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1.  Trends in major risk factors and mortality from main non-communicable diseases in Lithuania, 1985–2013 
BMC Public Health  2016;16:717.
Background
This study aimed to assess the trends in the prevalence and levels of risk factors and mortality from main non-communicable diseases in the Lithuanian population aged 45–64 years during 1985 to 2013.
Methods
Data from four general population surveys conducted between 1985 and 2008 were used. All these surveys were carried out in Kaunas city and five randomly selected municipalities of Lithuania. Risk factors measured at each survey included regular smoking, overweight, obesity, arterial hypertension, and high levels of blood lipids. In total, data of 10,719 subjects (4,965 men and 5,754 women) aged 45–64 were analysed. Trends in standardized all-cause mortality and mortality from cardiovascular disease (CVD), coronary heart disease (CHD), and malignant neoplasms were estimated for both sexes by joinpoint regression analysis.
Results
In 1985–2013, some favourable trends were observed in the age-standardized mean levels and prevalence of risk factors and mortality from main non-communicable diseases in the Lithuanian middle-aged population. The mean values of blood lipids (with the exception of triglycerides) and the prevalence of dyslipidemias declined. In women, mean levels of systolic blood pressure and body mass index decreased, while in men, the levels of these factors increased. The prevalence of arterial hypertension and obesity increased in men. The proportion of obese women decreased. Smoking prevalence increased in both men and women. From 2007 to 2008, significant downward trends, which were steeper in women than in men, were observed in all-cause, CVD, and CHD mortality.
Conclusions
Despite the favourable changes in some risk factors and mortality rates, the prevalence of risk factors and mortality from main non-communicable diseases in Lithuania are still high. This indicates the importance of the ongoing primary and secondary prevention and optimal treatment of these diseases.
doi:10.1186/s12889-016-3387-0
PMCID: PMC4972981  PMID: 27492379
Mortality; Risk factors; Trends; Non-communicable diseases; Middle-aged population
2.  Trends in the Attack Rates, Incidence, and Mortality of Stroke during 1986–2012: Data of Kaunas (Lithuania) Stroke Registry 
PLoS ONE  2016;11(4):e0153942.
Background
There is a lack of reliable epidemiological data on longitudinal trends in stroke attack rates, incidence, and mortality in the countries of the Baltic region.
Aims
The aim of the present study was to explore the longitudinal trends of stroke in middle-aged urban population of Lithuania during the period of 1986 through 2012.
Methods
All stroke events in the studied population were ascertained and validated according to the standardized criteria outlined by the WHO MONICA Project. The study included all patients in Kaunas (Lithuania) city aged 25 to 64 years who experienced a stroke between 1986 and 2012. Estimates of time-trends of the annual percentage change in stroke attack rates, incidence of stroke, and mortality from this condition were made by applying the Joinpoint regression analysis.
Results
During the study period, 9,992 stroke events were registered. The overall proportion of recurrent events was 25.7%. Overall, 18.9% of the events (20.0% in men, and 17.4% in women) were fatal within 28 days. During the period of 1986 to 2012, a flat trend in the incidence of stroke was observed among both male and female middle-aged inhabitants of Kaunas city, while attack rates were increasing due to the increase in recurrent strokes. Both mortality and 28-day case fatality of stroke declined significantly over the study period in both sexes.
Conclusions
An increase both in the incidence and recurrence of stroke among middle-aged men residing in Kaunas city and in the recurrence of stroke among women denotes the inefficiency of measures applied both for primary and secondary prevention of stroke in Lithuania. The revision of current prevention strategies and the introduction of new ones are of paramount importance in order to fight the epidemic of stroke.
doi:10.1371/journal.pone.0153942
PMCID: PMC4849788  PMID: 27124412
3.  The Prognostic Value of Family History for the Estimation of Cardiovascular Mortality Risk in Men: Results from a Long-Term Cohort Study in Lithuania 
PLoS ONE  2015;10(12):e0143839.
Aim
To evaluate the additional prognostic value of family history for the estimation of cardiovascular (CVD) mortality risk in middle-aged urban Lithuanian men.
