Paweł Nadrowski

Several reports have shown that more plant-based dietary patterns provide a higher intake of antioxidants compared to diets rich in meat and animal products. Data on the intake of key nutrients in cardiovascular disease (CVD) prevention in relation to particular diets in countries of Central and Eastern Europe are scarce. The aim of this study was to assess quality of nutrition and CVD characteristics in a representative sample of Polish adults following different dietary patterns. Special regard was paid to the intake of natural antioxidants. The study comprised 13,318 (7159 females) randomly selected adults aged ≥ 20 years participating in the National Multicentre Health Surveys WOBASZ and WOBASZ II. The subjects were categorized into groups of omnivores (92.4%), flexitarians (7.4%) and vegetarians (0.16%) according to type of diet using the Food Frequency Questionnaire and 24 h dietary recall. The obtained results showed that neither flexitarians nor vegetarians represented better dietary habits or lifestyle behaviors compared to omnivores. Flexitarians had significantly lower daily energy intake than omnivores, but their diet was rich in total fat (above 30% of daily energy consumption) and low in fiber. Omnivores declared a higher consumption of fresh vegetables (p < 0.001), fresh fruit (p < 0.01), coffee (p < 0.01) and tea (p < 0.05, in women only) than flexitarians. Omnivores had significantly higher intake of natural antioxidants (vitamin C, E, zinc in both genders and vitamin A in men) as compared with flexitarians. Among women, the highest adherence to the intake of recommended amounts of antioxidant nutrients was noted among omnivores. Among men, vegetarians had the highest proportion of meeting the guidelines for vitamin A (77.8%), E (66.7%) and C (66.7%), while the lowest proportions were found in flexitarians (69.9%, 39.5% and 32.4%, respectively). The groups did not differ in terms of smoking and physical activity level. There were no significant differences in the analyzed CVD characteristics between omnivores and flexitarians. In women, vegetarians had substantially lower BMI than omnivores (p < 0.05) and flexitarians (p < 0.05) and a lower mean serum glucose compared with omnivores (p < 0.01) and flexitarians (p < 0.05). Vegetarians had lower prevalence of hypertension and obesity than meat eaters. In conclusion, the results of the current research showed an inappropriate intake of several nutrients, including highly potent antioxidants, irrespective of the dietary regimen. Flexitarians did not have a more favorable CVD profile than omnivores. Taking into account the growing popularity of diets with reduced animal products, there is a need to elaborate strategies providing Polish adults with guidance regarding properly balanced nutrition.

Background: Socioeconomic status (SES) is an important factor of cardiovascular diseases (CVD) development. A decline in death from CVD among subjects with high SES is observed in developed countries. The aim of this study was to assess differences in cardiovascular risk between socioeconomic classes in Poland, a country currently in transition. Methods: A sample of 15200 people was drawn. A three stage selection was performed. Eventually, 6170 patients were examined (2013/2014). Data was collected using a questionnaire in face-to-face interviews, anthropometric data and blood tests were also obtained. Education was categorized as incomplete secondary, secondary and higher than secondary school. Monthly income per person was categorized as low (≤ 1000 PLN), medium (1001–2000 PLN) and high (≥ 2001 PLN). Education and income groups were analyzed by prevalence of CVD risk factors and high CVD risk (SCORE ≥ 5%). Results: Higher education was associated with lower prevalence of all analyzed CVD risk factors (p < 0.001), having the highest income with lower prevalence of hypertension, currently smoking, obesity and lower HDL-cholesterol. Multivariable analysis showed that frequency of high CVD risk decreased with increasing education level (OR 0.61; 95% CI 0.49–0.76; p < 0.01), a similar favorable impact of higher income on high CVD risk was demonstrated in the whole group (OR 0.81; 95% CI 0.67–0.99; p = 0.04). Conclusions: SES is an independent predictor of high cardiovascular (CV) risk of death. A favorable impact