Epidemiology of epilepsy in developing countries.

Epilepsy is an important health problem in developing countries, where its prevalence can be up to 57 per 1000 population. This article reviews the epidemiology of epilepsy in developing countries in terms of its incidence, prevalence, seizure type, mortality data, and etiological factors. The prevalence of epilepsy is particularly high in Latin America and in several African countries, notably Liberia, Nigeria, and the United Republic of Tanzania. Parasitic infections, particularly neurocysticercosis, are important etiological factors for epilepsy in many of these countries. Other reasons for the high prevalence include intracranial infections of bacterial or viral origin, perinatal brain damage, head injuries, toxic agents, and hereditary factors. Many of these factors are, however, preventable or modifiable, and the introduction of appropriate measures to achieve this could lead to a substantial decrease in the incidence of epilepsy in developing countries.     

Epidemiological aspects of cervical neoplasms]

A review concerning the epidemiological issues relating to cervical cancer, one of the most frequent in the women of developing countries, was undertaken in Brazil, the incidence rate varies from 23.7/100,000 in Porto Alegre to 83.2/100,000 in Recife. In the United States, the 1978 incidence rate was 6.8/100,000 in white women and 14.7/100,000 among black women. Several studies have suggested the hypotheses that cervical cancer could be related to some venereal agent. The evidences have shown the human papillomavirus (HPV) to be the main etiological agent. Several studies on the validity of such a hypotheses were realized and it became clear that there does in fact exist a relationship between the HPV and cervical cancer. Finally, the better known risk factors, such as sexual behaviour, smoking and the contraception were studied in the light of the various etiological hypotheses.     

The prevalence of epilepsy follows the distribution of onchocerciasis in a west Ugandan focus.

Epidemiological surveys indicate that the prevalence of epilepsy is higher in developing countries than in industrialized countries. Except for neurocystocercosis due to Taenia solium, little is known about possible underlying causes. This article reports the relationship between epilepsy and onchocerciasis in an Onchocerca volvulus endemic area in West Uganda. Individuals complaining of seizures were identified by means of a population census in 12 villages. Active epilepsy was confirmed in 61 of 4743 inhabitants (crude prevalence rate = 1.3%; age-standardized rate = 1.1%). Distribution of epilepsy in the study area was clustered, ranging from a prevalence of 0.2% to 3.4% in different villages. Age-specific prevalence was highest between 10 and 19 years, with a rate of 3.6% for the study are as a whole, and up to 10.0% in villages of high epilepsy prevalence. The prevalence of onchocerciasis in the 10-19-year-old age group was assessed by skin-snip biopsy and ranged from 15% to 85% in different villages. Epilepsy was significantly more frequent in the three villages with the highest levels of O. volvulus endemicity than in other villages (P < 0.0001). Serological testing for T. solium infection was positive in one and borderline in three of 53 epilepsy patients tested. The significant correlation between epilepsy and onchocerciasis did not change when these four patients were excluded from the analysis. These findings suggest a strong association between epilepsy and onchocerciasis in this area. This could have significant implications for the concept of morbidity due to O. volvulus.     

Carpal tunnel syndrome (CTS) in the Piedmont Region: regional incidence and prevalence of CTS based on hospital records of patients who underwent surgery

BACKGROUND: Carpal tunnel syndrome (CTS) is the most frequent entrapment neuropathy of the upper extremities. Despite CTS being a priority for public health, only a few studies have investigated the prevalence and incidence in the general population. In Italy, administrative data are available only for CTS cases which were judged work-related by the Workers Compensation Board. These data indicate a steady increase in CTS over the last decade. Hospital admission archives (SDO) also contain information on CTS patients who underwent surgery. OBJECTIVES: To determine: 1) the incidence and prevalence of first CTS, based on hospital records of patients who underwent surgery in the Piedmont Region; 2) to describe the geographical and temporal variation. METHODS: Crude and standardized incidence rates of CTS were computed for the period 2002-2003; geographical variation was assessed using bayesan estimators to detect spatial clusters. Crude and standardized prevalence rates of first hospitalization were calculated for every two-year period between 1996 and 2003. RESULTS AND CONCLUSIONS: The crude incidence rate was 227.2 (C.I.95% 221.9-232.7) per 100,000 women and 54.4 (C.I. 95% 51.9-57.1) per 100,000 men. The prevalence of first hospitalization was very high and varied widely by geographic area. Two possible explanations for such wide variation between areas include differences in exposure to risk factors for CTS and in the diagnostic criteria used. The increasing prevalence over time was only partly explained by an increase in work-related cases. The development of standardized diagnostic criteria would improve understanding of the effect of workplace exposures on CTS. The number of new cases per year in Piedmont was estimated at 1,500, much higher than the compensation claims related to CTS. Health education campaigns addressed to general practitioners on compensation law could improve reporting to the workers' compensation board.     

