Rywik Stefan L, Piotrowski Walerian, Rywik Tomasz M, Broda Grazyna, Szcześniewska Danuta
Department of Epidemiology and Prevention of Cardiovascular Disease, Institute of Cardiology, Warsaw, Poland.
Kardiol Pol. 2003 May;58(5):344-55; discussion: 355.
After an ascending trend of cardiovascular mortality, which was observed up to the sixties, there was a declining tendency in western countries thereafter. The decrease in mortality rates in Poland has been noticed since 1991. There is an uncertainty whether this improvement in prognosis was only due to the improvement in health care level or was accomplished, to some extent, by population life style changes.
To assess whether the decrease in cardiovascular mortality in Poland was accompanied by a simultaneous reduction in global cardiovascular risk profile.
The study was based on screened random samples from the Warsaw population aged 35-64 years, who were examined in the years 1984 (2646 subjects), 1988 (1433 subjects), 1993 (1539 subjects) and 2001 (853 subjects). The group evaluated in 1984 was followed up for 10 years with all fatal events recorded (364 deaths were registered including 166 cardiovascular deaths). The model of 10 years probability of total and cardiovascular death was developed, which was based on 11 risk factors (age, smoking cigarettes, systolic blood pressure, pulse pressure, ratio of total cholesterol/HDL-cholesterol, triglyceride, symptoms of coronary heart disease or heart failure, death of mother before 65 or death of father before 55 years due to myocardial infarction or stroke, energy in daily food intake and percentage of energy derived from saturated fatty acids). This model was applied to assess the probability of deaths between years 1984 and 2001, utilising data from screenings.
The probability of death (in %) decreased from 1984 to 2001 by 11% in men. However, it remained stable for women. On the other hand the probability of cardiovascular death decreased by 25% and 33%, respectively. The main role in global risk decrease was played by beneficial trends in mean systolic blood pressure (in both genders) and percentage of smokers in men.
Modification of life style influencing risk factors profile decreased the probability of death in the Warsaw population, correlating with changes in mortality rates.
在心血管死亡率呈现上升趋势（这种趋势一直持续到60年代）之后，西方国家的心血管死亡率此后呈下降趋势。自1991年以来，波兰的死亡率也出现了下降。目前尚不确定这种预后的改善仅仅是由于医疗保健水平的提高，还是在一定程度上得益于人群生活方式的改变。
评估波兰心血管死亡率的下降是否伴随着整体心血管风险状况的同步降低。
该研究基于从华沙35 - 64岁人群中筛选出的随机样本，这些人群分别在1984年（2646名受试者）、1988年（1433名受试者）、1993年（1539名受试者）和2001年（853名受试者）接受了检查。对1984年评估的人群进行了为期10年的随访，记录了所有死亡事件（共登记364例死亡，其中166例为心血管死亡）。建立了基于11个风险因素（年龄、吸烟、收缩压、脉压、总胆固醇/高密度脂蛋白胆固醇比值、甘油三酯、冠心病或心力衰竭症状、母亲在65岁前因心肌梗死或中风死亡或父亲在55岁前因心肌梗死或中风死亡、每日食物能量摄入量以及饱和脂肪酸提供的能量百分比）的全因死亡和心血管死亡10年概率模型。利用筛查数据，应用该模型评估1984年至2001年期间的死亡概率。
1984年至2001年，男性的死亡概率（百分比）下降了11%。然而，女性的死亡概率保持稳定。另一方面，心血管死亡概率分别下降了25%和33%。平均收缩压（男女均有）的有利趋势以及男性吸烟者比例的下降在整体风险降低中起了主要作用。
影响风险因素状况的生活方式改变降低了华沙人群的死亡概率，这与死亡率的变化相关。
