- Open Access
Cardiovascular Disease in Central and East Europe
Public Health Reviewsvolume 33, pages416–435 (2011)
Cardiovascular disease (CVD) contributes greatly to inequalities in health in Europe. The CVD death rate in Ukraine (the highest) is seven fold higher than in France (the lowest). There is also a striking difference in CVD mortality between European Union (EU) members before the enlargement in 2004 and Central and East European (CEE) countries that joined the EU in 2004 and non-EU countries. The difference in CVD mortality between West and East Europe grew during the 1970s and 1980s when rates declined in the West and either remained the same or rose in the CEE countries. Political reforms at the beginning of the 1990s, which were followed by great socio-economic changes coincided with further diversification in CVD mortality in CEE countries. Diverse trends in CVD mortality were followed by larger gaps in life expectancy between West and East Europe and within the CEE.
Rapid development of high technology treatment procedures, which followed the economic recovery of the CEE countries, would have only limited influence on the overall control of CVD. Exposure to classic risk factors might largely explain the longitudinal trend in falling CVD mortality in some countries, but it is unlikely that it could explain rapid changes in the others. Still, large potential to control the disease lies in developing effective preventive policies with targets to lower exposure to the classic CVD risk factors. The recent history of CVD in CEE countries makes the “alcohol hypothesis” less convincing as an explanation for CVD mortality trends and differences between East and West Europe. The hypothesis that dynamic changes in CVD mortality in CEE countries are triggered and explained largely by psychosocial factors is attractive. However, if confirmed, transforming such knowledge into a practical health policy would be a great challenge.
Allender S, Scarborough P, Peto V, Rayner M, Leal J, Luengo-Fernandez R, Gray A. European cardiovascular disease statistics, 2008 edition. British Heart Foundation; 2008. Available from URL: http://www.bhf.org.uk/publications/view-publication.aspx?ps=1001443 (Accessed 23 April, 2012).
Unia Europejska. Available from URL: http://europa.eu/about-eu/facts-fgures/living/index_pl.htm (Accessed January 2012). [in Polish]
World Health Organization Regional Office for Europe. European Health for All Database (HFA-DB). WHO Europe; 2011. Available from URL: http://www.euro.who.int/en/what-we-do/data-and-evidence/databases/european-health-for-all-database-hfa-db2 (Accessed 23 April, 2012).
Tunstall-Pedoe H, Vanuzzo D, Hobbs M, Mähönen M, Cepaitis Z, Kuulasmaa K, et al. For the WHO MONICA Project. WHO MONICA Project. Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortality: 10 year results from 37 WHO MONICA populations. Lancet. 1999;353:1547–57.
Centers for Disease Control. Achievements in Public Health, 1900–1999: Decline in Deaths from Heart Disease and Stroke–United States, 1900–1999. MMWR Morb Mortal Wkly Rep. 1999;48:241–3. Available from URL: http://www.cdc.gov/mmwr/preview/mmwrhtml/00056796.htm (Accessed January 2012).
Bunker JP, Frazier HS, Mosteller F. Improving health: measuring effects of medical care. Millbank Q. 1994;72:225–58.
Rayner M, Petersen S. European cardiovascular disease statistics, 2000 edition, British Heart Foundation; 2000.
Pajak A, Jankowski P, Dojka E, Kawecka-Jaszcz K. [Instructing of patients and delay of treatment in myocardial infartion and unstable angina in Cracovian Program of Secondary Prevention of Ischaemic Heart Disease (IHD)]. Przegl Lek. 2001;58:903–7. [in Polish]
Kopec G, et al. Knowledge of a patient-dependant phase of acute myocardial infarction in Polish adults: the role of physician advice. Eur J Public Health. 2011;21:603–8.
Bandosz P, Sobien B, Podolec M, Dziedzic H, Zarzecka J, Loster B, et al. Decline in mortality from coronary heart disease in Poland after socioeconomic transformation: modelling study. BMJ 2012;344:d8136.
Ford ES, Ajani UA, Croft JB, Critchley JA, Labarthe DR, Kottke TE, et. al. Explaining the decrease in US deaths from coronary disease, 1980–2000. N Engl J Med. 2007;356:2388–98.
Capewell S, Morrison CE, McMurray JJ. Contribution of modern cardiovascular treatment and risk factor changes to the decline in coronary heart disease mortality in Scotland between 1975 and 1994. Heart. 1999;81:380–6.
