confidence intervals.

Results During the study period, the overall morbidity rate decreased significantly in both males and females. In males, overall morbidity declined (APC = –1.66%; p < 0.05), with a sharper decrease from 2010–2023 (APC = –3.7%; p < 0.05). Mortality declined significantly after 2021 (APC = –30.7%; p < 0.05). Among females, morbidity declined over time (APC = –3.7%; p < 0.05), with fluctuations. Mortality dropped overall (APC = –2.3%; p < 0.05). Case-fatality increased during 2010-2021 in men (APC +8.8%, p<0.05) and 2011-2020 in women (APC +14.6%, p<0.05), before decreasing noticeably after 2020-2021 in both sexes (–35.1% in men and –26.1% in women, both p < 0.05).

Conclusions While long-term trends show declining morbidity and mortality, the transient rise in case-fatality—particularly from 2010 to 2020—may reflect health system strain and care disruptions during the COVID-19 pandemic. The incidence and mortality from stroke were lower during the COVID-19 pandemic.

Ši mokomoji knyga yra skiriama Lietuvos sveikatos mokslų universiteto studentams, kurie studijuoja fundamentinę epidemiologiją. Leidinyje pateiktos užduotys ir klausimai turėtų padėti besimokantiems geriau suvokti pagrindines fundamentinės epidemiologijos sąvokas ir koncepcijas bei žinoti jų pritaikymą praktikoje. Tikimės, kad ši mokomoji knyga padės sudominti studentus epidemiologijos teorija bei praktika ir leis plačiau suprasti populiacinių tyrimų svarbą medicinos ir visuomenės sveikatos mokslų srityse.

Background High systolic blood pressure (BP) and being overweight or obese highly contribute to the risk of developing ischemic heart disease (IHD) and stroke, both of which have been among the main causes of death in Lithuania since 2000. This study aimed to evaluate the prevalence of arterial hypertension (AH) and obesity and to determine their trends among middle-aged (45-64 years) urban citizens of Kaunas over the last 20 years. Methods During the observational cross-sectional study two population-based cohorts 2001-2002 (n=978) and 2023 (n=1951) of Kaunas males and females aged 45-64 years were analysed. We defined AH as having systolic blood pressure of 140 mm Hg or greater, diastolic blood pressure of 90 mm Hg or greater, or taking medication for hypertension over two weeks; we defined obesity as having a body mass index (BMI) of 30 kg/m2 or greater. The prevalence of AH and obesity changes were evaluated using ztest analysis. Results From 2001 to 2023 the prevalence of AH among males aged 45-64 significantly increased from 59.8% in 2001-2003 to 74.9% in 2023 (p<0.001), while among females aged 45-64, the prevalence of AH tended to decrease from 53.0% in 2001-2002 to 50.8% in 2023 (p=0.09). Over the years of the study, male obesity tended to increase from 28.0% in 2001-2002 to 32.6% in 2023, p=0.05), while the prevalence of obesity among females decreased significantly (46.3% in 2001-2002, 28.6% in 2023, p<0.001). Conclusions In the study years of 2001-2023, among Lithuanian middle-aged urban inhabitants, the prevalence of AH and obesity significantly increased in males, while in females the prevalence of AH tended to be stable, and the prevalence of obesity decreased significantly.

