The findings from the CHUK program study provide critical insights into the CV health of the Polish population and highlight significant public health challenges that need urgent attention. The study reveals a concerning escalation in various CV risk factors, underscoring the need for targeted interventions to mitigate these risks. The study also highlights significant trends over time in various CV risk factors. The number of people surveyed experienced notable fluctuations, with a high number of participants in 2012, a sharp decline in 2013, a steady increase from 2014 to 2019, and another sharp decline in 2020 due to the COVID-19 pandemic. These trends may reflect broader societal and healthcare changes, including the impact of public health campaigns, economic factors, and the global pandemic.
This study found the marked sex disparities in the prevalence of CV risk factors. Men consistently exhibited higher rates of smoking, hypertension, elevated TC, increased LDL-C, decreased HDL-C, hypertriglyceridemia, hyperglycemia, overweight, and obesity compared to women. These disparities suggest that men in Poland are at a significantly higher risk of developing CVDs than women. Therefore, public health initiatives should consider these sex differences and design tailored interventions that specifically address the higher risk profiles observed in men. The study observed high and relatively stable prevalence rates of hypertension and elevated cholesterol levels. While there were some improvements in total and LDL-C levels, these were insufficient to mitigate the overall risk, indicating a need for more aggressive interventions to manage blood pressure and cholesterol levels effectively.
According to the results of the a research from Austria, in the years 2007 and 2014 the percentage of men smoking tobacco did not change and amounted to 26.0%, while in the case of women it increased from 19.1–22.0% [29]. According to the results we received, men are also much more likely than women to smoke, but during the period of the study the prevalence of tobacco smoking in Poland has been systematically decreasing. However, the prevalence of smoking remained high throughout the entire study period, particularly among men. This persistent high prevalence indicates that existing anti-smoking campaigns may not be sufficiently effective and that new strategies are needed to reduce smoking rates. Interestingly, according to results obtained by Allagbé et al., different factors affect smoking cessation in men and women [30].
Data on the prevalence of hypertension vary in different regions of the world. In Poland, 35.3% of the general population was estimated to be hypertensive, including 20.6% of individuals not previously diagnosed with hypertension [31]. Similar prevalence of hypertension has been found in Italy (36%)32. According to the results obtained by Choi et al., the prevalence of hypertension is also higher in men (34.6%) than in women (30.8%) among Korean adults aged 30 years and over. It should be emphasized that this study also included elderly people, and among people aged 60 years and over, women are more likely to suffer from arterial hypertension [33]. Similarly, according to a study conducted in India on a large cohort of 699,686 women (15–49 years) and 112,122 men (15–54 years), hypertension was more common among men (16.32%) than among women (11.56%) [34]. On the other hand, a study conducted in Bangladesh showed that women suffer from hypertension more often than men (8.9% vs. 4.5%). The study included 2600 persons aged ≥ 18 years in one rural district. Although there was no upper age limit, the mean age of the study participants was 41.6 ± 17.8 years [35]. The study by Fahimfar et al. focuses on the prevalence and control of hypertension and its associated factors revealing that, despite the availability of effective antihypertensive medications, a significant proportion of the population remains uncontrolled [36]. This finding is particularly relevant to the CHUK study, which also identified high and stable rates of hypertension. Collectively, there is evidence that there are considerable gaps in treatment adherence and healthcare access that need to be addressed. Public health policies should include strategies to improve medication adherence, patient education, and regular monitoring to control hypertension and reduce CV risk.
Studies conducted in other countries also confirm that dyslipidemia remains a significant CV risk factor although the results from different parts of the world are very diverse. In Central and Eastern European countries, the estimated prevalence of hypercholesterolemia in the population ranges from 76.67 to 80.47% among men and from 82.89 to 89.60% among women [37]. According to a study conducted in Canada, dyslipidemia is more prevalent in males (56.7%) versus females (44.7%)38. It is difficult to compare this unambiguously with our results because in our study we performed separate statistics for individual lipid fractions, without referring to the diagnosis of dyslipidemia in general. In contrary to our results, according to researchers from Nigeria, hypercholesterolemia occurs more often in women than in men (42% vs. 38%)39. However, in the study conducted in Tehran the prevalence of hypercholesterolemia is clearly lower than in our study, with a predominance of women (25.8% vs. 19.1%), while hypertriglyceridemia occurs clearly more often than in our population, with a predominance of men (42.4% vs. 31.6%). In the mentioned study, women were also more likely than men to have high LDL-C (56.5% vs. 55.3%) and low HDL-C (30.5% vs. 27.4%), which is contrary to our results [40]. It is worth emphasizing that dyslipidemia is considered to be one of the worst controlled cardiovascular risk factors. According to a study by Ghazwani et al., about 60% of people have never had a lipid profile test [41].