Methods
The association between family history of CVD and the risk of CVD mortality was examined in a population-based cohort of 6,098 men enrolled during 1972–1974 and 1976–1980 in Kaunas, Lithuania. After up to 40 years of follow-up, 2,272 deaths from CVD and 1,482 deaths from coronary heart disease (CHD) were identified. Multivariate Cox proportional hazards models were used to estimate hazard ratios (HR) for CVD and CHD mortality.
Results
After adjustment for traditional CVD risk factors, the HR for CVD mortality was 1.24 (95% CI 1.09–1.42) and for CHD mortality 1.20 (1.02–1.42) in men with first-degree relatives having a history of myocardial infarction (MI), compared to men without positive family history. A significant effect on the risk of CVD and CHD mortality was also observed for the family history of sudden cardiac death and any CVD. Addition of family history of MI, sudden death, and any CVD to traditional CVD risk factors demonstrated modest improvement in the performance of Cox models for CVD and CHD mortality.
Conclusions
Family history of CVD is associated with a risk of CVD and CHD mortality significantly and independently of other risk factors in a middle-aged male population. Addition of family history to traditional CVD risk factors improves the prediction of CVD mortality and could be used for identification of high-risk individuals.
doi:10.1371/journal.pone.0143839
PMCID: PMC4667937  PMID: 26630455
4.  Anthropometric trends and the risk of cardiovascular disease mortality in a Lithuanian urban population aged 45–64 years 
Aims: To estimate trends in anthropometric indexes from 1992 to 2008 and to evaluate the risk of cardiovascular disease mortality in relation to anthropometric indexes (body mass index, waist circumference, waist:hip ratio, waist:height ratio). Methods: Data from the three surveys (1992–2008) are presented. A random sample of 5147 subjects aged 45–64 years was selected for statistical analysis. During follow-up there were 141 deaths from cardiovascular disease (excluding those with cardiovascular disease at entry). Cox’s regression was used to estimate the associations between anthropometric indexes and cardiovascular disease mortality. Results: During a 17-year period among men, the prevalence of obesity (body mass index ⩾30 kg/m2) increased from 18.4% to 32.1% (p<0.001) and a high level of waist:hip ratio (>0.9) from 59.3% to 72.9% (p<0.001). The risk profile of obesity did not change in women, but prevalence of a high level of waist:hip ratio (>0.85) increased from 25.9% to 41.5% (p<0.001). Multivariable-adjusted Cox’s regression models showed that body mass index, waist circumference, waist:hip ratio, waist:height ratio were associated with cardiovascular disease mortality risk only in men (hazard ratios 1.40, 1.45, 1.49, 1.46 respectively (p<0.01)). Conclusions: Our data indicate that anthropometric measures such as body mass index, waist circumference, waist:hip ratio and waist:height ratio are good indicators of cardiovascular disease mortality risk only in men aged 45–64 years.
doi:10.1177/1403494815597582
PMCID: PMC4639754  PMID: 26261188
body mass index; waist circumference; waist:hip ratio; waist:height ratio; cardiovascular disease
5.  Health Factors and Risk of All-Cause, Cardiovascular, and Coronary Heart Disease Mortality: Findings from the MONICA and HAPIEE Studies in Lithuania 
PLoS ONE  2014;9(12):e114283.
Aims
This study investigated the trends and levels of the prevalence of health factors, and the association of all-cause and cardiovascular (CVD) mortality with healthy levels of combined risk factors among Lithuanian urban population.
Methods
Data from five general population surveys in Kaunas, Lithuania, conducted between 1983 and 2008 were used. Healthy factors measured at baseline include non-smoking, normal weight, normal arterial blood pressure, normal level of total serum cholesterol, normal physical activity and normal level of fasting glucose. Among 9,209 men and women aged 45–64 (7,648 were free from coronary heart disease (CHD) and stroke at baseline), 1,219 death cases from any cause, 589 deaths from CVD, and 342 deaths from CHD occurred during follow up. Cox proportional hazards regression was used to estimate the association between health factors and mortality from all causes, CVD and CHD.