Ensuring Appropriate Care in Epilepsy

Epilepsy is an important health problem throughout the world. In order to best manage epilepsy within a population, its epidemiological profile should be established. Epidemiological studies have shown that epilepsy is a very common, chronic condition that particularly affects the young and those in developing countries. Although the reported rates vary widely, the annual incidence rate of epilepsy is estimated to be approximately 40 to 70 per 100 000 population, and the prevalence is estimated to be approximately 4 to 10 per 1000 population.It can also be demonstrated that epilepsy represents a significant economic burden on health services and society as a whole. The average annual cost of epilepsy may be as high as $US 14 500 (1995 values) per patient. Indirect costs, such as lost productivity, account for a large percentage of this cost. However, there are significant methodological limitations to the cost of illness studies that have been performed to date, and thus the true cost of epilepsy remains to be unequivocally established. Furthermore, it is not clear how changing economic status of countries, the aging of the population and advances in technology will affect the costs of epilepsy in the future.The priority given to managing epilepsy is often too low and identifying the economic cost of epilepsy and on whom this cost falls is an essential part of raising the awareness of this significant public health problem.Many important issues regarding the epidemiology and economics of epilepsy remain unexplored. For example, the relationship between socioeconomic status and epilepsy and the reasons for the changing demographic and secular trends are unknown. The relationship between the clinical type of epilepsy experienced, seizure frequency, seizure severity and cost of illness has not yet been clearly established.     

Epilepsy among the homeless: prevalence and characteristics

Homelessness is associated with several risk factors for epileptic seizures. Epilepsy is a stigmatizing condition, which can lead to problematic social adjustment and competence. We found a markedly higher prevalence of seizures among the homeless than that estimated in the general population, with a large majority of non-alcoholic etiology. Unexpected proportion of subject taking treatment and compliance rate call for reflection on the optimal management of epilepsy in this population.     

Nutrition and Gastric Cancer in Turkey

Gastric cancer remains to be one of leading causes of cancer deaths despite worldwide decreasing incidence. In Turkey gastric cancer incidence is 9.6/100,000 in men and 5.7/100,000 in females. Gastric cancer is also one of the leading causes of cancer deaths in Turkey with a crude death rate of 5.84/100,000 in men, 3.7/100,000 in women. The mean age of patients diagnosed with gastric cancer is 56 years in Turkey. The relatively high rate of gastric cancer in Turkey is mainly due to dietary factors. The traditional food preservation such as salt curing or smoking and lack of refrigeration of food play a significant role in gastric cancer development in the country. There are etiological and epidemiological differences among geographical regions in Turkey. Gastric cancer is seen much more often in the central, northeastern, and eastern part of Turkey. Increased HP pylori infection is also another important reason for increased incidence of gastric cancer in some parts of the country.     

The analysis of tobacco consumption in Croatia--are we successfully facing the epidemic?

