MEDICINSKI GLASNIK

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224 Medicinski Glasnik, Volumen 6, Number 2, August 2009 and as for the financial status (C=0.208) more than two thirds of participants had low income (monthly household income in average between 1000 and 2000 Kunas). DISCUSSION The prevalence of selected risk factors for CVDs in Western Croatia is high as expected. Our results support the findings of other authors (6, 15-18) that the prevalence of cardiovascular risk factors in Croatia is generally high, but that their ranking varies on the regions, age and sex. Equivalent to Croatian health survey in 2003, in neighbouring Slovenia there was a survey conducted in 2001 - “Risk Factors for Noncommunicable Diseases in Adults in Slovenia” (12). Similar findings regarding to age, sex and regional differences were found, although with some speciality. In Western Croatia smoking was found to be the most frequent risk factor in both genders. The frequency of daily smokers for the Western region in Croatia was higher than that found at the national level (6). In general, more males than females were cigarette smokers, but the difference has been very narrow (18,19). Consuming tobacco, especially cigarette smoking, is the main avoidable risk factor for CVDs. The total of one third of all deaths caused by CVDs can be related to smoking cigarettes (20). The risk for myocardial infarction increases with age and number of cigarettes smoked, so that in middle age female who smoke more than 40 cigarettes every day, the risk rises for 74.6% (22). This problem is more significant due to the fact that the habit is mostly present among the youngest males and females included in this study. Therefore, we conducted the analysis with the middle aged respondents (35-64) as more prominent for presence of cardiovascular risks and related/consequent mortality rates (3). In this age group, opposite to prevalent male smokers in general, more than a half of the males and two thirds of the females are daily smokers or quitted less than 10 years ago. So far Croatia has had many attempts to promote non smoking on the National level. The largest campaign was in 2002 under the title “Say yes to non smoking”. Unfortunately, on a larger scale this action did not last long enough to make its impacts durable (23). On the other hand, we argue that the absence of sensibility for the problem and its true picture, lack of financial support and genuine commitment on the regional level contribute to continuously high level of cigarette smoking. High blood pressure followed by obesity was present in more than 40 % of participants. We found these risks in the middle aged population of both genders. Both of these risks are the elements of the metabolic syndrome (24). More to add, physically inactive was nearly every fourth person, especially females of younger ages. Also, every seventh person in the Region had inadequate nutrition and it can be observed as a special risk for males. In younger males, findings of inadequate nutrition are more frequent. This is an interesting finding in view of the fact that the Western region belongs to the Adriatic area where Mediterranean food is widely accessible and a part of the tradition. (6). The frequency of high blood pressure as a second risk factor for the Western region in Croatia was found little lower than that at the national level (5, 6) and the lowest among the regions (16). The prevalence of hypertension in all regions of Croatia exceeds 50% in males and 44% in females (6). The frequency of obesity as a risk factor in Western region of Croatia was higher than found at the national level (5, 6). Interestingly, the assessment of the results at the national level showed that obesity was one of the most common risk factor found for females but the least prevalent in males (5). Opposite to these findings, in the Western region obesity is a seriously widespread risk factor for males prior to physical inactivity and heavy drinking. The occurrence of heavy drinking in the Western region in Croatia was found lower than that at the national level (6). Stressing the potential but insufficient implementation of secondary
prevention and health promotion, high alcohol consumers were rarely counselled to reduce or stop alcohol use. The importance of heavy drinking cessation is in well known relation to cardiovascular diseases, but also notably other diseases and injuries (25,26). To somewhat summarize the occurrence of risk factors we may say that in the middle aged males, the most prominent risk factor was smoking, followed by high blood pressure, obesity, inadequate nutrition and physical inactivity. The hierarchy was somewhat different in females, except smoking which has also been the leading risk factor in young females, followed by obesity in the middle aged, high blood pressure, physical inactivity and inadequate nutrition. Can the risk factors for CVD itself, without social determinants, correctly assess the situation and be used for health care policy recommendation? The risk assessment is important but insufficient. It would be sufficient if the effects of social determinants on appearance and outcome of cardiovascular disease were unknown. However, the facts and scientific analysis speak precisely the opposite (27). Socio-economic status (SES) is consistently among the most fundamental determinants of health status (28, 29). Furthermore, SES relationship can be attributed to CVDs together with combined effects of differences in health-related behaviours, environmental conditions, social structures, and the availability and delivery of health care (29). Our findings of low education status and low income in relation to high risk for CVDs is in agreement with the findings REFERENCES 1. 2. 3. World Health Organization. European Health for all Database (HFA- DB). http:// www.euro.who. int/HFADB (5 June 2005). Croatian Central Bureau of Statistics, Statistical yearbook 2004. Zagreb: Croatian Central Bureau of Statistics, 2004. Strnad M. Čorić T. Kern J. Polašek O. Mortality due to Cardiovascular Diseases. In: Proceedings of the Symposium on Regional Distribution of Populations Cardiovascular Risk factors in Croatia, Zagreb, Croatia, 2nd December, 2005. Academy of Medical Science Croatia, Zagreb, Croatia, 2005, p.1. Malatestinićet al Smoking in the Croatian Western Region of other authors (5, 29). They also pinpointed that education and income-related disparity influenced particularly the tobacco use and diabetes prevalence. They occur more among the people with a lower SES. The step up in lowering the frequency of CVD risk factors, and the concomitant decrease in CVD mortality among the adults is a chronic disease success story in the United States (29). It produced further good news: at least with regard to trends in blood pressure and blood cholesterol level, people with low annual incomes and low education levels were not left behind. These findings stress the need for public health efforts in finding ways to reach population with lower SES. There are some limitations to our study. First, study was based on cross-sectional samples, thus not designed to assess cause and effect between SES and cardiovascular disease risk factors. Our goal was not to assess the cause, but to determine the population burden of CVD risk factors. Finally, our assessment of disease and risk factors depended on respondents’ ´ honesty. Still, thanks to the CAHS, evidence base for CVD prevention programme in Croatia and its regions was good, providing a national and regional guidance for prevention and health promotion in cardiovascular health. It emphasises the need for a holistic approach in the promotion of healthier lifestyles, especially reducing tobacco use and alcohol consumption and promoting healthy nutrition and physical activities. ACKNOWLEDGEMENT/DISCLOSURE 4. 5. Competing interests: none decleared. Beland Y, Bailie L, Page J. Statistics Canada, Croatian Ministry of Health, and Central Bureau of Statistics: a joint effort in implementing the 2003 Croatian Adult Health Survey. In: Proceedings of the American Statistical Association Meeting on survey research methods. Toronto, Canada, August 2004. American Statistical Association, Toronto, 2004. Lukenda J, Kolaric B, Kolčić I, Pažur V, Biloglav Z. Cardiovascular diseases in Croatia and other transitinal countries: comparative study of publications, clinical interventions, and burden of disease. Croat Med J 2005; 46:865-74. 225
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MEDICINSKI GLASNIK

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