Tvrdoća vode za piće kao faktor rizika za ishemijsku bolest srca
Stevanović, Slavica D.
Faculty:University of Niš, Faculty of Medicine
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Prevalence of the ischemic heart disease (IHD) differs between populations of different countries. Also, amongst the population in a single country there are geographical variations in the incidence of IHD. If we exclude the unchanging risk factors for cardiovascular disease, a major changeable risk factors such a smoking, high blood pressure, increased cholesterol levels (total and LDL), diabetes mellitus, have so far not adequately explained the geographical variation in incidence of IHD. The existence of areas with high risk for IHD, especially for acute myocardial infarction, indicate that is very likely that environmental factors are also involved in the pathogenesis of the cardiovascular disease, and it is necessary to consider them carefully. In the last five decades epidemiological data have been accumulating on the protective effect of high values of hardness and Ca and Mg from drinking water on morbidity and mortality from cardiovascular disease. The aim of the study
was to determine the interdependence between of hardness of drinking water, as well the risk factor and morbidity from ischemic heart disease. The study presents an epidemiological and ecological (correlation) study, within which a prospective analytical (anamnestic) small-scale study was performed. The research is based on the analyses of water hardness and the content of Ca and Mg in the drinking water of the Nis water supply system (NIVOS). As a source of data for IHD in the territory of Nis district, the relevant section of the National population register of acute coronary syndrome (REAKS) referring to the Nis district was used. The crude and standardized incidence rates (per specific gender and age) in the territorial units of Nis district formed on the basis of different hardness values of drinking water were calculated. A spatial distribution (map) of the average total crude incidence rate of IHD in the reporting period 2010-2012 was produced as well. As part of the anamnestic study, through interviews and using the original structured epidemiological questionnaire, information has been collected on how to enter drinking water and risk factors for IHD (smoking, physical activity, hereditary burden of heart disease and diabetes) in 200 subjects with territorial units in which the highest and lowest values of the hardness of drinking water and the contents of Ca and Mg. To determine the average daily energy intake (which includes the daily intake of fat, protein and carbohydrates), as well as the intake of Mg and Ca in patients, we used the validated semi-quantitative questionnaire on the frequency of food intake in the previous year, Food Frequency Questionnaire (FFQ). Testing of the nutritional status of subjects was carried out by measuring the anthropometric parameters (height, weight) using standard procedures to determine body mass index (BMI) as the ratio of body weight in kilograms by height squared in meters (kg / m2). Having reviewed the medical records of patients, data was collected on blood cholesterol, triglycerides and LDL cholesterol levels, and systolic and diastolic blood pressure. Research has shown that subjects who consumed soft and medium soft water for drinking (area Niska Banja) for over 10 years had a significantly higher incidence rate of IHD compared to people of the same sex and age who consume hard drinking water (villagers connected to the Moravian-part of the water supply system NIVOS). Although the daily intake of drinking water in the subjects was on average less than 2 l, using an amnestic study it was found that a negative correlation between Ca and Mg from drinking water and its hardness with IHD and risk factors for IHD existed: elevated triglycerides, total and LDL cholesterol, systolic and diastolic blood pressure. This survey also confirmed low intake of Ca and Mg in the food as risk factors for IHD as well as known risk factors for cardiovascular disease: a hereditary predisposition to heart disease, smoking and fat intake. Using a binary logistic regression analysis it was shown that the greatest influence on the occurrence of IHD, out of all investigated risk factors, is due to the magnesium from water (equivalent to Ca from the water - a protective factor, p = 0.000), magnesium from food (protective factor, p = 0.000) and fat (factor risk, p = 0.000). From the aspect of prevention of IHD, the ROC analysis determined that it is necessary to add per day for at least 75 mg of Ca and Mg 7 mg though drinking water and 802 mg of calcium and 260 mg of Mg though food intake. The results of this study suggest that the degree of hardness of drinking water in the central water supply systems should increase to the optimal 180dH- 200dH. Legislating water hardness, Ca and Mg in the regular assessments of drinking water would lead to an overall reduction of morbidity and mortality from cardiovascular disease.View More
Keywords:tvrdoća vode za piće; hardness of drinking water; calcium; magnesium; ischemic heart disease; kalcijum; magnezijum; ishemijska bolest srca