Įvadas Širdies ir kraujagyslių ligos (ŠKL) yra viena iš pagrindinių Europos, kurios valstybių gyventojai sparčiai sensta, sveikatos bei socialinių-ekonominių problemų [WHO CVD Risk Chart Working Group 2019]. Kraujotakos sistemos ligos Lietuvoje kaip ir visoje Europoje išlieka pirmaujančia mirčių priežastimi tiek vyrų, tiek moterų grupėse ir bendrai siekia beveik 4,1 mln. (ES - 1,9 mln.) mirties atvejų per metus arba beveik pusę visų mirčių. Kraujotakos sistemos ligos kasmet Europos Sąjungai kainuoja 282 mlrd. Eur, iš kurių 27 proc. (77 mlrd. Eur) sudarė išeminės širdies ligos (IŠL) gydymo išlaidos [Luengo-Fernandez R, et al. 2023]. Higienos instituto Sveikatos informacijos centro duomenimis 2023 metais mirtys nuo kraujotakos sistemos ligų tarp visų mirties priežasčių Lietuvoje sudarė pusę mirčių (45,6 proc. vyrų ir 54,4 proc. moterų) [HI, 2024]. Pasaulio sveikatos organizacijos (PSO) duomenimis 2021 metais lėtinės ligos sudarė 75 proc. visų mirties priežasčių; IŠL sudarė didžiąją dalį visų mirčių pasaulyje – 16 proc. [WHO, 2022]. PSO duomenų analizė parodė, kad JK, JAV, Brazilijoje, Kazachstane ir Ukrainoje IŠL buvo dažniausia mirties priežastis, o mirtingumas nuo IŠL dešimtmečio eigoje palaipsniui mažėjo. Kai kuriose šalyse, ypač Rytų Europoje, standartizuotas pagal amžių mirtingumas nuo IŠL buvo daug didesnis nei JAV, Brazilijoje ar JK [Nowbar AN, et al., 2019]. Šie skirtumai siejami su skirtingu šalių išsivystymo lygiu ir ŠKL rizikos veiksnių didesniu paplitimu mažiau išsivysčiusiose šalyse. Lietuvoje mirtingumas nuo IŠL vis dar vienas aukščiausių Europoje [Moran AE, 2014, Tamošiūnas A, 2019]. Pagrindinė mirties priežastis Lietuvoje 2021 metais buvo IŠL, kuri lėmė beveik trečdalį visų mirties atvejų [OECD/European Observatory on Health Systems and Policies, 2023]. Didesnis mirtingumas nuo IŠL priklauso ir nuo suteiktos medicininės pagalbos apimties, diagnostikos galimybių, pagalbos suteikimo laiku bei gydymo galimybių ištiktiems ūminio miokardo infarkto (ŪMI) asmenims. Per pastaruosius du dešimtmečius medicininės pagalbos kokybiniai rodikliai asmenims, susirgusiems IŠL, gerėjo, bet šie rodikliai dar išliko gana skirtingi tarp atskirų šalių, lyčių ir amžiaus grupių [Aminorroaya A, et al., 2022]. Darbo tikslas buvo įvertinti medicinos pagalbos suteikimą laiku ir gydymo ypatumus susirgusiems ŪMI asmenims, remiantis Kauno IŠL registro duomenimis. [...].

Introduction. Ischemic stroke (IS) is a critical health issue, affecting individuals of all ages, sexes, and backgrounds. Mounting evidence suggests that sex indeed could play some distinct role in shaping the incidence, outcomes, and treatment of IS. In the context of the COVID-19 pandemic, contradictory findings from previous studies that also addressed sex differences in cerebrovascular diseases demonstrate the need for further focused research. This study aimed to evaluate the sex discrepancies in the clinical presentation of IS and its outcomes in patients admitted to Kaunas Hospital of the Lithuanian University of Health Sciences (LUHS), Lithuania. Methods. This is a retrospective record-based single-center study. All the study patients—727 men and 1082 women—enrolled between January 1, 2020, and February 27, 2022; suffered from acute IS; and had absolute contraindications against interventional IS treatment. These patients received a conservative non-interventional IS treatment at the neurological department of the LUHS’s Kaunas Hospital. The sociodemographic data; laboratory findings; comorbidities, including COVID-19; in-hospital complications; and outcome factors were obtained from the patients’ medical records and evaluated by deploying appropriate statistical tests. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated by the Cox proportional hazards regression for in-hospital lethality. Results. The mean age of IS patients was significantly higher in women compared to men (p < 0.001), as was the proportion of in-hospital deaths (19.10% and 15.36%, respectively; p < 0.05). The mean total number of in-hospital complications was again significantly higher in the group of women compared to men (p < 0.05). The prevalence of COVID-19 was higher in men compared to women (p < 0.05). COVID-19 diagnosis (HR = 1.53; p = 0.02) and acute in-hospital pulmonary complications (HR = 1.91; p = 0.008) significantly increased the risk of in-hospital lethality in men. The risk of in-hospital lethality was significantly higher in women with comorbid diabetes mellitus type 2 (DM) compared to those with comorbid isolated arterial hypertension (AH) (HR = 2.25, p = 0.007). Increased C-reactive protein elevated the risk of in-hospital lethality by more than twice in both men and women (HR = 2.46; p < 0.001 and HR = 2.28; p < 0.001, respectively). Conclusions. The following differences between men and women with IS were determined: Acute in-hospital pulmonary complications, including COVID-19, significantly increased the risk of in-hospital lethality in the male group, but not in women. However, women suffering from DM had a significantly increased risk of in-hospital lethality compared with those women IS patients with AH or chronic ischemic heart disease (IHD). Increased C-reactive protein was associated with an elevated risk of in-hospital lethality both in male and female groups.