Capewell S, Beaglehole R, Seddon M, McMurray J. Explanation for the decline in coronary heart disease mortality rates in Auckland, New Zealand, between 1982 and 1993. Circulation. 2000;102:1511–6.
Unal B, Critchley JA, Capewell S. Explaining the decline in coronary heart disease mortality in England and Wales, 1981–2000. Circulation. 2004;109:1101–7.
Laatikainen T, Critchley J, Vartiainen E, Salomaa V, Ketonen M, Capewell S. Explaining the decline in coronary heart disease mortality in Finland between 1982 and 1997. Am J Epidemiol. 2005;162:764–73.
Pajak A, Jankowski P, Kawecka-Jaszcz K, Surowiec S, Wolfshaut-Wolak R, Loster M, et al. Changes in secondary prevention of coronary artery disease in the post-discharge period over the decade 1997‐2007. Results of the Cracovian Program for Secondary Prevention of Ischemic Hart Disease and Polish part of the EUROASPIRE II and III surveys. Kardiol Pol. 2009;67:1353–9.
Jankowski P, Kawecka-Jaszcz K, Pajak A, Surowiec S, Wolfshaut R, Loster M, et al. Secondary prevention of coronary artery disease in hospital practice over the decade 1996–2006. Results of Ischemic Heart Disease and Polish parts of the EUROASPIRE II and EUROASPIRE III surveys. Kardiol Pol. 2009;67:970–7.
Kotseva K, Wood D, De Backer G, De Bacquer D, Pyörälä K, Keil UK. The EUROASPIRE Study Group. EUROASPIRE III: a survey on the lifestyle, risk factors and use of cardioprotective drug therapies in coronary patients from 22 European countries. Eur J Cardiovasc Prev Rehabil. 2009;16:121–37.
Fourth Joint Task Force of the European Society of Cardiology and other Societies on Cardiovascular Disease Prevention in Clinical Practice. European Guidelines on on cardiovascular disease prevention in clinical practice. Eur J Cardiovasc Prev Rehabil. 2007;14:S1–113.
Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. INTERHEART Study Investigators. Effect of potentially modifable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study). Lancet. 2004;364:9437.
Kuulasmaa K, Tunstall-Pedoe H, Dobson A, Fortmann S, Sans S, Tolonen H, et al. For the WHO MONICA Project. WHO MONICA Project. Estimation of contribution of changes in classic risk factors to trends in coronary-event rates across the WHO MONICA Project populations. Lancet. 2000;355:675–87.
Zatonski WA, McMichael AJ, Powles JW. Ecological study of reasons for sharp decline in mortality from ischaemic heart disease in Poland since 1991. BMJ. 1998;316: 1047–51.
Pajak A, Wiercinska E, Polakowska M, Kozakiewicz K, Kaczmarczyk-Chalas K, Tykarski A, et al. [Prevalence of dyslipidemia in men and women between the ages of 20-74 in Poland. Results of the WOBASZ program]. Kardiol Pol. 2005;63:S620–5. [in Polish]
Tykarski A, Posadzy-Malaczynska A, Wyrzykowski B, Kwasniewska M, Pajak A, Tendera M. [Prevalence of hypertension and effectiveness of its treatment in adult residents of our country. Results of the WOBASZ program]. Wyniki programu WOBASZ. Kardiol Pol. 2005;63:S614–9. [in Polish]
Pajak A, Szafraniec K, Janion M, Szpak A, Wizner B, Wolfshaut-Wolak R, et al. For a POLCARD study group. The impact of the Polish national Programme of Cardiovascular Disease Prevention on the quality of primary cardiovascular disease prevention in clinical practice. Kardiol Pol. 2010;68:1332–40.
Pajak A. [Myocardial infarction–threats and medical care. Longitudinal observations in a population of 280,000 women and men–Project POL-MONICA Krakow. II. Risk factors and mortality due to ischemic heart disease in men ages 35–64]. Przegl Lek. 1996;53:707–12. [in Polish]
Corrao G, Rubbiati L, Bagnardi V, et al. Alcohol and coronary heart disease: a meta-analysis. Addiction. 2000;95:1505–23.
McKee M, Britton A. The positive relationship between alcohol and heart disease in eastern Europe: potential physiological mechanisms. J R Soc Med. 1998;91:402–7.
