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Acute myocardial infarction (AMI) is a major public health problem. Cold winter weather increases the risk of AMI, but factors influencing susceptibility are poorly known. We conducted an individual-level case-crossover study of the associations between winter cold spells and the risk of AMI, with special focus on survival at 28 days and effect modification by age and sex. All 16,071 adult cases of AMI among the residents of the city of Kaunas in Lithuania in 2000–2015 were included in the study. Cold weather was statistically defined using the 5th percentile of frequency distribution of daily mean temperatures over the winter months. According to conditional logistic regression controlling for time-varying and time-invariant confounders, each additional cold spell day during the week preceding AMI increased the risk of AMI by 5% (95% CI 1–9%). For nonfatal and fatal cases, the risk increase per each additional cold spell day was 5% (95% CI 1–9%) and 6% (95% CI − 2–13%), respectively. The effect estimate was greater for men (OR 1.07, 95% CI 1.02–1.12) than for women (OR 1.02, 95% CI 0.97–1.08), but there was no evidence of effect modification by age. Evidence on factors increasing susceptibility is critical for targeted cold weather planning.

Background Cold winter weather increases the risk of stroke, but the evidence is scarce on whether the risk increases during season-specific cold weather in the other seasons. The objective of our study was to test the hypothesis of an association between personal cold spells and different types of stroke in the season-specific context, and to formally assess effect modification by age and sex. Methods We conducted a case-crossover study of all 5396 confirmed 25–64 years old cases with stroke in the city of Kaunas, Lithuania, 2000–2015. We assigned to each case a one-week hazard period and 15 reference periods of the same calendar days of other study years. A personal cold day was defined for each case with a mean temperature below the fifth percentile of the frequency distribution of daily mean temperatures of the hazard and reference periods. Conditional logistic regression was applied to estimate odds ratios (OR) and 95% confidence intervals (95% CI) representing associations between time- and place-specific cold weather and stroke. Results There were positive associations between cold weather and stroke in Kaunas, with each additional cold day during the week before the stroke increases the risk by 3% (OR 1.03; 95% CI 1.00–1.07). The association was present for ischemic stroke (OR 1.05; 95% CI 1.01–1.09) but not hemorrhagic stroke (OR 0.98; 95% CI 0.91–1.06). In the summer, the risk of stroke increased by 8% (OR 1.08; 95% CI 1.00–1.16) per each additional cold day during the hazard period. Age and sex did not modify the effect. Conclusions Our findings show that personal cold spells increase the risk of stroke, and this pertains to ischemic stroke specifically. Most importantly, cold weather in the summer season may be a previously unrecognized determinant of stroke.

Several studies reported statistically significant associations of blood pressure (BP) with short-term air temperature variability (TV), but the effect of TV on BP was found to differ in different areas. This study aimed to detect the association between BP and TV in Kaunas, Lithuania. Data from the international Health, Alcohol, and Psychosocial Factors in Eastern Europe study was used to gather information on the participants’ BP during 2006–2008. The TV variables were the diurnal temperature range (DTR), the standard deviation (SD) of hourly temperature during the 24 h (TSD) and the first 12 h of the day (TSDF), and the SD of daily minimum and maximum temperatures during the exposure days (DTV). Multiple linear regression was used after controlling for potential confounders. Among the participants, 45.5% were men, 30.9% were aged > 65 years, and 9.8% were normotensive. A positive association of systolic BP with TSD on the same day (TSD0), DTR with lags of 0–2 days, and DTV with lags of 0–1 day and of diastolic BP with TSD0 and TSDF was found, a stronger impact being observed in males and in physically active participants. The impact of TV was stronger at lower temperatures, and a statistically significant negative interaction between air temperature and TV variables was found. In May–June, a negative association of DTV with diastolic BP was observed. We found a positive association of BP with TV. Sex, the level of physical activity, and air temperature may modify the relationship between TV and BP.

Background Empirical evidence on the epidemiology of hypertension, diabetes and hypercholesterolemia is limited in many countries in Central and Eastern Europe. We aimed to estimate the prevalence, awareness, treatment and control of hypertension, diabetes and hypercholesterolemia in the Czech Republic, Russia, Poland and Lithuania, and to identify the risk factors for the three chronic conditions. Methods We analysed cross-sectional data from the HAPIEE study, including adults aged 45–69 years in the Czech Republic, Russia, Poland and Lithuania, collected between 2002 and 2008 (total sample N  = 30,882). Among prevalent cases, we estimated awareness, treatment, and control of hypertension, diabetes and hypercholesterolemia by gender and country. Multivariate logistic regression was applied to identify associated risk factors. Results In each country among both men and women, we found high prevalence but low control of hypertension, diabetes, and hypercholesterolemia. Awareness rates of hypertension were the lowest in both men (61.40%) and women (69.21%) in the Czech Republic, while awareness rates of hypercholesterolemia were the highest in both men (46.51%) and women (51.20%) in Poland. Polish participants also had the highest rates of awareness (77.37% in men and 79.53% in women), treatment (71.99% in men and 74.87% in women) and control (30.98% in men and 38.08% in women) of diabetes. The common risk factors for the three chronic conditions were age, gender, education, obesity and alcohol consumption. Conclusions Patterns of awareness, treatment and control rates of hypertension, diabetes and hypercholesterolemia differed by country. Efforts should be made in all four countries to control these conditions, including implementation of international guidelines in everyday practice to improve detection and effective management of these conditions.