on the prevalence of high CV risk was demonstrated for education and partly for income in the whole group. It may reflect a transition being undergone in Poland, moreover, it predicts how socioeconomic factors may generate health inequalities in other transitioning countries. Background: Socioeconomic status (SES) is an important factor of cardiovascular diseases (CVD) development. A decline in death from CVD among subjects with high SES is observed in developed countries. The aim of this study was to assess differences in cardiovascular risk between socioeconomic classes in Poland, a country currently in transition. Methods: A sample of 15200 people was drawn. A three stage selection was performed. Eventually, 6170 patients were examined (2013/2014). Data was collected using a questionnaire in face-to-face interviews, anthropometric data and blood tests were also obtained. Education was categorized as incomplete secondary, secondary and higher than secondary school. Monthly income per person was categorized as low (≤ 1000 PLN), medium (1001–2000 PLN) and high (≥ 2001 PLN). Education and income groups were analyzed by prevalence of CVD risk factors and high CVD risk (SCORE ≥ 5%). Results: Higher education was associated with lower prevalence of all analyzed CVD risk factors (p < 0.001), having the highest income with lower prevalence of hypertension, currently smoking, obesity and lower HDL-cholesterol. Multivariable analysis showed that frequency of high CVD risk decreased with increasing education level (OR 0.61; 95% CI 0.49–0.76; p < 0.01), a similar favorable impact of higher income on high CVD risk was demonstrated in the whole group (OR 0.81; 95% CI 0.67–0.99; p = 0.04). Conclusions: SES is an independent predictor of high cardiovascular (CV) risk of death. A favorable impact on the prevalence of high CV risk was demonstrated for education and partly for income in the whole group. It may reflect a transition being undergone in Poland, moreover, it predicts how socioeconomic factors may generate health inequalities in other transitioning countries.

Background: The aim of this study was to assess changes in the prevalence, awareness and treatment of hypertension and its effectiveness between 2007 (WOBASZ Senior study) and 2013–2014 (WOBASZ II) in a sample of the Polish population over the age of 75 years. Methods: Sampling had three stages, stratified according to voivodeships, type of community, and gender. Finally, the WOBASZ II study included 467 persons (290 women and 177 men). For a comparison of the data, 1096 persons (538 women and 554 men) examined in the WOBASZ Senior study were used. Result: Systolic and diastolic blood pressures significantly decreased from 153.0 ± 23.9 mmHg to 142.9 ± 22.3 mmHg and 85.2 ± 11.9 mmHg to 78.4 ± 11.3 mmHg, respectively, from 2007 to 2014 (p < 0.0001). Prevalence of hypertension among people included in WOBASZ studies slightly decreased from 83.8% to 77.9% (rate ratio [RR]: 0.95; 95% confidence interval [CI]: 0.78–1.16) in men, and from 75.4% to 71.8% (RR: 0.93; 95% CI: 0.8–1.09) in women. Hypertension awareness was improved from 59.2% to 72.9% (RR: 1.23; 95% CI: 0.97–1.56) in men, and 74,8% to 93% (RR: 1.26; 95% CI: 1.01–1.58) in women. The proportion of men and women, with implemented hypertension treatment, increased from 48.4% to 61.1% (RR: 1.26; 95% CI: 1.01–1.58), and from 63.2% to 82.0% (RR: 1.3; 95% CI: 1.1–1.53), respectively. The effectiveness of the treatment was improved over two-fold, there was an increase from 10.3% to 26.8% (RR: 2.65; 95% CI: 1.81–3.89) in men, and from 13.8% to 33.5% in women (RR: 2.44; 95% CI: 1.81–3.3). Conclusions: The prevalence of hypertension in Polish seniors remains high, but has decreased slightly in the perspective of the last 7 years. Although treatment andontrol has improved over the last decade, it remains below expectations. Efforts to improve the diagnosis and effective treatment of hypertension in Polish seniors should be intensified. Background: The aim of this study was to assess changes in the prevalence, awareness and treatment of hypertension and its effectiveness between 2007 (WOBASZ Senior study) and 2013–2014 (WOBASZ II) in a sample of the Polish population over the age of 75 years. Methods: Sampling had three stages, stratified according to voivodeships, type of community, and