Tobacco is the largest cause of morbidity and mortality. The aim of this study is to analyse several health and economically related indicators of tobacco consumption: smoking prevalence, standardized death rates (SDRs) from lung cancer and the proportion of GDP spent on tobacco in Croatia and other transitional countries--the Czech Republic, Slovakia, Poland, Hungary, Slovenia, Romania, and Bulgaria. The overall smoking prevalence in Croatia decreased by 5.2% during 1994-2005, more among females (-9.9%) than males (-0.3%). There is no significant difference in the smoking prevalence between Croatia (27.4%) and other countries. However, 33.8% of Croatian males smoked during 2002-2005, more than in Romania and the Czech Republic, and less than in Hungary and Poland. The prevalence of female smoking (21.7%) in Croatia is similar to the female smoking prevalence in Poland, the Czech Republic, and Hungary, but male smoking is predominant in all countries. The proportion of smokers among youth is above 20% and it is the highest in the Czech Republic (29.7%), followed by Hungary (26.7%), Slovenia (24.9%), Croatia (24.1%), and Poland (21.5%). The proportion of smokers among girls is higher than among boys in Slovenia, Hungary, the Czech Republic, and Croatia, contrary to Slovakia, Bulgaria, and Poland where boys smoke slightly more. There is no significant difference between the prevalence of smoking among girls in Croatia and Bulgaria, Poland, the Czech Republic, Hungary, Slovenia, and Slovakia. According to the SDR from lung cancer in males (70.3/100,000), Croatia is ranked high assuming the 3rd place, after Hungary (99.7) and Poland (72.0). With a SDR of 15.9/100,000 for females, Croatia is ranked slightly better--5th place. Tobacco consumption continues to be a major public health problem in transitional countries. Croatia conducted several campaigns and programmes in the past. However, results reveal that current anti-tobacco strategies are ineffective in reducing the smoking prevalence among men and youth. Men do not smoke less than a decade ago and, despite the observed decline among women, increasing trends are observed among teenage girls. Croatia should apply a comprehensive approach that would include raising awareness of health risks, restriction of smoking in public places, higher taxing, implementing stricter bans on advertising and promotion of tobacco as well as supporting smoking cessation. This last measure is believed to bring about some results in the medium term in targeted population groups, provided that it is supported by all health professionals. Otherwise, we may expect progress at the population level in the field of social stigmatization of smoking and wider intolerance to second-hand smoke. The full impact of smoking on the population health is yet to be seen and in the future it will undoubtedly remain one of the major contributors to the poor public health situation in Croatia.     

广西城乡成年居民脑卒中流行特征及其危险因素研究

目的了解广西城乡居民脑卒中患病流行病学特征及脑卒中发生的危险因素,为有针对性防治脑卒中提供科学依据。方法采取多阶段整群随机抽样,对广西4个城市和4个县18岁及以上城乡居民进行问卷调查和体检与抽血化验。结果共调查18岁以及以上成人8 388人,报告脑卒中病例60例,脑卒中粗患病率为715/10万、标化患病率519/10万,其中城市居民粗患病率、标化率分别高达1 253/10万、1 026/10万,显著高于农村（215/10万、178/10万,P〈0.01）;男性居民粗患病率、标化率分别为658/10万、548/10万,显著高于女性（357/10万、292/10万,P〈0.01）;城乡居民均呈现出随着年龄增长脑卒中患病率而上升。单因素分析显示,大专以上学历、高收入、低体力活动和汉族人群是脑卒中高发人群,超重、肥胖、高血压、糖尿病、高TG、高TC、有心脑血管或脑卒中家族史的人群易罹患脑卒中;而非条件Logis-tic回归模型多因素分析结果显示,心脑血管家族史、年龄是城乡居民脑卒中的危险因素。结论估计广西成人中有12.33万脑卒中现患病人,其中城市5.57万,农村6.76万,对广西社会、家庭经济和劳动生产力危害严重;预防脑卒中发生,除有效预防控制好高血压、肥胖和高TG、高TC外,加强体力活动和积极防治糖尿病十分重要。     

1980-2010年凤山县麻疹流行病学特征分析

目的分析麻疹流行病学特征,评价麻疹控制效果。方法根据控制策略将凤山县31年来麻疹控制工作划分为4个阶段,对各阶段麻疹流行情况进行描述性流行病学分析。结果各阶段以15岁以下儿童发病最多,其中0~5岁组发病率最高。Ⅰ阶段麻疹平均发病率为197.12/10万,死亡率为1.40/10万,乡镇覆盖率达100%,冬春季为高发,流行峰间隔期为3~4年,峰形陡峭;Ⅱ阶段平均发病率为74.88/10万,死亡率为0.36/10万,流行峰间隔期为5~6年;Ⅲ阶段平均发病率35.53/10万,死亡率为0.29/10万,流行峰间隔期为7~8年,峰形上升迅速下降缓慢;Ⅳ阶段平均发病率为1.38/10万,无死亡病例,乡镇覆盖率下降到72.73%,高发季节向春夏季后移,流行峰间隔期为8~9年,峰形矮小。结论高质量实施麻疹减毒活疫苗预防接种和规范麻疹疫情管理是控制和消除麻疹的良策。     