Results
Between 1983 and 2008, the proportion of subjects with 6 healthy levels of risk factors was higher in 2006–2008 than in 1983–1984 (0.6% vs. 0.2%; p = 0.09), although there was a significant increase in fasting glucose and a decline in intermediate physical activity. Men and women with normal or intermediate levels of risk factors had significantly lower all-cause, CVD and CHD mortality risk than persons with high levels of risk factors. Subjects with 5–6 healthy factors had hazard ratio (HR) of CVD mortality 0.35 (95% confidence interval (CI) 0.15–0.83) compared to average risk in the whole population. The hazard ratio for CVD mortality risk was significant in men (HR 0.34, 95% CI 0.12–0.97) but not in women (HR 0.38, 95% CI 0.09–1.67).
Conclusions
An inverse association of most healthy levels of cardiovascular risk factors with risk of all-cause and CVD mortality was observed in this urban population-based cohort. A greater number of cardiovascular health factors were related with significantly lower risk of CVD mortality, particularly among men.
doi:10.1371/journal.pone.0114283
PMCID: PMC4257606  PMID: 25479610
6.  Trends in Prevalence of Dyslipidaemias and the Risk of Mortality in Lithuanian Urban Population Aged 45–64 in Relation to the Presence of the Dyslipidaemias and the Other Cardiovascular Risk Factors 
PLoS ONE  2014;9(6):e100158.
The aim of this study was to provide reliable information on dyslipidaemias, to estimate the trend of the prevalence of dyslipidaemias and other selected cardiovascular disease (CVD) risk factors at population level, and to evaluate the risk of all-cause and CVD mortality in relation to presence of mixed dyslipidaemias and other CVD risk factors.
Methods
Data from the five surveys (1983–2008) are presented. A random sample of 9,209 subjects aged 45–64 was selected for statistical analysis. During follow-up there were 1653 death cases from any cause, 864 deaths from CVD. Estimates of hazard ratios (HR) and 95% confidence intervals (CI) were based on the multivariate Cox proportional hazards regression for all-cause mortality and CVD mortality.
Results
During 25 year period the prevalence of normal total cholesterol level (<5.2 mmol/L) significantly increased only in women; triglycerides and high density lipoprotein (HDL) cholesterol did not change in men and women. Findings in our longitudinal study showed that in men and women mixed dyslipidaemias (HDL cholesterol <1.03 mmol/L plus triglycerides ≥1.70 mmol/L) significantly increased the risk for all-cause and CVD mortality (respectively in men HR = 1.30; HR = 1.15, in women HR = 1.83; HR = 2.13). These mixed dyslipidaemia combinations combination with the other risk factors such as arterial hypertension, high fasting glucose level increased all-cause and CVD mortality risk in men and women; while, these mixed dyslipidaemias plus smoking increased all-cause and CVD mortality risk only in men compared to never smokers without these dyslipidaemias (respectively HR = 1.89; HR = 1.92); and these dyslipidaemias plus obesity increased all-cause and CVD mortality risk in women (respectively HR = 2.25; HR = 2.39) and CVD mortality risk in men (HR = 1.72), as compared to responders without obesity and these dyslipidaemias.
Conclusion
Mixed dyslipidaemias (reduced HDL cholesterol plus elevated triglycerides) significantly increased the risk for all-cause and CVD mortality in this Lithuanian population aged 45–64 years.
doi:10.1371/journal.pone.0100158
PMCID: PMC4067295  PMID: 24955583
7.  Accessibility and use of urban green spaces, and cardiovascular health: findings from a Kaunas cohort study 
Environmental Health  2014;13:20.
Background
The aims of this study were to explore associations of the distance and use of urban green spaces with the prevalence of cardiovascular diseases (CVD) and its risk factors, and to evaluate the impact of the accessibility and use of green spaces on the incidence of CVD among the population of Kaunas city (Lithuania).
Methods
We present the results from a Kaunas cohort study on the access to and use of green spaces, the association with cardiovascular risk factors and other health-related variables, and the risk of cardiovascular mortality and morbidity. A random sample of 5,112 individuals aged 45-72 years was screened in 2006-2008. During the mean 4.41 years follow-up, there were 83 deaths from CVD and 364 non-fatal cases of CVD among persons free from CHD and stroke at the baseline survey. Multivariate Cox proportional hazards regression models were used for data analysis.