Background Ageing populations experience greater risks associated with health and survival. It increases the relevance of identifying variables associated with mortality. Grip strength (GS) has been identified as an important biomarker for all cause and cardiovascular mortality, however, its prognostic value has not been studied in Lithuania. The aim of the present study is to evaluate the relationship of GS to vital status in a representative sample of the Lithuanian 45–72-year-old urban population during the period of 12 years of follow-up and to explore associations of GS with all-cause mortality and mortality from cardiovascular diseases (CVD). Methods Within the framework of the international study Health, Alcohol and Psychosocial Factors in Eastern Europe (HAPIEE) 7,115 men and women 45–72 years of age were examined in the baseline survey (2006 to 2008). Data from the Official Lithuanian Mortality Register were used to evaluate CVD and all-cause mortality from follow-up till 2020. Cox proportional hazards regression was used, and four models for all-cause and CVD mortality were assessed. Results The mean GS was significantly higher among survivors’ men and women as compared to individuals deceased from CVD and other causes of death. In survivor men and women groups, minimal values of GS in all terciles were higher as compared to all three deceased groups. In both men and women groups, the lowest GS (1st tercile) was associated with a significantly higher risk of all-cause and CVD mortality as compared to the highest levels of GS (3rd tercile) in three Cox regression models. In both men and women were found to have a 1.34- and 1.35-fold higher risk of all-cause mortality, respectively, at lower GS, but no significant difference in the risk of CVD mortality. When GS was treated in all models as decrement per 1 kg and decrement per 1 SD, in both men and women, the risk of all-cause mortality significantly increased with decreasing of GS. Conclusions The mean GS was significantly higher among survivors’ men and women as compared to deceased from CVD and other causes of death. Risk of all-cause mortality significantly increased with decreasing of GS.

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.

Background and Objectives. Over the past two decades, 28-day acute myocardial infarction (AMI) case-fatality rates have declined globally due to improved treatment and secondary prevention. This study aimed to evaluate AMI case-fatality levels and trends in the Kaunas population aged 25–64 from 2000 to 2023. Materials and Methods. Data were obtained from the population-based Kaunas Ischemic Heart Disease Registry, operating under the WHO MONICA standards. The study included adults with AMI or coronary heart disease death registered within 28 days from the onset of AMI. Case-fatality was defined as the proportion of AMI deaths among all AMI cases. Trends were assessed using JoinPoint regression. Results. From 2000 to 2023, 28-day AMI case-fatality in males showed no significant change, while in females it increased by 2.5% per year (p = 0.002). In-hospital AMI case-fatality remained stable in both sexes. Males had higher average AMI case-fatality rates than females in both age groups (25–54 and 55–64). Only females aged 55–64 showed a significant rise in AMI case-fatality (3.0%/year, p = 0.002). A trend change point was identified in 2006 for males (no significant trend) and in 2010 for females, after which the AMI case-fatality rates increased. Among males, in-hospital AMI case-fatality decreased significantly from 2015 to 2023 (14.7%/year). Conclusions. Over the two decades, 28-day AMI case-fatality among 25–64-year-old-persons remained unchanged in males but increased in females. In-hospital AMI case-fatality showed no major change in either sex. Males consistently had higher AMI case-fatality rates with age. While aging did not affect AMI case-fatality trends in males, rates rose significantly among older females.