武汉市前列腺癌的流行病学研究

前列腺癌是欧美国家男性的主要死亡原因，我国还没有全面的发病率和死亡统计资料。为了解我国前列腺癌的流行情况，在武汉市１９９０～１９９２年前列腺癌的发病及死亡报告的基础上，收集了１９９０～１９９５年住院治疗的１０２例前列腺癌现患病例进行了１１配比的病例对照研究。结果显示：武汉市前列腺癌的发病率和死亡率分别为１．３７／１０万和０．７５／１０万，世界人口年平均标化发病率和死亡率分别为１．１０／１０万和０．６６／１０万。泌尿系统病史〔ＯＲ＝５．４２，９５％可信区间（ＣＩ）＝１．５６～１８．８３〕、子女数超过３个（ＯＲ＝２．４３，９５％ＣＩ＝１．１７～５．０２）、青壮年期每周性交超过３次（ＯＲ＝３．３８，９５％ＣＩ＝１．５１～７．５８）、滥用药物（ＯＲ＝４．１１，９５％ＣＩ＝１．６５～１０．２５）、体质指数高（ＯＲ＝２．５８，９５％ＣＩ＝１．３０～５．１１）等是前列腺癌的危险因素，而体力劳动（ＯＲ＝０．３５，９５％ＣＩ＝０．１７～０．７１）、初次遗精年龄晚于１８岁（ＯＲ＝０．２０，９５％ＣＩ＝０．０８～０．５２）等是其保护性因素。     

The treatment of epilepsy in developing countries: where do we go from here?

Epilepsy is the most common serious neurological disorder and is one of the world's most prevalent noncommunicable diseases. As the understanding of its physical and social burden has increased it has moved higher up the world health agenda. Over four-fifths of the 50 million people with epilepsy are thought to be in developing countries; much of this condition results from preventable causes. Around 90% of people with epilepsy in developing countries are not receiving appropriate treatment. Consequently, people with epilepsy continue to be stigmatized and have a lower quality of life than people with other chronic illnesses. However, bridging the treatment gap and reducing the burden of epilepsy is not straightforward and faces many constraints. Cultural attitudes, a lack of prioritization, poor health system infrastructure, and inadequate supplies of antiepileptic drugs all conspire to hinder appropriate treatment. Nevertheless, there have been successful attempts to provide treatment, which have shown the importance of community-based approaches and also indicate that provision for sustained intervention over the long term is necessary in any treatment programme. Approaches being adopted in the demonstration projects of the Global Campaign Against Epilepsy--implemented by the International League Against Epilepsy, the International Bureau for Epilepsy, and the World Health Organization--may provide further advances. Much remains to be done but it is hoped that current efforts will lead to better treatment of people with epilepsy in developing countries.     

2011-2016年山东省梅毒流行特征及发病趋势分析

目的 分析2011-2016年山东省梅毒的流行特征,为预防梅毒的传播提供科学依据。 方法 收集山东省2011-2016年通过中国疾病预防控制信息系统上报的梅毒数据。采用描述流行病学的方法对梅毒的流行特征进行分析。 结果 2011-2016年山东省梅毒的平均年发病率为14.45/10万,时间上呈不断上升趋势(χ²_趋势=31.532,P<0.001),由2011年的8.56/10万,上升至2016年的19.75/10万,上升130.72%。山东省梅毒的构成以隐性梅毒为主,占43.07%。女性梅毒的发病率(14.86/10万)明显高于男性(13.74/10万),差异有统计学意义(χ² =36.348, P<0.001)。以35岁~年龄组为峰值,发病率最高,为23.66/10万。25~<55岁是山东省梅毒的高发年龄,发病率在14.97/10万以上。青岛、威海、烟台梅毒的发病率居全省前三位,分别为16.41/10万、15.24/10万、14.98/10万。梅毒职业分布以农民为主,占32.22%。 结论 2011-2016年山东省梅毒发病率增长迅速,控制形势仍然十分严峻。加强大众梅毒知识宣教,普及梅毒血清学筛查,对进一步降低山东省梅毒的流行具有重要意义。     