Results
We found that the distance from people’s residence to green spaces was not related to the prevalence of health-related variables. However, the prevalence of cardiovascular risk factors and the prevalence of diabetes mellitus were significantly lower among park users than among non-users. During the follow up, an increased risk of non-fatal and fatal CVD combined was observed for those who lived ≥629.61 m from green spaces (3rd tertile of distance to green space) (hazard ratio (HR) = 1.36), and the risk for non-fatal CVD–for those who lived ≥347.81 m (2nd and 3rd tertile) and were not park users (HR = 1.66) as compared to men and women who lived 347.8 m or less (1st tertile) from green space. Men living further away from parks (3rd tertile) had a higher risk of non-fatal and fatal CVD combined, compared to those living nearby (1st tertile) (HR = 1.51). Compared to park users living nearby (1st tertile), a statistically significantly increased risk of non-fatal CVD was observed for women who were not park users and living farther away from parks (2nd and 3rd tertile) (HR = 2.78).
Conclusion
Our analysis suggests public health policies aimed at promoting healthy lifestyles in urban settings could produce cardiovascular benefits.
doi:10.1186/1476-069X-13-20
PMCID: PMC4000006  PMID: 24645935
Green spaces; Cardiovascular diseases; Risk factors
8.  Health, Alcohol and Psychosocial factors In Eastern Europe (HAPIEE) study: dietary patterns and their association with socio-demographic factors in Lithuanian urban population of Kaunas city 
Objectives
The purpose of this study was to identify the main dietary patterns in Lithuanian urban population and to determine their association with socio-demographic factors.
Methods
Data from the survey performed in the framework of the HAPIEE (Health, Alcohol, Psychosocial factors in Eastern Europe) study were presented. A random sample of 7087 individuals aged 45-72 years was screened in 2006-2008.
Results
Factor analysis of the main dietary patterns revealed five-factor solution which accounted 47.8 % of the variance: “fresh vegetables and fruit” “sweets” “porridge and cereals” “potatoes, meat, boiled vegetables and eggs” “chicken and fish”. “Fresh vegetables and fruits” factor and “sweets” factor were inversely associated with age both in men and women: older people consumed less frequent than average of particular food groups. Dietary patterns of people with good self-rated health and university education were healthier than among people with lower education and poorer health.
Conclusion
Nutrition education efforts should focus on improving food diversity, with particular targeting of lower educated, single, and older people.
doi:10.1007/s00038-010-0170-3
PMCID: PMC3947489  PMID: 20703510
dietary patterns; socio-demographic factors; education; self-rated health
9.  Comparison of four definitions of the metabolic syndrome and odds of ischemic heart disease in the Lithuanian urban population 
Objectives
The purpose of this study was to compare the prevalence of metabolic syndrome diagnosed using four different definitions in the Lithuanian urban population and to determine their association with ischemic heart disease.
Methods
Data from the survey performed in the framework of the HAPIEE (Health, Alcohol, and Psychosocial factors In Eastern Europe) study were presented. A random sample of 7087 individuals aged 45-72 years was screened in 2006-2008.
Results
In Lithuanian urban population of Kaunas city aged 45-72 years, the highest prevalence of metabolic syndrome was determined according to the new Joint Interim Societies (JIS) definition (44.1% of men and 48.7% of women). After adjusting for age, education, smoking habits the metabolic syndrome (irrespective of definition) was associated with a significantly higher risk of ischemic heart disease.
Conclusion
All four metabolic syndrome definitions were associated with ischemic heart disease risk; however odds of this disease were higher in people with metabolic syndrome defined by American Heart Association National Heart Lung Blood Institute definition and National Cholesterol Education program Adult Treatment Panel III definition, than by the new JIS definition.
doi:10.1007/s00038-011-0244-x
PMCID: PMC3947490  PMID: 21384223
metabolic syndrome; odds of ischemic heart disease
10.  Association between APOE, SCARB1, PPARα polymorphisms and serum lipids in a population of Lithuanian adults 
Background
Dyslipidemia is one of several known risk factors for coronary heart disease, a leading cause of death in Lithuania. Blood lipid levels are influenced by multiple genetic and environmental factors. Epidemiological studies demonstrated the impact of nutrition on lipid levels within the Lithuanian population although the role of genetic factors for dyslipidemias has not yet been studied. The objective of this study was to assess the distribution of the APOE, SCARB1, PPARα genotypes in the Lithuanian adult population and to determine the relationship of these genotypes with dyslipidemia.
