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Hypercholesterolemia and Prevention Of REVIEW/COMMENT International Journal of Occupational Medicine and Environmental Health 2019;32(6):865 – 872 https://doi.org/10.13075/ijomeh.1896.01446 HYPERCHOLESTEROLEMIA AND PREVENTION OF CARDIOVASCULAR DISEASES IN THE LIGHT OF PREVENTIVE MEDICAL EXAMINATIONS OF EMPLOYEES IN POLAND DANIEL ŚLIŻ1,2, ANDRZEJ MARCINKIEWICZ3, DOMINIK OLEJNICZAK4, PIOTR JANKOWSKI5, ANNA STANISZEWSKA6, ARTUR MAMCARZ1, and JOLANTA WALUSIAK-SKORUPA3 1 Medical University of Warsaw, Warsaw, Poland 3rd Department of Internal Medicine and Cardiology 2 Centre of Postgraduate Medical Education in Warsaw, Warsaw, Poland School of Public Health 3 Nofer Institute of Occupational Medicine, Łódź, Poland Department of Occupational Diseases and Environmental Health 4 Medical University of Warsaw, Warsaw, Poland Department of Public Health 5 Jagiellonian University Medical College, Kraków, Poland 1st Department of Cardiology, Interventional Electrocardiology and Hypertension 6 Medical University of Warsaw, Warsaw, Poland Department and Institute of Experimental and Clinical Pharmacology Abstract Long-term exposure to hypercholesterolemia is the cause of atherosclerosis, which in turn causes cardiovascular and cerebrovascular events. In de- veloped countries, including Poland, vascular diseases are the main cause of death. They affect an ever younger part of the population, including the working population. The authors address the problem of epidemiology of cardiovascular diseases, unsatisfactory detection and treatment, economic consequences for the health care system, and the possibilities of using occupational medicine services in the prevention of this health problem. Due to the fact that the early detection of diseases caused by high blood cholesterol levels is relatively low in Poland, obligatory occupational medicine examinations seem to be a key element of the second-line prevention. Therefore, it seems natural to consider the idea of extending the scope of obligatory examina- tions and introducing tests that allow lipid disorders to be detected at an early stage. This can contribute to a general improvement of the health of the population, and to economic benefits, such as a decrease in the costs of treatment of the disorders that have been detected too late. Broadening the scope of occupational examinations is also important from the perspective of public health and epidemiology of cardiovascular diseases, thus being an element of prevention of civilization diseases. It means improving health and building health awareness, and it should translate into regular health examinations. The performance of these examinations should result not only from the obligation, but also from the patient’s conviction about the importance of early detection of disorders, including lipid disorders, for an effective therapy. Int J Occup Med Environ Health. 2019;32(6):865–72 Key words: cardiovascular diseases, occupational health, prophylaxis, hypercholesterolemia, secondary prevention, cholesterol Received: February 11, 2019. Accepted: August 9, 2019. Corresponding author: Dominik Olejniczak, Medical University of Warsaw, Department of Public Health, Nielubowicza 5, 02-097 Warsaw, Poland (e-mail: [email protected]). Nofer Institute of Occupational Medicine, Łódź, Poland 865 REVIEW/COMMENT D. ŚLIŻ ET AL. INTRODUCTION of changes depend heavily on the length and intensity of Cardiovascular diseases (CVDs) are the main cause of exposure to risk factors, such as stress, lack of physical ac- death worldwide. According to the World Health Organ- tivity, or poor diet. The phenomenon of a rapidly aging isation (WHO), about 17 million people die of CVDs an- society seems important in this context, too. nually (49% of all deaths due to non-communicable dis- A high level of cholesterol is the most important modifi- eases). This rate is almost 2 times higher than the mortali- able risk factor for cardiovascular diseases. Its reduction ty rate for cancer, which is the second cause of death in the decreases the risk of cardiovascular diseases in the pop- world. In addition, CVDs are the main cause of premature ulation. Health intervention in the group at the highest deaths. Data on the European population in 2012 showed CVD risk, that is the population group aged 40–59, pro- that CVDs caused 38% and 35% of deaths among women duces the best health effects. and men < 75 years of age, respectively [1]. Since 1991, a gradual decrease in CVD mortality has been The epidemiological situation in Poland in 2014 was observed. However, due to these diseases, the life expec- similar: cardiovascular diseases accounted for 45% of all tancy of the Polish population is still shorter by 3–7 years, deaths (40% among men, 50% among women), thus be- compared to the life