gender. Finally, the WOBASZ II study included 467 persons (290 women and 177 men). For a comparison of the data, 1096 persons (538 women and 554 men) examined in the WOBASZ Senior study were used. Result: Systolic and diastolic blood pressures significantly decreased from 153.0 ± 23.9 mmHg to 142.9 ± 22.3 mmHg and 85.2 ± 11.9 mmHg to 78.4 ± 11.3 mmHg, respectively, from 2007 to 2014 (p < 0.0001). Prevalence of hypertension among people included in WOBASZ studies slightly decreased from 83.8% to 77.9% (rate ratio [RR]: 0.95; 95% confidence interval [CI]: 0.78–1.16) in men, and from 75.4% to 71.8% (RR: 0.93; 95% CI: 0.8–1.09) in women. Hypertension awareness was improved from 59.2% to 72.9% (RR: 1.23; 95% CI: 0.97–1.56) in men, and 74,8% to 93% (RR: 1.26; 95% CI: 1.01–1.58) in women. The proportion of men and women, with implemented hypertension treatment, increased from 48.4% to 61.1% (RR: 1.26; 95% CI: 1.01–1.58), and from 63.2% to 82.0% (RR: 1.3; 95% CI: 1.1–1.53), respectively. The effectiveness of the treatment was improved over two-fold, there was an increase from 10.3% to 26.8% (RR: 2.65; 95% CI: 1.81–3.89) in men, and from 13.8% to 33.5% in women (RR: 2.44; 95% CI: 1.81–3.3). Conclusions: The prevalence of hypertension in Polish seniors remains high, but has decreased slightly in the perspective of the last 7 years. Although treatment andontrol has improved over the last decade, it remains below expectations. Efforts to improve the diagnosis and effective treatment of hypertension in Polish seniors should be intensified.

Background: Cardiovascular diseases are one of the most frequent causes of morbidity and death both in men and women. Well known is the influence of such factors as: hypertension, hypercholesterolemia, tobacco smoking, obesity, diabetes, age and sex on the occurrence and progression of atherosclerosis. Apart from the typical risk factors of cardiovascular diseases, there is also a significant association between the incidence of those diseases and the socioeconomic status (SES). Aim: The aim of this study was to establish the correlation between the socioeconomic status and the cardiovascular disease risk assessed according to the SCORE algorithm. Methods: The study encompassed 516 participants (207 men and 309 women) aged 40-74, who had never been diagnosed with any cardiovascular disease. The SES was calculated by multiplying the patient's education and net monthly income. The correlation between the socioeconomic status and SCORE was established using linear and logistic regression analysis. Results: After considering the influence of age, an inverse correlation between the SCORE risk value and the SES index was established, both in the entire group (p=0.006) and in the men’s group (p=0.007). In the analysis of individual age subgroups, this correlation was demonstrated in the following groups: 55-59 year-olds (p=0.011), 60-64 year-olds (p=0.014) and 65-69 year-olds (p=0.034). A similar relationship was established in men aged 65-69 (p=0.038) and women aged 40-44 (p=0.003). The logistic regression analysis demonstrated that, after considering the influence of age, the odds of the SCORE risk value being≥10% were becoming smaller along with the increase in the SES index value in the entire group under study (p=0.048) and in the men's group (p=0.011). The odds ratio for the SCORE risk value being ≥10% depending on the SES index value was OR=0.978 (95% CI: 0.956-0.999) in the entire group and OR=0.964 (95% CI: 0.938-0.992) in men. Furthermore, we also established that the risk of SCORE≥5% decreases with the increase in the SES index value in the women's group (p=0.042; OR=0.970 (95% CI: 0.941-0.999)). Conclusions: 1. We demonstrated a statistically significant correlation between the socioeconomic status and the cardiovascular disease risk assessed according to the SCORE algorithm. 