Methods
A cross-sectional health survey was carried out in a representative random sample of the Lithuanian population aged 25–64 (n=1030). A variety of single-nucleotide polymorphisms (SNPs) of the APOE (rs429358 and rs7412), SCARB1 (rs5888) and PPARα (rs1800206) genes were assessed using real-time polymerase chain reaction. Serum lipids were determined using enzymatic methods.
Results/Principal findings
Men and women with the APOE2 genotype had the lowest level of total and low-density lipoprotein cholesterol (LDL-C). Men with the APOE2 genotype had significantly higher levels of triglycerides (TG) than those with the APOE3 genotype. In men, the carriers of the APOE4 genotype had higher odds ratios (OR) of reduced (<1.0 mmol/L) high density lipoprotein cholesterol (HDL-C) levels versus APOE3 carriers (OR=1.98; 95% CI=1.05-3.74). The odds of having elevated (>1.7 mmol/L) TG levels was significantly lower in SCARB1 genotype CT carriers compared to men with the SCARB1 genotype CC (OR=0.50; 95% CI=0.31-0.79). In men, carriers of the PPARα genotype CG had higher OR of elevated TG levels versus carriers of PPARα genotype CC (OR=2.67; 95% CI=1.15-6.16). The odds of having high LDL-C levels were lower in women with the APOE2 genotype as compared to APOE3 genotype carriers (OR=0.35; 95% CI=0.22-0.57).
Conclusions/Significance
Our data suggest a gender difference in the associations between APOE, SCARB1, PPARα genotypes and lipid levels. In men, the APOE4 genotype and PPARα genotype CG were correlated with an atherogenic lipid profile while the SCARB1 genotype CT had an atheroprotective effect. In women, APOE2 carriers had the lowest odds of high LDL-C.
doi:10.1186/1476-511X-12-120
PMCID: PMC3751123  PMID: 23919842
Apolipoprotein E (APOE) genotype; Scavenger receptor class B type 1 (SCARB1) genotype; Peroxisome proliferator-activated receptor-alpha (PPARα) genotype; Dyslipidemia
11.  SCARB1 single nucleotide polymorphism (rs5888) is associated with serum lipid profile and myocardial infarction in an age- and gender-dependent manner 
Background
Mutation in SCARB1 gene, exon 8 rs5888, has been associated with altered lipid levels and cardiovascular risk in humans though the results have been inconsistent. We analysed the impact of SCARB1 single nucleotide polymorphism (SNP) rs5888 with plasma lipid profile and association with coronary artery disease (CAD) in a Lithuanian population characterized by high morbidity and mortality from CAD and high prevalence of hypercholesterolemia.
Methods
The study included 1976 subjects from a random sample (reference group) and an myocardial infarction (MI) group of 463 patients. Genotyping of SCARB1 (rs5888) was carried out using the real-time polymerase chain reaction method.
Results/principal findings
Analysis of rs5888 C/T gene polymorphism in the reference group revealed that male TT genotype carriers (25–74 years) had significantly higher total cholesterol and triglyceride concentrations (5.70 mmol/l vs. 5.49 mmol/l; p = 0.036, and 1.70 mmol/l vs. 1.40 mmol/l, p = 0.023, respectively) than CT carriers and the oldest males (65–74 years) TT carriers had significantly higher high density lipoprotein cholesterol concentrations in comparison to heterozygous (1.52 mmol/l vs. 1.36 mmol/l, p = 0.033). The youngest female (25–44 years) TT genotype carriers had significantly lower low density lipoprotein cholesterol concentrations in comparison to C homozygous (2.59 mmol/l vs. 2.92 mmol/l, p = 0.023). The frequency of the SCARB1 TT genotype in the oldest male MI group (65–74 years) was significantly lower than in the corresponding reference group subjects (9.4% vs. 22.3%, p = 0.006). SCARB1 TT genotype was associated with decreased odds of MI in males aged 65–75 years (OR = 0.24, 95% CI 0.10-0.56, p = 0.001).