Roerecke M, Rehm J. Irregular heavy drinking occasions and risk of ischemic heart disease: a systematic review and meta-analysis. Am J Epidemiol. 2010;171:633–44.
Sundell L, Salomaa V, Vartiainen E, Poikolainen K, Laatikainen T. Increased stroke risk is related to a binge-drinking habit. Stroke. 2008;39:3179–84.
Fan AZ, Russell M, Naimi T, Li Y, Liao Y, Jiles R, et al. Patterns of alcohol consumption and the metabolic syndrome. J Clin Endocrinol Metab. 2008;93:3833–8.
Rakic V, Puddey IB, Burke V, Dimmitt SB, Beilin LJ. Influence of pattern of alcohol intake on blood pressure in regular drinkers: a controlled trial. J Hypertens. 1998;16:165–74.
Shkolnikov VM, Nemtsov A. The anti-alcohol campaign and variations in Russian mortality. In: Costello CA, Mitchell F, editors. Premature Death in the New Independent States. Washington DC: National Academy Press; 1997.
Leon DA, Chenet L, Shkolnikov VM, Zakharov S, Shapiro J, Rakhmanova G, et al. Huge variation in Russian mortality rates 1984–94: artefact, alcohol, or what? Lancet. 1997;350:383–8.
Malyutina S, Bobak M, Kurilovitch S, Gafarov V, Simonova G, Nikitin Y, et al. Relation between heavy and binge drinking and all-cause and cardiovascular mortality in Novosibirsk, Russia: a prospective cohort study. Lancet. 2002;360:1448–54.
Deev A, Shestov D, Abernathy J, Kapustina A, Muhina N, Irving S. Association of alcohol consumption to mortality in middle-aged U.S. and Russian men and women. Ann Epidemiol. 1998;8:147–53.
Bobak M, Marmot M. Alcohol and mortality in Russia: is it different then elsewhere? Ann Epidemiol. 1999;9:335–8.
McKee M, Shkolnikov V, Leon AD. Alcohol is implicated in the fluctuations in cardiovascular disease in Russia since 1980s. Ann Epidemiol. 2001;11:1–6.
Stuckler D, Basu S, McKee M. Public health in Europe: power, politics, and where next? Public Health Reviews. 2010;32;213–42.
Stuckler D, King L, McKee M. Mass privatization and the post-communist mortality crisis. Lancet. 2009;373:399–407.
Central Statistical Office, Poland. Unemployment rate 1990–2011 (registered). Available from URL: http://www.stat.gov.pl/gus/5840_677_ENG_HTML.htm (Accessed 23 April 2012).
Central Statistical Office, Poland. Yearly price indices of consumer goods and services from 1950 till 2010. Available from URL: http://www.stat.gov.pl/gus/5840_1634_ENG_HTML.htm (Accessed 23 April 2012).
Wojtyniak B. National Institute of Public Health Database, 2002.
Shkolnikov VM, Leon DA, Adamets S, Andreev E, Deev A. Educational level and adult mortality in Russia: an analysis of routine data 1979 to 1994. Soc Sci Med. 1998;47:357–69.
Leinsalu M, Vågerö D, Kunst AE. Estonia 1989–2000: enormous increase in mortality differences by education. Int J Epidemiol. 2003;32:1081–7.
Pikhart H, Bobak M, Pajak A, Malutina S, Kubinova R, Topor-Madry R, et al. Psychosocial factors at work and depression in three countries of Central and Eastern Europe. Soc Sci Med. 2004;58;1475–82.
Pikhart H, Bobak M, Siegrist J, Pajak A, Rywik S, Kyshegyi J, et al. Psychosocial work characteristics and self rated health in four post-comunist countries. J epidemiol Community Health. 2001;55:624–30.
Rosengren A, Hawken S, Ounpru S, Sliwa K, Zubaid M, Almahmeed WA, et al. INTERHEART investigators. Association of psychosocial risk factors with risk of myocardial infarction in 11,119 cases and 13,648 controls from 52 countries (the INTERHEART study): case control study. Lancet. 2004;364:953–62.
World Health Organization. World Health Organization Final Report of the Commission on Social Determinants of Health. Closing the gap in a generation: Health equity through action on the social determinants of health. Geneva: WHO; 2008. Available from URL: http://www.who.int/social_determinants/thecommission/finalreport/en/index.html (Accessed 23 2012).