2. The value of the cardiovascular disease risk according to SCORE was inversely correlated with the socioeconomic status. Background: Cardiovascular diseases are one of the most frequent causes of morbidity and death both in men and women. Well known is the influence of such factors as: hypertension, hypercholesterolemia, tobacco smoking, obesity, diabetes, age and sex on the occurrence and progression of atherosclerosis. Apart from the typical risk factors of cardiovascular diseases, there is also a significant association between the incidence of those diseases and the socioeconomic status (SES). Aim: The aim of this study was to establish the correlation between the socioeconomic status and the cardiovascular disease risk assessed according to the SCORE algorithm. Methods: The study encompassed 516 participants (207 men and 309 women) aged 40-74, who had never been diagnosed with any cardiovascular disease. The SES was calculated by multiplying the patient's education and net monthly income. The correlation between the socioeconomic status and SCORE was established using linear and logistic regression analysis. Results: After considering the influence of age, an inverse correlation between the SCORE risk value and the SES index was established, both in the entire group (p=0.006) and in the men’s group (p=0.007). In the analysis of individual age subgroups, this correlation was demonstrated in the following groups: 55-59 year-olds (p=0.011), 60-64 year-olds (p=0.014) and 65-69 year-olds (p=0.034). A similar relationship was established in men aged 65-69 (p=0.038) and women aged 40-44 (p=0.003). The logistic regression analysis demonstrated that, after considering the influence of age, the odds of the SCORE risk value being≥10% were becoming smaller along with the increase in the SES index value in the entire group under study (p=0.048) and in the men's group (p=0.011). The odds ratio for the SCORE risk value being ≥10% depending on the SES index value was OR=0.978 (95% CI: 0.956-0.999) in the entire group and OR=0.964 (95% CI: 0.938-0.992) in men. Furthermore, we also established that the risk of SCORE≥5% decreases with the increase in the SES index value in the women's group (p=0.042; OR=0.970 (95% CI: 0.941-0.999)). Conclusions: 1. We demonstrated a statistically significant correlation between the socioeconomic status and the cardiovascular disease risk assessed according to the SCORE algorithm. 2. The value of the cardiovascular disease risk according to SCORE was inversely correlated with the socioeconomic status.

Introduction : Hypertension is one of the main risk factors of cardiovascular diseases. The first aim of the study was to evaluate the prevalence, awareness and treatment of hypertension as well as treatment effectiveness (blood pressure Material and methods : Sampling was performed in...

Abnormal body mass and related metabolic disorders may affect female reproductive health. The purpose of the study was to determine the prevalence of underweight, overweight, obesity, lipid and glucose metabolism disorders, hypertension, and metabolic syndrome, among Polish women of childbearing age. One thousand five hundred eighty-eight non-pregnant Polish women of childbearing age (20–49 years) who participated in the Multi-Centre National Population Health Examination Survey (WOBASZ II study) in 2013–2014, were assigned to 3 age groups: 20–29 years (n = 403), 30–39 years (n = 600) and 40–49 years (n = 585). Measurements of weight, height, waist circumference, blood pressure, blood lipids, and blood glucose were taken. For statistical analysis, the Kruskal-Wallis, Chi-Square, and Cohran-Armitage tests were used. Of the participants, 4.3% were determined to be underweight, 25.2% were overweight, 15% were obese, and 53.1% had abdominal obesity. With age, the prevalence of both excessive body mass and abdominal obesity tended to increase, and that of underweight to decrease. Frequency of hypercholesterolemia and hypertriglyceridemia found in the whole group were 50% and 12.6% respectively, and also tended to rise with age. Low serum HDL-cholesterol (high density lipoprotein cholesterol) levels were found in 15.1% of the participants. Prevalence of impaired fasting glucose in the whole group was 8.2% and tended to increase with age. Diabetes was found in 1.2% of the participants and its prevalence also tended to rise with age, at the borderline of significance. Frequency of arterial hypertension and metabolic syndrome in the whole group was 15.7% and 14.1% respectively and both tended to increase with age. Overweight and obesity, especially of abdominal type, and the related metabolic abnormalities are common in Polish women of childbearing age. Their prevalence tends to increase with age. Underweight is relatively common in the youngest age group.

