Aim. The aim of this cross-sectional prospective study was investigate whether there is a correlation between age, BMI and severity of chronic venous disease (CVD), evaluated clinically (CEAP classification) and anatomically (extent of the epifascial venous reflux).Methods. 213 patients, 65 males (30.5%, mean age 45.1±13.9 years) and 148 females (69.5%, mean age 47.5±13.5 years) were divided into three age categories: 18-40 years (40.8%), 41-74 years (56.3%) and ≥75years (2.8%). BMI was classified as normal weight (18.5 -<25 kg/m 2 ), overweight (25 -<30 kg/m 2 ) and obesity (≥30 kg/m 2 ). Clinical examination of the lower limbs assessed presence and severity of venous signs as included in the CEAP classification. BMI was calculated. Anatomical extent of CVD was described as the number of segments of the superficial and perforating veins with documented reflux by duplex imaging.Results. Median age increased the number of insufficient venous segments (1 insufficient venous segment -median age 41.0 years, 5 insufficient venous segments -median age 51.0 years). The frequency of reflux in the superficial and perforating veins sign i ficantly increased with age (p<0.05). A statistically significan correlation was also found between age and the CEAP classification (p<0.01). This was more significant than the correlation between age and number of insufficient venous segments. In the whole group and in women the Spearman's correlation analysis revealed only a weak positive correlation between BMI and reflux in the superficial veins (r=0.145 respectively r=0.264) (p<0.05). No correlation was found in men (r=0.091). Weak positive correlation between BMI and stage of venous insufficiency (CEAP classification) was demonstrated for the whole group of patients (r=0.229, p<0.01), for women (r=0.293, p<0.05) and for men (r=0.245, p<0.01). Multiple linear regression showed age (p<0.0001) and BMI (p=0.049) as significant predictors of clinical grade according to the CEAP classification and the CEAP clinical class (p<0.0001) as a significant predictor of extent of the epifascial venous reflux.Conclusions. The study confirmed the relationship between age, clinical (CEAP clinical class) and pathophysiological (extent of the venous reflux) severity of CVD. Older age means an increased number of insufficient venous segments and increased risk of the clinical progression of CVD from varicose veins to chronic venous insufficiency (C 3 -C 6 , trophic skin changes and venous ulcers). Our results support the BMI, in term of frequency of venous reflux, as a risk factor in the whole group of patients but only in women but not in men. Multiple linear regression showed BMI together with age as significant predictors of clinical grade of CVD (p<0.05) according to the CEAP classification. As regards the influence of BMI on clinical severity/grade of CVD (CEAP), the results of our study support BMI as an important risk factor.

The aim of the study was to determine the prevalence of risk factors for cardiovascular diseases among physicians at a teaching hospital. In total, 203 men and 167 women were included in the study. The participants filled in a questionnaire; their height, weight, blood pressure, serum cholesterol and glucose levels were added. 19.2 % males and 13.8 % females were smokers, hypertension was diagnosed in 10 % of males and in 6.6 % of females, 52.2 % males and 17.4 % females were overweight, 37 % males and 43.1 % females had hypercholesterolemia. The above findings suggest that Czech physicians have more favourable values of all the studied cardiovascular diseases risk factors than the general Czech population. However, Czech physicians smoke more than those in other countries and their level of cardiovascular diseases risk factors is unsatisfactory and calls for further intensive prevention. Preliminary outcomes of the study repeated after two years show no positive trends as well as physicians' low willingness to actively participate in lowering cardiovascular diseases risk factors.

Aims This study was aimed to investigate the prevalence of venous thromboembolism in patients with chronic venous disease and the impact of some intrinsic and extrinsic risk factors. Methods A retrospective study on 641 outpatients (489 women) with primary chronic venous disease (C-C). The prevalence of venous thromboembolism was evaluated according to sex, age, BMI, the presence of ≥1 first-degree siblings diagnosed with venous thromboembolism, CEAP clinical class, smoking and the use of hormone therapy. Results Venous thromboembolism episodes occurred in 32 patients (5%) with no gender predominance (OR 1.49, 95% CI = 0.90-2.45; p = 0.146). There was no increased RR of venous thromboembolism in the age group 46-69 years compared with patients aged ≤45 years ( p = 0.350). In persons aged ≥70 years, the risk of venous thromboembolism was 3.2 times higher than in patients aged 46-69 years and 4.78 times higher than in patients aged ≤45 years. The risk of venous thromboembolism rose very significantly in obese compared with normostenic patients ( p = 0.002). There were significantly more venous thromboembolism episodes in patients with chronic venous insufficiency (55.3%) than patients with varicose veins (44.7%) ( p < 0.001). A family history of venous thromboembolism ( p = 0.12), smoking ( p = 0.905) and hormone therapy ( p = 0.326) were not associated with increased risk of venous thromboembolism. Smoking was a risk factor in obese patients ( p = 0.033), but the combination of obesity, smoking, estrogens in women did not increase the risk of venous thromboembolism. Conclusions The 5% prevalence of venous thromboembolism episodes in patients was comparable with the prevalence of venous thromboembolism in the general European population. Age ≥70 years and obesity were strongly associated with an occurrence of venous thromboembolism. Obese patients with chronic venous disease were at higher risk for venous thromboembolism than obese people in the general population. A family history of venous thromboembolism, smoking and estrogens alone or in combination were not revealed as significant risk factors.

