International Study (Poland)
Joint Poland-US Publications
09/17/99 10:34:50
of The National Institutes of Health
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International Study (Poland)
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| Sponsored by the National Heart, Lung & Blood
Institute of The National Institutes of Health |
| Authors | Wayne Rosamond, Grazyna Broda, Ewa Kawalec, Stefan Rywik, Andrzej Pajak, Lawton Cooper, Lloyd Chambless |
| Journal | The American Journal of Cardiology 1999;83(April 15, 1999):1180-5 |
| Title | Comparison of Medical Care and Survival of Hospitalized Patients with Acute Myocardial Infarction in Poland and the United States. |
| Abstract | Few studies have evaluated between-country differences in medical care and survival after acute myocardial infarction, and none have compared the US with countries from Eastern Europe. Comparable data from the US (Atherosclerosis Risk in Communities Study [US-ARIC]) and Poland (Multinational Monitoring of Trends and Determinants in Cardiovascular Disease project [Pol-MONICA]) were developed. From 1987 through 1993, a total of 3,694 patients were hospitalized with acute myocardial infarction events in the 2 Pol-MONICA communities and 4,801 in the 4 US-ARIC communities. Patients in the US-ARIC were 1.7 times more likely to be treated in a coronary care unit and received cardiac procedures, calcium channel blockers,and thrombolytic agents significantly more often than patients in the Pol-MONICA. The use of antiplatelet agents, nitrates, angiotensin-converting enzyme inhibitors, and á blockade agents was similar in both countries. Case fatality (28-day) rates after hospitalized acute myocardial infarction were nearly identical (men, 7% in Pol-MONICA vs 6% in US-ARIC; women, 9% in Pol-MONICA vs 8% in US-ARIC). However, when fatal coronary heart disease events not associated with a hospitalized myocardial infarction were included, the US-ARIC rates were less than half than those seen in Pol-MONICA. Substantial differences in treatment of hospitalized acute myocardial infarction between countries did not translate into a survival advantage for patients reaching clinical attention. Differences in case severity, arising from the high out-of-hospital coronary death rate in Poland may play an important role in this finding. |
| Authors | Abernathy JR, Rywik S, Pajak A, Thomas RP, Broda G, Kawalec E |
| Journal | CVD Prevention 1998;1(1):25-31 |
| Title | Correlates of Total and CVD Mortality in US and Polish Men and Women Aged 35-64 Years. |
| Abstract | Background: Two research studies, the US Lipids Research Clinics (LRC) Program Prevalence Study and the Polish Pol-MONICA Study, provided comparative data for determining mortality correlates in men and women of both countries. Design and Methods:The Polish Study was a random sample of 2,600 subjects aged 35-64 from Warsaw and 2,673 from Tarnobrzeg Province. Polish participants were examined in 1983-84 and subsequently followed for mortality and causes of death. The US study was 5,087 participants from 9 LRC populations examined in 1972-76 and subsequently followed. Adjusted total and cardiovascular disease (CVD) mortality rates on 11-14 years of follow-up are presented for each country and gender. Results: One of the striking findings was the difference in Polish men and women in age-adjusted death rates. In the rural sample, mortality in women was one-third that of men; in the urban sample, mortality in women was 43 percent of men. Polish mortality was generally higher than US with the exception of Polish rural women. This was attributed in part to different lifestyle practices of women in rural Poland compared to other women, and some of these practices, such as more manual labor and less smoking, are conducive to lower mortality risk. Less obesity and reduced blood pressure in rural Polish women could be a by-product of their more rigorous life. Age, systolic blood pressure (SBP), body mass index (BMI) and smoking were major risk factors for mortality in both countries and genders. Conclusions: It was concluded that behavior modification of lifestyles may be the best hope for reducing total and CVD mortality in Poland |
| Authors | Massing MW, Rywik SL, Jasinski B, Manolio TA, Williams OD, Tyroler HA |
| Journal | Stroke 1998;29:1366-72 http://services.lww.com/journals/journalsites.cfm |
| Title | Opposing National Stroke Mortality Trends in Poland and for African Americans and Whites in the United States, 1968 to 1994. |