Background and aim: To compare the cardiovascular health knowledge (CHK) of the adult Polish population in the years 2003–2005 and 2013–2014, and to evaluate the CHK determinants in the Polish adult population. Methods: Data came from the two random samples of the Polish population, screened in 2003–2005 in the WOBASZ health survey (6392 men and 7153 women, aged 20–74 years) and in 2013–2014 in the WOBASZ II health survey (2751 men and 3418 women, aged 20+ years). For the present analysis, the population of WOBASZ II was limited to persons aged 20–74 years. A CHK score (CHKs) was constructed based on questionnaire answers of responders, and the results of physical examination and ranged from –1 (lowest knowledge) to +6 (highest knowledge). Results: Women had greater CHK than men. In both studies, about 30% of women and 40% of men did not know their blood pressure (BP). About 20% of men and women that declared their BP awareness was not able to classify it correctly to the normal or high category. Most persons that declared body weight awareness could give their body weight to within 2 kg and could correctly classify it as normal or overweight/obesity. The mean CHKs raised in men from 1.74 in WOBASZ to 1.93 in WOBASZ II (in women, respectively, from 2.10 to 2.23). The chance of having CHK greater than mean value of CHKs increased in men by 31% and in women by 27% in WOBASZ II compared to WOBASZ (ORC_HK = 1.31, p < 0.0001 in men; OR_CHK = 1.27, p < 0.0001 in women). Younger, better educated persons and men with coronary artery disease history and persons with familial history of death from myocardial infarction or stroke had greater health knowledge. Conclusions: Since 2003 Polish adults significantly advanced their knowledge and awareness of cardiovascular risk factors. Gender, age, education level, coronary artery disease history, and family history of cardiovascular disease death are significant determinants of CHK. From 20% to 30% of studied persons who declared their awareness, were shown to be unaware of their own cardiovascular disease risk factors. Background and aim: To compare the cardiovascular health knowledge (CHK) of the adult Polish population in the years 2003–2005 and 2013–2014, and to evaluate the CHK determinants in the Polish adult population. Methods: Data came from the two random samples of the Polish population, screened in 2003–2005 in the WOBASZ health survey (6392 men and 7153 women, aged 20–74 years) and in 2013–2014 in the WOBASZ II health survey (2751 men and 3418 women, aged 20+ years). For the present analysis, the population of WOBASZ II was limited to persons aged 20–74 years. A CHK score (CHKs) was constructed based on questionnaire answers of responders, and the results of physical examination and ranged from –1 (lowest knowledge) to +6 (highest knowledge). Results: Women had greater CHK than men. In both studies, about 30% of women and 40% of men did not know their blood pressure (BP). About 20% of men and women that declared their BP awareness was not able to classify it correctly to the normal or high category. Most persons that declared body weight awareness could give their body weight to within 2 kg and could correctly classify it as normal or overweight/obesity. The mean CHKs raised in men from 1.74 in WOBASZ to 1.93 in WOBASZ II (in women, respectively, from 2.10 to 2.23). The chance of having CHK greater than mean value of CHKs increased in men by 31% and in women by 27% in WOBASZ II compared to WOBASZ (ORC_HK = 1.31, p < 0.0001 in men; OR_CHK = 1.27, p < 0.0001 in women). Younger, better educated persons and men with coronary artery disease history and persons with familial history of death from myocardial infarction or stroke had greater health knowledge. Conclusions: Since 2003 Polish adults significantly advanced their knowledge and awareness of cardiovascular risk factors. Gender, age, education level, coronary artery disease history, and family history of cardiovascular disease death are significant determinants of CHK. From 20% to 30% of studied persons who declared their awareness, were shown to be unaware of their own cardiovascular disease risk factors.