Apgar scores and long-term risk of epilepsy

BACKGROUND: Low Apgar scores are associated with high risk of neonatal death, cerebral palsy, and mental retardation, but the association between Apgar scores and long-term risk of epilepsy remains unresolved. METHODS: We carried out a population-based cohort study of 1,538,732 live newborns in Denmark between 1 January 1978 and 31 December 2002 by using national registers. The Apgar scores at 1 or 5 minutes were recorded by midwives following standardized procedures. We obtained information on epilepsy by linking the cohort with the National Hospital Register. Cohort members were followed from birth until onset of epilepsy, death, emigration, or 31 December 2002, whichever came first. RESULTS: The incidence rate of epilepsy increased consistently with decreasing Apgar scores. The incidence rate of epilepsy was 628 per 100,000 person-years for those with 5-minute Apgar scores of 1 to 3 and 86 per 100,000 person-years for those with a score of 10; the resulting incidence rate ratio was 7.1 (95% confidence interval = 5.8-8.8). The incidence rate ratios of epilepsy associated with low Apgar scores were particularly high in early childhood but remained high into adulthood. The association did not change after excluding children with cerebral palsy, congenital malformations, or a parental history of epilepsy. CONCLUSIONS: Neonates with a suboptimal Apgar score have a higher risk of epilepsy that lasts into adult life. These findings suggest that prenatal or perinatal factors play a larger role in the etiology of epilepsy than has previously been recognized.     

西北三省十五万人口癫痫发病情况调查

本文调查了工人、农民、军人共158,223人,有患癫痫者174人,占调查人数的1.09‰,为109/10万,其中工人101例,占1.88‰,为188/10万,农民64例,占1.27‰,为127/10万,军人9例,占0.16‰,为16/10万。工农之间无差异,而军人中最少,男女之间患病率以女性为多。各年龄组患病率以10~19岁为最高,原发与继发之间无显著差异。在继发性99例中以头部外伤史及高热引起者多见。家族史中近亲有癫痫病者21例。发作形式以大发作为最多见。有110例智能低下。67例进行了脑电图检查,符合癫痫波形者5例。经规则治疗91例,发作多得以控制。不规则治疗54例,多数减轻。未经治疗29例,病情多无变化。     

Neurocysticercosis in patients with active epilepsy from the pig farming community of Lucknow district, north India

Epilepsy is a major health problem worldwide, and neurocysticercosis (NCC) is one of the important causes of epilepsy in the tropics. The present study was carried out in a rural pig farming community of north India to estimate the prevalence of NCC in patients with active epilepsy (AE) and to determine the associated risk factors. Based on 30-cluster sampling recommended by WHO, a total of 1640 individuals belonging to 294 families from 30 villages were enrolled in the study. Demographic and socio-economic details of all individuals and families were recorded. Individuals with AE were identified by door-to-door survey. NCC was diagnosed by clinical, immunological, neuroimaging (brain magnetic resonance imaging) and epidemiological criteria. During the survey, 95 (5.8%) patients with AE were identified and clinically confirmed; 91 agreed to further evaluation for NCC and 44 (48.3%) of them fulfilled either definitive or probable diagnostic criteria for NCC. These 44 patients belonged to 37 households. Epilepsy in the family and no separate place for keeping pigs were identified as risk factors for NCC clustering in a family. The study shows a very high prevalence of AE in the pig farming community and NCC as its major cause. Since NCC is a preventable and potentially eradicable disease, appropriate intervention strategies may help to reduce the disease burden.     

湖州市病毒性肝炎血清流行病学调查

目的了解湖州市自然人群病毒性肝炎感染情况与流行病学特征。方法在湖州市按农村山区、平原水乡、城镇,随机抽取1 666名健康人为研究对象,用酶联免疫吸附试验检测血清甲型肝炎(甲肝)病毒抗体(抗-HAV)、乙型肝炎(乙肝)病毒表面抗原(HBsAg)、乙肝病毒表面抗体(抗-HBs)、乙肝病毒核心抗体(抗-HBc)、乙肝病毒e抗原(HBeAg)、乙肝病毒e抗体(抗-HBe)、丙型肝炎(丙肝)病毒抗体(抗-HCV)、戊型肝炎(戊肝)病毒抗体(抗-HEV),同时调查相关危险因素。结果湖州市自然人群的HAV、乙肝病毒(HBV)、HEV标化流行率分别为53.93%、36.47%、38.88%,抗-HCV阳性2例,未发现丁型肝炎病毒(HDV)感染者;HAV流行率与年龄呈正相关(r=0.944),城镇、平原水乡HAV流行率的差异有非常显著的统计学意义(P<0.01);HBV流行率<10岁儿童最低,为4.93%;HBsAg携带率为4.14%,<10岁儿童携带率为0;人群HBV标志物存在11种不同组合模式。HEV流行率随年龄增长而逐渐升高(r=0.993),城镇和平原水乡与山区HEV流行率的差异有非常显著的统计学意义(P<0.001),且存在家庭聚集性现象。结论湖州市病毒性肝炎主要流行型别为甲、乙、戊型,流行病学特征各不相同;HEV流行率较高,HBV流行率较低,HCV流行率低,未发现HDV感染者;HBsAg携带率低;乙肝疫苗接种效果明显。     