| Abstract | Background and Purpose: The United States (US) has experienced declines in stroke mortality in contrast to the increases reported for Poland. As part of the Poland and US Agreement on Cardiovascular and Cardiopulmonary Research, stroke mortality trends in Polish and US subpopulations were compared in the context of cross-population differences in competing causes of death and determinants of stroke. Methods: Age-adjusted annual stroke, cardiovascular disease (CVD), non-CVD, and all-cause mortality rates were determined for men and women aged 35 to 64 and 65 to 74 years from 1968 to 1994 for African Americans and US whites and in Poland. Mean annual percent changes of mortality rates were estimated during 1968 to 1980 and 1981 to 1994 with the use of piecewise log-linear regression. Results: US stroke mortality rates declined 3.7% to 4.8% annually during 1968 to 1980 and 2.0% to 3.1% during 1981 to 1994, with similar declines in each ethnic, gender, and age group. Polish rates increased 3.3% to 5.5% annually for all age-gender groups in Poland during 1968 to 1980. Polish men aged 35 to 64 experienced increasing rates during 1981 to 1994 (1.6% annually), while Polish women and older men experienced slight declines or little change. Only Polish men aged 35 to 64 years exhibited increases in stroke, CVD, and non-CVD mortality rates during both time intervals. Conclusions: Poland and the US experienced opposing stroke mortality rate trends between 1968 and 1994. These national and ethnic trends occurring in just one generation suggest major effects of lifestyle, socioenvironmental, and/or medical care determinants. |
| Authors | Pajak A, Broda G, Manolio T, Kawalec E, Rywik S, Davis CE, Pikon J., Pytlak A, Thomas RP |
| Journal | International Journal of Epidemiology 1998;27:953-61 |
| Title | Constitutional, biochemical and lifestyle correlates of fibrinogen and factor VII activity in Polish urban and rural populations. |
| Abstract | Background: Fibrinogen and factor VII activity are known to be related to atherosclerosis and coronary heart disease, but population differences in clotting factors and modifiable characteristics that influence their levels have not been widely explored. Methods: This paper examines correlates of plasma fibrinogen concentration and factor VII activity in 2443 men and women aged 35-64 in random samples selected from the residents in two districts in urban Warsaw (618 men and 651 women) and from rural Tarnobrzeg Province (556 men and 618 women) screened in 1987-1988, and assesses which characteristics might explain urban-rural differences. Fibrinogen and factor VII activity were determined using coagulation methods. Results: Fibrinogen was 12.9 mg/dl higher in men and 14.1 mg/dl higher in women in Tarnobrzeg compared to Warsaw. Factor VII activity was higher in Warsaw (9.2% in men and 15.3% in women). After adjustment for selected characteristics, fibrinogen was higher in smokers compared to non-smokers by 28 mg/dl in men and 22 mg/dl in women. In women, a 15 mg/dl increase in HDL-cholesterol was associated with a 10 mg/dl decrease in fibrinogen (P<0.01). After adjustment for other variables, a higher factor VII activity in Warsaw remained significant (a difference of 9.4% in men and 14.8% in women). Lower fibrinogen in Warsaw remained significant only in women (15.4 mg/dl difference). Conclusions: The study confirmed that sex, age, BMI, smoking and blood lipids are related to clotting factors. However, with the exception of gender differences and smoking, associations between clotting factors and other variables were small and of questionable practical importance. |
| Authors | Rywik S, Davis CE, Pajak A, Broda G, Folsom AR, Kawalec E, Williams OD |
| Journal | Annals of Epidemiology 1998;8(1):3-13 |
| Title | Poland and U.S. Collaborative Study on Cardiovascular Epidemiology Hypertension in the Community: Prevalence, Awareness, Treatment, and Controll of Hypertension in the Pol-MONICA Project and the U.S. Atherosclerosis Risk in Communtities Study. |
| Abstract | Purpose: The objectives of this manuscript are to assess differences in blood pressue levels and in hypertension prevalence, awareness, treatment, and control for selected rural and urban areas in the U.S. and Poland, where ischemic heart disease mortality trends are different. Methods: Included are white persons aged 45-64 selected in Minneapolis, MN suburbs [urban] and Washington County, MD [semi-rural] from the U.S. Atherosclerosis Risk in Communities Study (ARIC) surveyed in 1987-89, and in Warsaw [urban] and Tarnobrzeg Province [semi-rural] from Poland's Pol-MONICA Project surveyed in 1987-88. Sample sizes were: U.S.-3,696 men, 3,801 women; Poland-875 men, 960 women. Results: Mean blood pressures were >15% higher for Polish samples than for the U.S. (p<0.01). In multivariable analysis, hypertension was significantly positively related to age and body mass index (BMI) in both U.S. and Polish samples (except age in Polish men), and to heart rate in Polish samples and U.S. rural women. Smoking was significantly negatively related to hypertension in urban Polish and rural U.S. men. Hypertension awareness, treatment, and control were better in U.S. than in Polish samples. In the U.S.