Cardiovascular diseases (CVDs) are the main cause of morbidity and mortality in developed countries. Despite the progress in diagnostics and treatment, it is expected that CVD will still be the main cause of death worldwide until at least 2030. From 1991 CVD mortality in Poland systematically decreased, but it is still higher than the average in Western Europe. In 2013 CVDs were the cause of 46% of all deaths in Poland (40.9% in men and 51.1% in women) and 26.9% of deaths among persons under 65 years of age. The epidemiologic assessment of prevalence, control and treatment of CVD risk factors, and monitoring of healthy behaviour and morbidity due to diseases like coronary artery disease, hypertension and diabetes is very important for health policy planning. The WOBASZ II is the newest Polish population based survey, performed in 2013-2014 to evaluate prevalence, control, treatment, and morbidity. The study was the continuation of WOBASZ (2003-2005). To describe the goals and methods of the WOBASZ II study and to present the results of the recruitment. The WOBASZ II study was planned as a cross-sectional survey of a random sample of Polish residents aged over 20 years. The selection, using the National Identity Card Registry of the Ministry of Internal Affairs, was made as a three-stage sampling, stratified according to administrative units (voivodeships), type of urbanisation (commune), and gender. The study protocol consisted of a questionnaire used in face-to-face interviews, physical examination, and blood samples. WOBASZ II was coordinated by the Department of Epidemiology, Cardiovascular Diseases Prevention and Health Promotion of the Institute of Cardiology in Warsaw in cooperation with medical universities in Gdansk, Katowice, Krakow, Lodz, and Poznan. Out of 15,120 persons, 1557 persons were not eligible. Out of eligible persons, 6170 (2760 men and 3410 women) were examined (the response rate 45.5%). The highest response rates were observed in Warminsko-Mazurskie (64.2%), Zachodniopomorskie (58.1%), and Kujawsko-Pomorskie (53.1%). The importance of the WOBASZ study for the monitoring of the health state of Polish society, and for the as-sessment of prophylaxis efficiency and treatment of CVD and metabolic diseases, as well as for the evaluation of the actions in the field of health promotion, is difficult to overstate.

Clinical studies have suggested increased risk of thrombotic events after planned cessation of clopidogrel therapy due to increased platelet reactivity (platelet rebound), however in many studies platelet function was not assessed before introducing clopidogrel. Patients who are scheduled to stop clopidogrel therapy, do it abruptly, so a gradual drug cessation might provide a beneficial treatment strategy.We aimed to determine whether a clopidogrel discontinuation results in platelet rebound hyperaggregability with increased activity compared to pre-treatment values and to assess whether abrupt or tapering clopidogrel cessation may affect platelet reactivity.Patients with stable coronary artery disease (n =49), on chronic aspirin treatment, who underwent coronary angiography and were scheduled for elective percutaneous coronary intervention with stent implantation, were enrolled. Patients were randomized to either a tapering clopidogrel discontinuation over 2 weeks period (tapering group, n=25) or abrupt drug cessation (abrupt group, n=24). After 12 months of dual antiplatelet therapy with clopidogrel and aspirin, we performed 3 follow-up visits with blood sampling. Platelet aggregation was assessed using multiple electrode aggregometer at inclusion, at cessation day and 7 and 14 days after complete clopidogrel discontinuation. The primary end point was the level of adenosine-diphosphate (ADP) induced platelet aggregation. We also analyzed platelet function in the ASPI test and platelet count as secondary endpoints.In 36 patients included in the main analysis, we found significant differences between the 2 study groups in the levels of ADP-induced platelet aggregation at days 7 and 14 after cessation of clopidogrel (p=0.004 and p=0.04, respectively). In abrupt group, platelet aggregation returned to the values similar to baseline at day 7. There were no significant differences between baseline, 7 and 14 days after drug cessation (p=0.92 and p=0.37, respectively). However in tapering group, ADP values at 7 and 14 days after drug cessation were significantly decreased, comparing to baseline (p<0.0001 and p=0.009, respectively). For the ASPI test and platelet count, we did not find significant differences between the groups. All values returned to the similar level of the baseline. During the follow-up, there were no serious cardiovascular events or bleedings.Tapering versus abrupt discontinuation of clopidogrel treatment results in significantly lower platelet aggregation values after 14 days from complete drug cessation. We found no evidence of a platelet rebound effect.