Background and Aims: The study aimed to evaluate the prevalence of IHD in the Lithuanian (Kaunas) urban population during the past 40 years. Methods: The prevalence of IHD has been evaluated in repeated cross-sectional studies of Kaunas population aged 45-64 years. Six study databases were included: 1982-1983 (n=1660), 1986-1987 (n=1152), 1992-1993 (n=824), 2001-2002 (n=978), 2006-2008 (n=4604) and 2023 (n=554). The prevalence of IHD was evaluated individually, applying Minnesota codes for the diagnosis of Myocardial infarction (MI) (1-1, 1-2) and/or ischemic changes on electrocardiogram (IC ECG) (1-3, 4-1, 4-2, 4-3, 5-1, 5-2, 5-3, 6-1, 6-2, 7-1, 8-3), and using Rose questionnaire for the diagnosis of angina pectoris (AP). The highest priority was given to previous MI and the lowest to IC ECG. The prevalence of IHD changes was evaluated using regression analysis and for comparison of prevalences among sexes, the Z-test criterion was used. Results: During the past 40 years, the prevalence of MI and IC ECG decreased significantly in females, while in men changes in the prevalence of MI and IHD forms were without significant changes. During the first study point and the last two study points, the prevalence of MI in males (3.2%, 5.9%, and 4.2% respectively) was significantly higher compared to females (1.2%, 2.3%, and 1.4% respectively), while females had significantly more frequent AP (6.3%, 6.3%, and 7.3% respectively) compared to males (3.9%, 2.4%, and 1.5% respectively). The prevalence of MI and IC ECG tended to increase in men, but the prevalence of AP and IHD tended to decrease in women. Conclusions: In 1982-1983, 2006-2008, and 2023, the prevalence of MI was significantly higher in males, but the prevalence of AP was significantly higher in females. The prevalence of all IHD forms was without significant changes in males, while the prevalence of IC ECG has significantly decreased in females.

Background and Aims: The study aimed to evaluate the prevalence of IHD in the Lithuanian (Kaunas) urban population during the past 40 years. Methods: The prevalence of IHD has been evaluated in repeated cross-sectional studies of Kaunas population aged 45-64 years. Six study databases were included: 1982-1983 (n=1660), 1986-1987 (n=1152), 1992-1993 (n=824), 2001-2002 (n=978), 2006-2008 (n=4604) and 2023 (n=554). The prevalence of IHD was evaluated individually, applying Minnesota codes for the diagnosis of Myocardial infarction (MI) (1-1, 1-2) and/or ischemic changes on electrocardiogram (IC ECG) (1-3, 4-1, 4-2, 4-3, 5-1, 5-2, 5-3, 6-1, 6-2, 7-1, 8-3), and using Rose questionnaire for the diagnosis of angina pectoris (AP). The highest priority was given to previous MI and the lowest to IC ECG. The prevalence of IHD changes was evaluated using regression analysis and for comparison of prevalences among sexes, the Z-test criterion was used. Results: During the past 40 years, the prevalence of MI and IC ECG decreased significantly in females, while in men changes in the prevalence of MI and IHD forms were without significant changes. During the first study point and the last two study points, the prevalence of MI in males (3.2%, 5.9%, and 4.2% respectively) was significantly higher compared to females (1.2%, 2.3%, and 1.4% respectively), while females had significantly more frequent AP (6.3%, 6.3%, and 7.3% respectively) compared to males (3.9%, 2.4%, and 1.5% respectively). The prevalence of MI and IC ECG tended to increase in men, but the prevalence of AP and IHD tended to decrease in women. Conclusions: In 1982-1983, 2006-2008, and 2023, the prevalence of MI was significantly higher in males, but the prevalence of AP was significantly higher in females. The prevalence of all IHD forms was without significant changes in males, while the prevalence of IC ECG has significantly decreased in females.