>80% of subjects with hypertension (systolic blood pressure (SBP) greater than or equal to 160mmHg or diastolic blood pressure (DBP) greater than or equal to 95 mmHg or on treatment) were controlled whereas in Polish samples less than or equal to 17% of hypertensive men and 16% of hypertensive women were controlled. When SBP greater than or equal to 140 mmHg or DBP greater than or equal to 90 mmHg or on treatment defined hypertension, control was about 55% in U.S. samples and about 2% in Polish samples. Conclusions: Hypertension prevalence is higher and blood pressure levels are less well controlled in Polish than in U.S. samples. These striking differences can be expected to contribute to opposing trends in coronary heart disease (CHD) mortality in the two countries. Hypertension control programs in the U.S. are almost certainly responsible for much of the observed differences. There is a clear need for similar programs in Poland |
| Authors | Davis CE, Williams DH, Oganov RG, Tao S, Rywik S, Stein Y, Little JA |
| Journal | American Journal of Epidemiology 1997;143(11):1100-6 |
| Title | Sex Difference in High Density Lipoprotein Cholesterol in Six Countries. |
| Abstract | It is known that women have higher levels of high density lipoprotein (HDL) cholesterol than men. The authors examined the association between HDL cholesterol and biologic sex in 8,631 women and 10,690 men aged 45-54 years from six countries studied between 1972 and 1989. The variation in the sex difference for HDL cholesterol was significant; the smallest difference (0.06 mmol/liter) was seen in China and the largest (0.40 mmol/liter) in Canada. Adjustment for differences in body mass index, smoking, alcohol use, and heart rate reduced but did not eliminate the variability. The sex difference in HDL cholesterol levels, usually assumed to be due to biologic factors, differs across cultures and may be related to environmental factors |
| Authors | Pajak A, Williams OD, Broda G, Baczynska E, Rywik S, Davis CE, Kawalec E, Chodkowska E, Irving SH, Manolio T |
| Journal | Annals of Epidemiology 1997;7(2):115-24 |
| Title | Changes over Time in Blood Lipids and Their Correlates in Polish Rural and Urban Populations: The Poland-United States Collaborative Study in Cardiopulmonary Disease Epidemiology. |
| Abstract | Purpose: The purpose of this manuscript is to examine changes in blood lipid levels and related factors between 1983 and 1987 in two selected Polish populations, to evaluate these changes and their association with other coronary heart disease (CHD) risk factors, and to examine the nutrient intake changes for consistency with observed lipid changes. Methods: Men and women, aged 35-64 were screened from Warsaw and rural Tarnobrzeg province, Poland- the Pol-MONICA screening sites. An independent random sample of 5132 screened in 1983-84 and a second independent random sample of 2596 screened in 1987- 88 were compared. A 25% cohort of the 1983-84 sample was also rescreened in 1987-88 (n=1236) and 24-hour dietary recall information on this cohort was used to evaluate nutrient intake changes and their relationship to the lipid changes. Results: For the random samples, the total cholesterol increased by 5.1 mg/dL (rural) and by 7.9 mg/dL (urban) for women; there were no significant changes among men. Low-density lipoprotein cholesterol (LDL-C) increased for all site and gender subgroups by 5.4-8.7 mg/dL. Among rural men and women, high-density lipoprotein cholesterol (HDL-C) decreased by 3.4 and 3.3 mg/dL, respectively, whereas it increased by 3.3 mg/dL among urban women and did not change among urban men. Total triglycerides (TG) increased by 9.5 mg/dL for rural men, with no significant change for rural women. For urban men and women, TG decreased by 29.5 and 21.8 mg/dL respectively. In the cohort, changes in dietary intake (decreases in energy from fat, Keys index and increases in the polyunsaturated to saturated fats ratio) were related to a decrease in TC at both sites and to a decrease or smaller increase in LDL-C for rural men. Conclusions: The observed changes were generally unfavorable, with a decrease in the proportion of persons with desirable lipid levels. At both sites nutritional changes were favorable, including a drop in total energy intake. Less pronounced were changes in percentages of total energy from fats, where the only significant decrease was for rural women; however, improvements in dietary fat composition and declines in cholesterol consumption were found. These favorable changes in diet were not strong enough or were not in effect long enough to counter the unfavorable changes in blood lipids |
| Authors | Broda G, Davis CE, Pajak A, Williams OD, Rywik S, Baczynska E, Folsom AR, Szklo M |