expectancy in the 15 “old” countries ing the first cause of death in the Polish population, pre- of the European Union [2]. ceding cancer. The average was 476 deaths a day, with There is no doubt that cardiovascular diseases constitute every fifth death being premature. It is worth noting that the main health risk for the Polish population and a great CVDs are becoming the main cause of death in the age challenge for the Polish health care system. This challenge group > 69 years [2]. In addition, the NATPOL 2011 study involves the need to use existing organizational and legal showed that the incidence of elevated low-density lipopro- solutions, such as preventive medical examinations of em- tein cholesterol (LDL-C) was approx. 58% for both sexes. ployees. These examinations are performed > 4.5 million Improper levels of total cholesterol (TC) and LDL-C have times a year, and each of more than 12.5 million of work- been most frequently found in persons aged 40–59 (> 71% ers in Poland is obliged to undergo a preventive exami- of respondents); therefore, this age group is considered to nation at least once in 4 years [6], which means that the be at the highest CVD risk [3]. occupational health care system may, and should, be con- Data presented in the study of 2016, entitled “Health sidered an element of public health aimed at the preven- condition of the Polish population and its determinants,” tion of civilization disorders, which should result in fitness show that Poland is one of the developed countries that to work being sustained or prolonged. are characterized by a high percentage of premature The risk factors for cardiovascular diseases and their oc- deaths (according to the PYLL index – potential years of currence in the Polish population are presented below. life lost), where cardiovascular diseases are the first cause of death among men (26%), and the second cause of death MAIN RISK FACTORS among women (21% preceded by cancer – 41%). FOR CARDIOVASCULAR DISEASES In addition to being the main cause of death, CVDs are Cardiovascular diseases are mainly caused by atheroscle- also the main cause of morbidity, hospitalizations, inva- rosis. The predominant role in etiopathogenesis, develop- lidity and sickness absenteeism [4,5]. It should be empha- ment and progression of atherosclerosis is played by modi- sized that the formation and development of atheroscle- fiable risk factors associated with improper lifestyle (poor rotic plaques progress with age, and the pace and type diet, too low physical activity, etc.). These risk factors 866 IJOMEH 2019;32(6) HYPERCHOLESTEROLEMIA AMONG POLISH EMPLOYEES REVIEW/COMMENT may lead to lipid metabolism disorders (hyperlipidemia) fied for the statin therapy. They receive recommendations or hypertension, which are considered to be the main for a healthy lifestyle (which they often do not follow). The risk factors for CVDs. A multicenter INTERHEART initial lack of symptoms can pose a certain health threat, study, the results of which were included in the WOBASZ since the patient leaves the doctor’s office with a delusive (Wieloośrodkowe Ogólnopolskie Badanie Stanu Zdrowia feeling of being in full health, and often has no motiva- Ludności) study [4], showed that the 2 risk factors men- tion to follow the recommendations. Consequently, when tioned above, nicotine addiction, diabetes, abdominal obe- the patient visits the doctor again after many years, he/she sity and psychosocial factors, as well as cardioprotective might already suffer from advanced atherosclerosis, myo- factors: fruit and vegetable intake, low alcohol consump- cardial infarction or stroke. Therefore, the key role of the tion and regular physical activity, influenced 90% and 94% doctor is to make the patient aware of the health threat. of cardiovascular events in men and women, respectively. In this respect, obligatory employee medical examinations It is worth noting that this relationship was demonstrated may prove particularly helpful, as they can help achieve in all regions of the world and in all age groups. a much higher rate of following medical recommendations A reduction of the risk factors, as the best method of decreas- among patients, reaching > 90% [8]. ing CVD mortality, has been confirmed in numerous studies around the world, which were presented in the introduction LIPID DISORDERS – GOALS OF TREATMENT to the WOBASZ analysis. Similar results were obtained in The most important treatment goal is related to LDL-C, an analysis conducted in Poland in 1991–2005, which showed and it depends on the overall cardiovascular risk. Non-high that a reduction of the risk factors in the population of adult density lipoprotein cholesterol levels can be the secondary Poles brought about a 54% decrease in mortality from coro-
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