Cardiovascular health among the Czech population at the beginning of 21st century

Michala Lustigova, Charles University in Prague
Dagmar Dzurova, Charles University in Prague

Background: In late 1980s, the Czech Republic was among countries with the highest cardiovascular (CVD) mortality in the world. In spite of enormous improvements since that time, there are still large opportunities to further improve cardiovascular health of the population. Methods: Based on the Czech HAPIEE sample (n=8857 at baseline, 10 years of follow-up, 326 CVD deaths up to 2012) the impact of selected covariates such as education, smoking, high blood pressure, high blood cholesterol level, diabetes, obesity, physical activity and binge drinking (model controlled for age, gender, partner and prevalence of CVD) was evaluated by Cox regression. Further population attributable fractions (PAF%) were used to quantify the impact of these factors in the population. Results: The prevalence of modifiable risk factors was high; the presence of three or more CVD risk factors were found in 35 % of participants, and 55% of participants fulfilled the criteria of metabolic syndrome. Education was found to be the strongest determinant of population’s CVD mortality (HR=2.92 (basic vs. university), p-value<0.001; PAF%=47.7). The risk was also twice higher for persons with diabetes compared to those without (HR=2.12, p-value<0.001), even the impact on population CVD health was not so high (PAF%=8). From other major risk factors similar impacts was found for smoking (HR=1.72 (smoker vs. non-smoker), p-value<0.001; PAF%=20.6), high blood pressure (HR=1.71, p-value<0.001; PAF%=27.9) and physical inactivity (FR=1.72, (none vs. sufficient) p-value<0.001; PAF%=19.4). Results moreover confirmed that quitting smoking reduces the cardiovascular risk very quickly and that even insufficient physical activity is beneficial to cardiovascular health. Conversely, the effects of obesity, binge drinking and high total cholesterol were not significant. Conclusions: Education had the largest impact on cardiovascular mortality in the Czech population. Almost 50% of CVD death could be prevented if the whole population had the same risk as the highest educated population.