| Journal | Arteriosclerosis, Thrombosis, and Vascular Biology 1996;16(2):339-49 http://services.lww.com/journals/journalsites.cfm |
| Title | Poland and United States Collaborative Study on Cardiovascular Epidemiology: A Comparison of HDL Cholesterol and Its Subfractions in Populations Covered by the United States Atherosclerosis Risk in Communities Study and the Pol-MONICA Project. |
| Abstract | HDL cholesterol (HDL-C) levels are inversely related to coronary heart disease (CHD) risk, and HDL-C distributions vary among countries. Poland is one of the few developed countries in which CHD rates are increasing at the same time that US rates have been falling, but whether these differences are explained by differences in risk factors such as HDL-C has not been determined. To examine this possibility, levels of HDL-C and its subfractions were compared in US and Polish urban and rural men and women aged 45-64 years. Age-adjusted HDL-C means were 0.20 mmol/L higher in urban Polish men and 0.37 mmol/L higher in rural Polish men than in their US counterparts (P<.0001); means in urban urban Polish women were 0.06 mmol/L higher (P<.05) and in rural Polish women 0.09 mmol/L higher (P<.001) than in their US counterparts. Adjustment for age, education, alcohol intake, smoking, BMI, heart rate, and menopause status (in women) had little effect on differences. Means of HDL2 and HDL3 levels showed similar between-country differences, although differences were minimal for HDL2 in urban men and women, and HDL3 means did not differ between rural women. BMI was inversely related to HDL-C and both subfractions in all gender-country-site strata (P<.001), and alcohol was directly related to HDL-C (P<.001) in all strata except Polish women. Cigarette smoking was negatively related to HDL-C and both subfractions in all US samples except HDL2 in urban men, whereas in Polish samples, significant associations were found only in urban women for HDL-C and in rural and urban women for HDL3. Age, heart rate, and education showed inconsistent or no association with HDL-C and its subfractions in either country. This profile of HDL-C and its subfractions in Polish samples contrasts sharply with the opposite trend in CHD mortality rates, which suggests either that other risk factors may account for the trends or that the relationship between HDL-C and CHD may differ between the two countries |
| Authors | Davis CE, Pajak A, Rywik S, Williams DH, Broda G, Pazucha T, Ephross S |
| Journal | Annals of Epidemiology 1994;4(6):445-8 |
| Title | Natural Menopause and Cardiovascular Disease Risk Factors: The Poland and US Collaborative Study on Cardiovascular Disease Epidemiology. |
| Abstract | Changes in risk factor levels associated with menopause have been reported in many studies in the United States and western Europe, where estrogen replacement therapy and surgical menopause are common. We studied risk factor associations in Polish women, for whom estrogen replacement therapy and surgical menopause are uncommon. The 357 postmenopausal women had higher total cholesterol levels (0.43 mmol/L) and low-density-lipoprotein cholesterol levels (0.36 mmol/L than did the 372 premenopausal women of similar ages. Triglycerides, high-density-lipoprotein cholesterol, body mass index, and blood pressure did not differ by menopausal status. We conclude that natural menopause is associated with higher levels of total and low-density-lipoprotein cholesterol levels. Natural menopause is not associated with large changes in other risk factors in this sample |
| Authors | Rywik S, Pajak A, Abernathy JR, Broda G, Thomas RP, Polakowska M, Baczynska E, Irving SH, Kurjata P, Morawska I, Williams OD, Davis CE |
| Journal | Cardiovascular Risk Factors 1993;3(2):99-106 |
| Title | Poland and U.S. Collaborative Study on Cardiovascular Epidemiology: Prevalence and correlates of hyperlipidemia as defined by European Atherosclerosis Society Guidelines in selected Polish and U.S. populations. |
| Abstract | Three diverse samples of men and women aged 35-64 years living in the two Pol-MONICA projects- an urban Poland site (N=2544) and a rural Poland site (N=2651) - and the nine sites of the LRC Prevalence Study population of the United States (N=2768) are described and compared with regard to the prevalence and correlates of hyperlipidemia. Hyperlipidemia, as broadly defined by three categories in European Atherosclerosis Society Guidelines using total cholesterol and triglycerides, was used for comparisons among the three populations. The proportions of hyperlipidemic participants were 23% in the US, 26% in rural Poland and 32% in urban Poland. Ten potential correlates of hyperlipidemia were used and four (age, diastolic blood pressure, Quetelet index, and smoking) were statistically associated with hyperlipidemia in all three populations. Education and heart rate were associated in two of the three populations. Sex and ethanol consumption were correlated with hyperlipidemia only in the rural Polish sample. These results indicate that elevated blood lipids are a common public health issue in both countries and that programs to address hyperlipidemia should include methods for controlling blood pressure, obesity and smoking as well |