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Summary:Background: Primary chronic venous disease (CVD) is associated with an increased risk of superfi cial vein thrombosis (SVT). While CVD is a predominant factor in SVT, there is a range of additional predisposing factors. The objective was to investigate the association between age, gender, BMI, smoking, oestrogen hormone therapy, family history of venous thromboembolism (VTE) and CEAP clinical classifi cation in patients with CVD and a history of SVT. Patients and methods: In a retrospective observational study on consecutive patients with primary CVD, 641 outpatients were enrolled (152 men, 23.7 %; 489 women, 76.3 %). The prevalence of SVT was evaluated according to age, BMI, smoking, presence of family history of VTE, use of hormone therapy, and clinical class of CVD. Results: Risk of SVT was signifi cantly increased in women (OR 1.68, 95 % CI = 1.02 -2.76; p = 0.041), older patients (46 -69 years, OR 1.57, 95% CI = 1.03 -2.4; p = 0.036, ≥ 70 years, OR 2.93, 95 % CI = 1.5 -5.76; p = 0.001), smokers (OR 1.69, 95 % CI = 1.1 -2.58; p = 0.015) and in persons with fi rst-degree siblings diagnosed with VTE (OR 2,28, 95 % CI = 1.28 -4.05; p = 0.004). The risk was signifi cantly increased in older male smokers (p -0.042). In women, smoking and oestrogen therapy (p = 0.495) did not increase the risk of SVT even older women or in those with increased BMI. In CVD (C0 -C3), a history of episodes of SVT was found in 103/550 (18.7 %), in chronic venous insuffi ciency (CVI) in 27/91 (29.7 %). There was a signifi cantly higher prevalence of SVT in patients with CVI (OR 1.70, 95% CI = 1.1 -2.5; p = 0.016). Conclusions: In patients with primary CVD, SVT was signifi cantly associated with female gender. In men, older age, smoking and positive family history of VTE were relevant SVT risk factors. In women, risk factors were older age, BMI ≥ 25 kg/m 2 and positive family history of VTE. Compared with C0 -C3 clinical classes, CVI signifi cantly increases the risk of SVT.

Objectives: Health care workers constitute a high-risk occupational category owing to the character of their work that includes high-risk environment, shift work and mental as well as physical stress. In occupational medicine, caring for their health condition should be a priority and include measures aimed at preventing cardiovascular diseases. The study aimed at determining the prevalence of cardiovascular disease (CVD) risk factors in employees of a large hospital and assessing their effect on the incidence of cardiovascular events. Materials and Methods: The group comprised 3124 employees with a mean age of 36.1 years (SD = 11.4), out of whom 562 were males (mean age of 37.1 years, range: 18-72; SD = 12.26) and 2562 were females (mean age of 35.9 years, range: 18-68; SD = 11.24). At their initial examination, the employees filled in a questionnaire on basic CVD risk factors (according to valid recommendations). This was supplemented with objective data to determine the risk of CVD using valid charts. From this group, a subset of persons at a high or intermediate risk was selected, comprising 247 individuals with a mean age of 54.1 years (SD = 5.73). After 5-9 years (mean 7.24±1.38 years), they either underwent another examination or their health status was ascertained by phone or in a computer database. The end point was the incidence of cardiovascular events (sudden death, acute myocardial infarction, unstable angina pectoris, percutaneous coronary intervention, cardiac failure, stroke or transient ischemic attack). Results: The end point was noted in a total of 15 males (6.07%) and 6 females (2.42%), being statistically significantly present in managers (males p < 0.00007, females p < 0.00001), male physicians/surgeons (p < 0.025), tertiary-educated males (p < 0.0095), female smokers (p < 0.015), male ex-smokers (p < 0.007), overweight or obese males (p < 0.02) and those with the waist-to-hip ratio above 1.0 (p < 0.005). Conclusions: Cardiovascular events are most likely to occur in obese male physicians/surgeons holding managerial positions and in female managers.

AbstractCardiovascular disease (CVD) remains the leading cause of mortality in developed countries. According to the 2012 European Guidelines on Cardiovascular Disease Prevention in Clinical Practice, family history is a cornerstone for risk stratification of CVD. First-degree relatives are persons in whom CVD should be assessed and targeted intervention should be performed. The aims of this pilot study were (i) to determine risk factors (RFs) for cardiovascular disease (CVD) in a group of first-degree relatives of patients with CVD at baseline and after 1 year, (ii) to measure adipocyte fatty acid-binding protein (A-FABP) levels as a potential connecting link between metabolic disease and atherosclerosis, and (iii) to determine the impact of targeted intervention on these parameters. The study comprised 62 asymptomatic subjects (41 males; mean age of 53.8±8.3 years). Preventive examinations and interventions were carried out at baseline and at 1-year follow-up to assess RFs and evaluate A-FABP levels. At 1 year, males had significantly lower levels of cholesterol (median 5.18 vs 4.67, p=0.005), HDL (median 1.24 vs 1.14, p=0.021), LDL (median 3.08 vs 2.46, p=0.021), ApoB (median 0.99 vs 0.82, p=0.012) and A-FABP (median 19.84 vs 16.73, p = 0.015). In females after 1 year, only significantly lower levels of fibrinogen (median 3.10 vs 2.79, p=0.043) were found. All subjects were clinically examined or contacted by phone after a mean of 36.7 months (range, 11–55). Over that time, no serious complications were noted. In males, intervention for RFs leads to lower levels of A-FABP as a potential RF linking metabolic syndrome to atherosclerosis.

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