Bladder cancer in Asturias, Spain: incidence and trends (1982-1993)

OBJECTIVES: To assess epidemiological aspects of bladder cancer in Asturias, as a preliminary step before undertaking epidemiological and genetic research of the etiology and survival of bladder neoplasm. METHODS: cases from the Asturias Regional Cancer Registry, Spain were used to calculated annual incidence rates between 1982 and 1993 for Asturias and all its health areas. It has been Standardized incidence ratios with the indirect method for the Asturian areas and other Spanish regions were obtained our results are also compared with other european countries. RESULTS: The trend in bladder cancer in Asturias has been increasing significantly in the last twelve years (11.03 to 15.10 age standardized rate per 100,000). For the different health areas no differences have been identified, while there were not significant differences between our region and other Spanish regions. Standardized rates for Asturian men are in the highest group among European countries, while women rates are at an intermediate level. CONCLUSIONS: Between 1982 and 1993, bladder cancer incidence has been increasing in Asturias. The different behaviour of incidence ratios between men and women and the similar epidemiological factors between Asturias and other parts of Spain point at the need for further epidemiological research to look at the different occupational factors existing in an industrial area like Asturias.     

Changing the neurology policy landscape in the United States: Misconceptions and facts about epilepsy

Epilepsy has a relatively high prevalence, and diagnosis and treatment are often challenging. Seizure freedom without significant side effects is the ultimate goal for both physicians and patients, but not always achievable. In those cases, the treatment goals of patients and providers may differ. In the United States, many clinicians continue to prescribe older AEDs, even though newer AEDs have a more desirable safety and tolerability profile, fewer drug–drug interactions, and are associated with lower epilepsy-related hospital visits. Newer AEDs are more commonly prescribed by neurologists and epilepsy center physicians, highlighting the importance of access to specialty care. We report that antiepileptic drugs are not the dominant cost driver for patients with epilepsy and costs are considerably higher in patients with uncontrolled epilepsy. Poor drug adherence is considered a main cause of unsuccessful epilepsy treatment and is associated with increases in inpatient and emergency department admissions and related costs. Interventions and educational programs are needed to address the reasons for nonadherence. Coverage policies placing a higher cost burden on patients with epilepsy lead to lower treatment adherence, which can result in higher future health care spending. Epilepsy is lagging behind other neurological conditions in terms of funding and treatment innovation. Increased investment in epilepsy research may be particularly beneficial given current funding levels and the high prevalence of epilepsy.     

The metabolic syndrome in Bulgaria

The prevalence of the metabolic syndrome (MetS), a cluster of central obesity, hyper/dyslipiemia, hyperglycemia, and hypertension is constantly increasing worldwide. Although, the exact mechanisms underlying the development of the MetS are not completely understood, modern lifestyle of physical inactivity and unhealthy nutrition, obesity, and their interaction with genetic factors are considered largely responsible. It has been convincingly demonstrated that the metabolic syndrome is associated with substantially increased risk for the development of type 2 diabetes mellitus, as well as, with increased cardiovascular disease (CVD) morbidity and mortality. The prevalence of obesity and type 2 diabetes in Bulgaria has dramatically increased in the last decades. For the same period CVD mortality in the country have also gradually increased and Bulgaria is nowadays among the countries with the highest macrovascular disease death rates in Europe. A number of epidemiological studies have demonstrated that the prevalence of the MetS and of its individual components has also increased during the last decades and is nowadays relatively high among the general population in Bulgarian and extremely high among high-risk individuals. Surprisingly, the prevalence of the MetS is also high among the low risk population in the country and most of its components that are independent predictors of CVD mortality are largely undiagnosed. Furthermore, the presence of the MetS is associated with history of myocardial infarction in the country. Although objective data is somewhat scarce, several studies have reported association of the low physical activity level and the unhealthy nutritional habits with the prevalence of cardiometabolic diseases among the Bulgarian population. Taking into account these observations it may be suggested that indeed the high metabolic syndrome prevalence that results as a consequence of unhealthy lifestyle is responsible for the extremely high CVD mortality rates in Bulgaria. Therefore, large-scale screening programmes should be undertaken within this population in combination with health prevention strategies promoting regular physical activity and improvement of nutritional habits.