Correspondence

The Epidemic of Cardiovascular Disease in Eastern Europe

N Engl J Med 1997; 336:1915-1916June 26, 1997

Article

To the Editor:

Mortality from cardiovascular disease in Eastern Europe was low at the beginning of the 1960s, but a serious increase has occurred and in 1990 mortality was substantially higher than in Western Europe and the United States.1 The political changes in Eastern Europe after 1990 caused serious economic problems and simultaneously led to a further increase in mortality from cardiovascular disease (Figure 1Figure 1Trends in Premature Cardiovascular Mortality (Standardized Mortality Rates for Men and Women 64 Years of Age or Younger) in Europe. (Data are from the World Health Organization.1)). Premature mortality from cardiovascular disease among men in the Russian Federation is now almost four times as high as in the United States.

The causes of the epidemic of cardiovascular disease in Eastern Europe are not known. The affected area has 400 million inhabitants and is almost 2.5 times as large as the United States. Mortality from cardiovascular disease in Eastern Europe has substantially overtaken the previous maximum rate, reached in the 1960s in the United States and Finland. Currently, nearly 500 in 100,000 men in the Russian Federation die prematurely from cardiovascular disease. Such a level has never before been observed anywhere in the world and is twice as high as the maximum reached in the United States in the 1960s. The epidemic is concentrated in the countries that were governed by Communist regimes; if one passes through the former Iron Curtain from west to east, mortality from cardiovascular disease increases by two to six times. The epidemic affected not only the post-Communist countries of Central Europe that had a lifestyle similar to that of Western Europe, but also the former Soviet republics of Central Asia that have cultures influenced by Islam. The World Health Organization's Monitoring Trends and Determinants in Cardiovascular Disease (MONICA) project2 found a higher prevalence of smoking and hypertension in men living in Eastern Europe than in Western Europe, but the prevalence of hypercholesterolemia was lower. In women, the prevalence of hypertension was higher than in Western Europe, but the number of female smokers and the level of cholesterol were lower,2 because economic problems in this area limited consumption of meat and dairy products. In the United States, epidemiologic studies have quantified the effects of smoking, hypertension, and hypercholesterolemia on coronary mortality.3 Similar studies are not possible in Eastern European countries for economic reasons, so the help of the international scientific community is necessary. Such help would not only be humanitarian, but research on the epidemic of cardiovascular disease in Eastern Europe could also broaden our knowledge of nontraditional cardiovascular risk factors.

Emil Ginter, D.Sc.
Institute of Preventive and Clinical Medicine, 83301 Bratislava, Slovakia

3 References

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   Health for All. Statistical database 1996. Copenhagen, Denmark: World Health Organization Regional Office for Europe, 1996.
   

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   Ginter E. Cardiovascular risk factors in the former communist countries: analysis of 40 European MONICA populations. Eur J Epidemiol 1995;11:199-205
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   Stamler J, Wentworth D, Neaton JD. Is relationship between serum cholesterol and risk of premature death from coronary heart disease continuous and graded? Findings in 356,222 primary screenees of the Multiple Risk Factor Intervention Trial. JAMA 1986;256:2823-2828
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Citing Articles (4)

Citing Articles

1. 1

   G. Weidner, V. S. Cain. (2003) The Gender Gap in Heart Disease: Lessons From Eastern Europe. American Journal of Public Health 93:5, 768-770
   CrossRef

2. 2

   Gerdi Weidner. (2000) Why Do Men Get More Heart Disease Than Women? An International Perspective. Journal of American College Health 48:6, 291-294
   CrossRef

3. 3

   Emil Ginter. (1998) Cardiovascular Disease Prevention in Eastern Europe. Nutrition 14:5, 452-457
   CrossRef

4. 4

   KATIJA CATEPOVIC-VESELICA. (1998) SOCIOECONOMIC CHANGES ASSOCIATED WITH MEDICAL INDICES IN THE DEMOCRATIC REPUBLIC OF CROATIA. Psychological Reports 83:5, 129
   CrossRef