Conclusions/significance
SCARB1 polymorphism is associated with lipid metabolism and CAD in an age- and gender- dependent manner. Analysis of SCARB1 SNP rs5888 C/T genotypes revealed an atheroprotective phenotype of lipid profile in older men and in young women TT genotype carriers in the reference group. SCARB1 TT genotype was associated with decreased odds of MI in aged men.
doi:10.1186/1476-511X-12-24
PMCID: PMC3599926  PMID: 23510561
Coronary artery disease (CAD); Myocardial infarction (MI); Scavenger receptor Class B Type 1 gene (SCARB1); Single nucleotide polymorphism (SNP)
12.  Cardiovascular risk factors and cognitive function in middle aged and elderly Lithuanian urban population: results from the HAPIEE study 
BMC Neurology  2012;12:149.
Background
The purpose of this study was to examine associations between cardiovascular risk factors and cognitive ability in middle aged and elderly Lithuanian urban population.
Methods
Data from the survey performed in the framework of the HAPIEE (Health, Alcohol, Psychosocial Factors in Eastern Europe) study were presented. A random sample of 7,087 individuals aged 45–72 years was screened in 2006–2008.
Results
The scores of immediate recall and delayed verbal recall, cognitive speed and attention were significantly lower in men than in women; yet numerical ability scores were higher in men. Significant associations between lowered cognitive functions and previous stroke (in male OR = 2.52; 95% CI = 1.75-3.64; in female OR = 2.45; 95% CI = 1.75, 3.64) as well as ischemic heart disease history (among male OR = 1.28; 95% CI = 1.03-1.60) have been determined. Higher level of physical activity in leisure time (among female OR = 1.32; 95% CI = 1.03-1.69), poor self-rated health (among male OR = 1.57; 95% CI = 1.15-2.14) and poor quality of life (in male OR = 1.67; 95% CI = 1.07-2.61; in female OR = 2.81; 95% CI = 1.92-4.11) were related to lowered cognitive function.
Conclusions
The findings of the study suggest that associations between cardiovascular risk factors and lowered cognitive function among healthy middle-aged and elderly adults strongly depend on gender.
doi:10.1186/1471-2377-12-149
PMCID: PMC3517768  PMID: 23199035
13.  Trends in prevalence, awareness, treatment, and control of hypertension, and the risk of mortality among middle-aged Lithuanian urban population in 1983–2009 
Background
Arterial hypertension (AH) is a main risk factor for the risk from cardiovascular (CVD) and stroke mortality. Only few data was published on prevalence, awareness and management of AH in Lithuania. Development of objective approaches to the treatment and control of AH reduces the risk of mortality. The aim of this study was to evaluate time trends, the prevalence, awareness, treatment and control of AH and risk of mortality among Lithuanian urban population aged 45–64 years during the period of 1983–2009.
Methods
Time trends of AH and risk of mortality were examined in three MONICA health surveys in 1983, 1986, 1992, and in one health survey according to MONICA protocol in 2002 included randomly recruited of 2,218 men and 2,491 women. AH was defined as systolic blood pressure (BP) ≥140 mmHg and/or diastolic BP of ≥90 mmHg or current use of antihypertensive medication. The main outcome measures were all-cause mortality, mortality from CVD, coronary heart disease (CHD) and stroke. The mean duration of follow-up was 11.8 ± 9.2 years. All survey periods were age standardized to the year 2006 of Kaunas population. The estimates of hazard ratio and 95% confidence interval were based on the multivariate Cox proportional hazards regression.
Results
In men during 1983–2002 period hypertension prevalence was 52.1–58.7% and did not significantly change whereas in women decreased from 61.0 to 51.0%. There was a significant increase in hypertension awareness among hypertensive men and women (45.0 to 64.4% and 47.7 to 72.3%, respectively) and in treated hypertensives (55.4 to 68.3% in men and 65.6 to 86.2% in women). Adjusted Cox proportional hazard regression analyses revealed a strong dose–response association between blood-pressure level and all-cause, CVD, CHD and stroke-mortality risk in both men and women groups.
Conclusion
In Lithuanian urban population the prevalence of hypertension remains high. Despite positive changes in hypertension awareness and treatment, hypertension control remains poor. A strong dose–response association between the level of BP and all-cause, CVD, CHD and stroke mortality risk was indicated.
doi:10.1186/1471-2261-12-68
PMCID: PMC3480954  PMID: 22937997
Hypertension; Awareness; Treatment; Control; Risk of mortality

Results 1-13 (13)