| Authors | Pajak A, Broda G, Abernathy JR, Sznajd J, Rywik S, Irving SH, Czarnecka H, Wagrowska H, Thomas RP, Celinski A, Chotkowska E, Williams OD, Kupsc W |
| Journal | Atherosclerosis 1992;95:43-50 |
| Title | Poland-US collaborative study on cardiovascular epidemiology: classification agreement between US National Cholesterol Education Program and European Atherosclerosis Society hyperlipidemia guidelines in selected Polish and US populations. |
| Abstract | 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 nin 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 |
| Authors | Rywik S, Sznajd J, Williams OD, Pajak A, Przestalska-Malkin H, Thomas RP, Kupsc W, Misiowiec P, Irving SH, Magdon M, Wagrowska H, Abernathy JR |
| Journal | American Journal of Epidemiology 1989;130(3):431-45 |
| Title | Poland and US Collaborative Study on Cardiovascular Epidemiology: I. Introduction and Baseline Findings. |
| Abstract | The Poland-US Agreement for Health Cooperation has as its goal the sharing of scientific information in cardiovascular disease epidemiology between the two countries. Patterns of cardiovascular disease and identification of risk factors were investigated through two large epidemiologic studies, the Pol-Monica Study in Poland and the US Lipid Research Clinics Program Prevalence Study in the United States. These two studies are described with regard to methodological issues, comparability of data collection procedures, and demographic and behavioral characteristics of the two populations involved. Mean blood pressure, lipids, and body mass indices of participants in these studies are also compared |
| Authors | Sznajd J, Rywik S, Furberg B, Pajak A, Kurjata P, Williams OD, Sznajderman-Ciswicka M, Misiowiec P, Irving SH, Baczynska E, Wagrowska H, Abernathy JR, Czarnecka H, Thomas RP, Konopka M, Morawska I |
| Journal | American Journal of Epidemiology 1989;130(3):446-56 |
| Title | Poland and US Collaborative Study on Cardiovascular Epidemiology: II. Correlates of Lipids and Lipoproteins in Men and Women Aged 35-64 Years From Selected Polish Rural, Polish Urban, and US Samples. |
| Abstract | Three diverse samples of men and women aged 35-64 years living in urban Poland, rural Poland, and the United States, are described and subsequently analyzed by multiple regression methods. Total cholesterol, low density lipoproteins (LDL) cholesterol, high density lipoprotein (HDL) cholesterol, and the natural logarithm (ln) of triglycerides are treated separately as dependent variables. In the analyses of total cholesterol, systolic blood pressure was statistically significant in men and women in all three samples, while Quetelet index, cigarette smoking, age, ethanol consumption, and education were significant in at least one of the samples. In the LDL cholesterol analyses, Quetelet index and cigarette smoking were the predominant variables; in the HDL cholesterol analyses, Quetelet index, cigarette smoking, ethanol consumption, and age were key variables; and in the ln triglycerides analyses, Quetelet index, cigarette smoking, education, and systolic blood pressure were significant |
| Authors | Williams OD, Rywik S, Sznajd J, Abernathy JR, Pajak A, Kupsc W, Furberg B, Broda G, Celinski A, Thomas RP, Morawski R, Polakowska M, Przestalska-Malkin H, Irving SH |
| Journal | American Journal of Epidemiology 1989;130(3):457-68 |
| Title | Poland and US Collaborative Study on Cardiovascular Epidemiology: III. Correlates of Systolic and Diastolic Blood Pressure in Men and Women Aged 35-64 Years from Selected Polish Rural, Polish Urban, and US Samples. |
| Abstract | Three diverse samples of men and women aged 35-64 years living in urban Poland, rural Poland, and the United States are described and subsequently analyzed using systolic blood pressure and diastolic blood pressure separately as dependent variables in multiple regression. Several demographic, behavioral and biologic factors are included in the models as independent variables. Heart rate, Quetelet index, high density lipoprotein cholesterol, and the natural logarithm of triglycerides were statistically significant in accounting for variation in systolic pressure in men in all three samples, whereas only heart rate and Quetelet index were significant in women in all samples. In the analysis of diastolic pressure, Quetelet index, heart rate, and ethanol consumption were statistically significant in men in all three samples, white only Quetelet index and heart rate were significant in women in all samples |