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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.

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.

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.

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). 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. 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. 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 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.

: The Lancet Commission proposes a new obesity definition that combines body mass index (BMI) with anthropometric measurements to distinguish adipose tissue excess more effectively. This study aims to determine the prevalence of obesity based on the new definition and to examine cardiometabolic risk factors and lifestyle habits across different obesity phenotypes in the urban population of Lithuania. : This study was conducted among residents of Kaunas city from 2020 to 2024. A total of 3426 adults aged 25-69 years (57.1% of the random sample) were participated. Three individuals were excluded due to missing anthropometric data. Participants were categorized into three phenotypes: (1) no obesity (BMI < 30 kg/m and no or one elevated anthropometric measure, (2) anthropometric-only obesity (BMI < 30 kg/m and at least 2 elevated anthropometric measures), and (3) BMI-plus-anthropometric obesity (BMI ≥ 30 kg/m plus at least one elevated anthropometric measure or BMI ≥ 40 kg/m ). Standardized anthropometric, biochemical, and clinical measurements were collected, along with self-reported dietary habits and leisure-time physical activity. : Anthropometric-only obesity was highly prevalent, affecting 36.1% of males and 22.7% of females ( < 0.05). The prevalence of BMI-plus-anthropometric obesity was 24.1% among males and 21.4% among females. Individuals with anthropometric-only obesity had significantly higher odds of metabolic syndrome (OR 8.64; 95% CI 6.97-10.71), diabetes (OR 3.01; 95% CI 1.72-5.25), coronary heart disease (OR 1.48; 95% CI 1.12-1.97), and several lipid abnormalities compared with those without obesity. The highest cardiometabolic risk was observed in the BMI-plus-anthropometric obesity group. Greater adiposity was associated with higher intake of red meat, junk foods, and sugary drinks, while physical activity levels declined across obesity categories. : Anthropometric-only obesity is a common and metabolically adverse phenotype that cannot be detected using BMI alone. A new obesity definition enhances identification of high-risk individuals and supports targeted prevention strategies.

It is unclear whether the dose–response relationship between lung function and all-cause and cardiovascular mortality in the Central and Eastern European populations differ from that reported in the Western European and American populations. We used the prospective population-based HAPIEE cohort that includes randomly selected people with a mean age of 59 ± 7.3 years from population registers in Czech, Polish, Russian and Lithuanian urban centres. The baseline survey in 2002–2005 included 36,106 persons of whom 24,944 met the inclusion criteria. Cox proportional hazards models were used to estimate the dose–response relationship between lung function defined as FEV1 divided by height cubed and all-cause and cardiovascular mortality over 11–16 years of follow-up. Mortality rate increased in a dose–response manner from highest to lower FEV1/height 3 deciles. Adjusted hazard ratios (HR) of all-cause mortality for persons in the 8th best, the 5th and the worst deciles were 1.27 (95% CI 1.08‒1.49), 1.37 (1.18–1.60) and 2.15 (1.86‒2.48), respectively; for cardiovascular mortality, the respective HRs were 1.84 (1.29–2.63), 2.35 (1.67–3.28) and 3.46 (2.50‒4.78). Patterns were similar across countries, with some statistically insignificant variation. FEV1/height 3 is a strong predictor of all-cause and cardiovascular mortality, across full distribution of values, including persons with preserved lung function.

The aim of this study was to determine the association between the daily number of cases of ischemic stroke (IS) and hemorrhagic stroke (HS) in patients aged 25–64 years and the El Niño-Southern Oscillation (ENSO) events during 2000–2015. As an indicator of the effect of the ENSO, the monthly NIÑO 3.4 index (Equatorial Pacific Sea Surface Temperature) was used. During the 5844-day study period, 5600 cases of stroke (3170 (56.61%) in men and 2430 (43.39%) in women) were analyzed. Of these, 4354 (77.8%) cases were IS, and 1041 (18.6%) cases were HS. In 3496 (62.2%) cases, stroke occurred in the age group of 55–64 years. In the analysis, we used the following categories of the ENSO events: strong La Niña, moderate La Niña, moderate El Niño, and strong El Niño. The effect of the ENSO was examined by using the multivariate Poisson regression adjusting for weather variables. The highest risk of both strokes (BS) was observed on days of strong and moderate La Niña (rate ratio (RR) 1.27, 95% CI 1.13–1.42) and RR = 1.15 (1.07–1.23), respectively), while the risk for IS was the highest on days of moderate El Niño (RR = 1.11(1.02–1.20)). A lower risk for BS was found on days of strong El Niño (RR = 0.77(0.62–0.97)). We found that ENSO events affected the occurrence of BS and IS in all age groups, and the strongest effect was observed among females. The results of this study provide new evidence that ENSO events may affect the risk of stroke, especially the risk of IS.

Background and Objectives: Over the past decades, various epidemiological analyses have reported a significant decrease in the number of deaths related to cardiovascular diseases (CVDs). Trends in acute myocardial infarction (AMI) morbidity and mortality from ischemic heart disease (IHD) were less studied in Eastern and Central Europe. This study aimed to determine and evaluate changes in AMI morbidity and mortality from IHD among the middle-aged urban Lithuanian population during 2000–2023. Materials and Methods: The data source was the Kaunas ischemic heart disease registry for residents aged 25–64. The diagnosis of AMI was based on the proposed epidemiological criteria used in the WHO MONICA project protocol. Age-standardized morbidity and mortality rates were calculated per 100,000 population. The changes in morbidity and mortality rates were calculated using the Joinpoint regression analysis method, and changes presented as a percentage estimate per year. Results: During 2000–2023, it was observed that age-standardized AMI morbidity significantly changed in the 25–64-year-old male and female population (−1.3%/yr., p = 0.006 and −2.3%/yr., p < 0.001, respectively). In males aged 25–54, a significant decrease in AMI morbidity rates by an average of 2.2%/yr. (p < 0.001) was found, contrary to the males aged 55–64, where morbidity was without substantial changes. We found a significant decrease in AMI morbidity in both age groups (the younger and older) of females, by 2.1%/yr. (p = 0.002) and 2.4%/yr. (p < 0.001), respectively. In the 25–64-year-old male population mortality from IHD significantly decreased (−2.0%/yr., p < 0.001), whereas in females it did not significantly change. Mortality from IHD in males aged 25–54 and 55–64 years significantly decreased by an average of 3.3%/yr. (p = 0.002) and 1.2%/yr., (p = 0.004), respectively. No significant trends in mortality from IHD in both age groups of females over the past 24 years were observed. Conclusions: During the study period, the age-standardized AMI morbidity among Kaunas middle-aged males and females significantly decreased. The age-standardized mortality from IHD decreased significantly among Kaunas middle-aged males, but there were no significant changes among females.