Background Several lifestyle behaviours, including physical activity, smoking, alcohol consumption, nutrition habits, and social activity have been associated with psychological well-being (PWB). However, their effect on PWB prospectively has been less studied. The aim of the present study was to evaluate the influence of lifestyle factors on higher future PWB during the 10-year follow-up of middle-aged and elderly urban population. Methods In the baseline survey (2006 to 2008), 7115 men and women 45–72 years of age were examined within the framework of the international study Health, Alcohol and Psychosocial Factors in the Eastern Europe (HAPIEE). In the follow-up survey (in 2016), which was performed among all 6210 participants who survived till that year, 4266 individuals participated responding to postal questionnaires. PWB was assessed by a CASP-12 questionnaire. The lifestyle behaviours, including smoking and nutrition habits, alcohol consumption, social and physical activity, were evaluated by the questionnaire. Multivariable logistic regression models were applied for statistical data analysis. Results After accounting for several potential confounders, healthy levels of lifestyle behaviours were associated with higher PWB after 10-year follow-up. Never-smokers in men and former smokers in women had higher PWB by 43 and 67% odds respectively in comparison with smokers. Physical activity in women and high social activity both in men in women was positively related to higher PWB. More frequent fresh vegetable and fruit consumption was associated with higher odds of higher PWB (odds ratio 1.57 in men and 1.36 in women, p  < 0.05) compared to less frequent consumption of such food groups. Dose-response relationship between increasing number of healthy lifestyle factors and higher PWB was determined both in men and women. Conclusions Lifestyle factors such as never smoking and former smoking, high social activity, and more frequent fresh vegetable and fruit consumption increased the odds of higher PWB over 10 years of follow-up in men and women groups. The increase of the protective health behaviour score was directly associated with the odds of higher PWB.

Background and Objectives: Depression has emerged in recent years as a significant global health issue, drawing considerable research interest and attention. The development of depression could be impacted by a range of environmental factors. Aim: To investigate the relationship between depressive symptoms and various indoor environmental factors, such as microclimate, odors, mold, and room ventilation, in association with some sociodemographic and lifestyle factors. Materials and Methods: This epidemiological health survey of the study “Chronic diseases and their risk factors in the adult population” was performed during 2023–2024 in Kaunas city (Lithuania) following the methodology of the WHO MONICA study. A random sample of Kaunas inhabitants aged 25–69 years, stratified by sex and age, was randomly selected from the Lithuanian population register. The 3426 individuals were screened. The associations of various indoor environmental factors with depressive symptoms were investigated using binary logistic regression analysis. Results: Depressive symptoms were associated with sociodemographic, lifestyle, and indoor environmental factors. Poor microclimate conditions, unpleasant household odors, mold exposure, and insufficient room ventilation were associated with increased odds of depressive symptoms. The significance of these associations varied across sex, age, marital status, socioeconomic status, and physical activity of responders. Additional multivariable logistic regression analyses, including interaction terms between each indoor environmental factor and the stratification variables (sex, age groups, marital status, family economic situation, and physical activity), were performed. Significant interaction was found only between family status and room ventilation (p = 0.007). This indicates that the association between ventilation and depressive symptoms differed by family status. Conclusions: This study contributes to the cross-disciplinary understanding of the role of indoor environmental quality, sociodemographic, and lifestyle factors in the development of depression, adding to the evidence on the role of other factors in depression inequalities.

Background and Objectives: Stroke remains a major contributor to global morbidity and mortality, with substantial geographic variation in incidence and outcomes. Although declining trends in stroke incidence and mortality have been documented in several Western European populations, countries in Eastern Europe have historically experienced a disproportionately high cardiovascular disease burden. Comprehensive long-term evaluations assessing simultaneous trends in stroke attack rates, mortality, and case-fatality in Lithuania are limited. This study aimed to investigate 24-year trends (2000–2023) in stroke epidemiology among working-age residents of Kaunas city. Materials and Methods: Data were derived from the Kaunas population-based stroke registry and included individuals aged 25–64 years. Age-standardized attack rates, mortality rates, and case-fatality rates per 100,000 population were calculated using the World Health Organization standard population. Temporal trends were assessed using Joinpoint regression analysis to estimate annual percentage changes (APCs) with corresponding 95% confidence intervals (CIs). Analyses were stratified by sex, age group (25–54 and 55–64 years), and stroke subtype (ischemic and hemorrhagic). Results: During 2000–2023, overall stroke attack rates declined significantly in both sexes, with a more pronounced reduction observed among females. Stroke mortality decreased significantly among females over the entire study period, whereas no significant overall change was observed among males, largely due to increases during 2010–2021 that attenuated earlier and subsequent improvements. Case-fatality rates demonstrated no significant overall long-term trend in either sex but exhibited marked temporal variability, including significant increases during 2010–2021 followed by substantial declines after 2021. Age-stratified analyses confirmed significant reductions in attack rates across both age groups. Ischemic stroke incidence declined significantly in both sexes, while hemorrhagic stroke mortality decreased significantly among males and females. The period 2021–2023 was characterized by pronounced reductions in mortality and case-fatality across multiple subgroups. Conclusions: Over the past two decades, the stroke burden among working-age residents of Kaunas has declined substantially, particularly among females. Despite period-specific deteriorations, recent improvements underscore the impact of advances in stroke prevention and acute care. Sustained risk factor control and continued healthcare system development remain essential to maintain favourable trends.