Based on a large study conducted in Austria, it was estimated that prediabetes affects 21.084% of the population [42]. In a meta-analysis of 17 studies (data from 1995 to 2018) performed in Pakistan by Hasan et al., the prevalence of prediabetes was estimated to be 11.0% and diabetes 10.0%43. According to a meta-analysis conducted by Vera-Ponce et al., the prevalence of diabetes in Latin America is much higher and amounts to 24% [44]. The Columbia study found that 11.2% of subjects had abnormal fasting venous plasma glucose levels [45]. The cited studies typically included adults without age restrictions, differing from our study. The observed incidence of hyperglycemia consistent with diabetes was lower than reported by Hasan et al. However, a single glycemia measurement without clinical symptoms cannot confirm or exclude diabetes or carbohydrate metabolism disorders. Diagnosing diabetes often requires glycated hemoglobin levels or an oral glucose tolerance test, complicating direct comparisons with other studies.
The high prevalence of low physical activity, overweight, and obesity is particularly alarming. Despite numerous public health initiatives promoting physical activity and healthy eating, these risk factors remained prevalent and even increased over time. Similar conclusions come from other scientific studies conducted in various countries of the world [46, 47]. This trend is concerning as it suggests that current strategies may not be effective enough and that a more comprehensive approach, including policy changes, community-based interventions, and individual behavior modifications, is required.
Our findings align closely with Pająk et al., who also identified persistent issues with hypertension, hypercholesterolemia, smoking, obesity, and diabetes in the Polish population [48]. Pająk et al. reported that the prevalence of hypertension in men ranged between 29% and 46% and in women between 29% and 43%, which is consistent with our findings. However, our study extends these findings by highlighting the significant impact of the COVID-19 pandemic on the control of these risk factors. Our study extends this by examining the impact of the COVID-19 pandemic on trends in cardiovascular risk factors. Routine screenings and follow-ups decreased, likely worsening trends such as unawareness of hypercholesterolemia and insufficient treatment targets. Pająk et al. also noted declining smoking rates, our data reveal pandemic-related relapses among former smokers and increased smoking rates overall. Rising trends in obesity and diabetes, including BMI and central obesity, observed by Pająk et al., were exacerbated during the pandemic by lockdown-induced lifestyle changes and stress-related behaviors [48].
A large-scale UK study examined trends in CVD incidence among 22 million people over 20 years. It found that while the incidence of atherosclerotic diseases like CAD and stroke declined significantly, non-atherosclerotic conditions such as heart failure, atrial fibrillation, and valvular heart disease increased. Additionally, socioeconomic disparities played a significant role in CV health outcomes, with the most deprived populations experiencing higher incidence rates of various CV conditions [49]. This highlights the importance of addressing socioeconomic determinants of health in Poland as part of a comprehensive CVD prevention strategy. Furthermore, the stalling decline in CAD incidence in younger age groups suggests that preventive efforts need to be expanded to include lifestyle interventions aimed at younger populations to curb the rising trends of obesity, physical inactivity, and type 2 diabetes. The sharp decline in survey participation in 2020 highlights the impact of the COVID-19 pandemic on healthcare accessibility, disrupting routine medical services, delaying chronic disease management, and restricting access to preventive measures. This underscores the need for resilient healthcare systems to maintain continuity of care during global health crises.
Implications for public health policy
The findings of this study have several implications for public health policy in Poland. Firstly, there is a need for more robust and targeted public health campaigns to address the high prevalence of CV risk factors, particularly among men. Secondly, interventions should focus on promoting healthy lifestyles, including increased physical activity and healthier dietary habits, to combat the rising rates of obesity and overweight. Thirdly, there is a need to improve the effectiveness of existing programs aimed at reducing smoking rates and managing hypertension and cholesterol levels. Lastly, healthcare systems must be strengthened to continue providing essential services and monitoring public health trends during global health emergencies like the COVID-19 pandemic.
Study limitation
This study has several limitations that should be considered when interpreting the results. First, the analysis relied on data from a CVD prevention program, which may introduce selection bias, as participants were likely individuals already motivated to address health issues. Second, no information about current pharmacological treatment was available, limiting the assessment of differences between treated and untreated individuals. Third, no laboratory-confirmed data or clinical measurements were available beyond the reported indicators, which restricts the depth of conclusions drawn from clinical and biological data. Fourth, the absence of personal data collection prevents the study from accounting for potential confounders, such as socioeconomic status or family history of CVD, which may have influenced the observed trends. Additionally, due to the absence of validated SCORE risk charts for individuals under 40 years of age, participants aged 35–39 were assigned an age of 40 for the purpose of risk estimation. While this method has precedent in epidemiological research, it may have introduced bias in absolute risk estimation for this subgroup. Finally, the study spans a decade, during which public health policies and access to healthcare likely evolved, potentially affecting the trends. Finally, the sharp decline in participation during the COVID-19 pandemic in 2020 and 2021 may have skewed the data for those years, further limiting representativeness. These factors should be taken into account in future research to allow for a more comprehensive understanding of cardiovascular risk trends.