International Journal of Epidemiology, Vol 28, 437-444, Copyright © 1999 by International Epidemiological Association
M Bobak, HW Hense, J Kark, B Kuch, P Vojtisek, R Sinnreich, J Gostomzyk, M Bui, A von Eckardstein, R Junker, M Fobker, H Schulte, G Assmann and M Marmot
BACKGROUND: The large differences in cardiovascular disease rates between
Eastern and Western Europe have largely developed over the last few
decades, and are only partly explained by classical risk factors. This
study was set up to identify other potential determinants of these
differences. METHODS: This was an ecological study comparing random samples
of men aged 45-64 years selected from three cities representing populations
with different rates of cardiovascular mortality: Pardubice (Czech
Republic), Augsburg (Bavaria, Germany), and Jerusalem (Israel). In total,
191 (response rate 70%), 153 (70%) and 162 (62%) men, respectively,
participated. All centres followed the same study protocol. Lifestyle,
anthropometry and biochemical risk factors were assessed by identical
questionnaires, standardized medical examination, and central analyses of
fasting blood samples. RESULTS: The mortality rates in the study
populations, as well as the prevalence of coronary heart disease in study
samples, were highest in Czech, intermediate in Bavarian and low in Israeli
men. This pattern was replicated across the three samples by mean blood
pressure (P < 0.001), cigarette smoking (not significant), triglycerides
(P < 0.05), fibrinogen or D-dimer levels (P < 0.05). On the other
hand, the prevalence of diabetes and obesity were similar; total and high
density lipoprotein (HDL)- cholesterol, apolipoprotein B, lipoprotein
(Lp(a)) and glucose did not differ between Czech and Bavarian men; and
Czechs had particularly low levels of serum insulin and factor VIIc.
Israelis had low fasting glucose and total cholesterol, as well as
HDL-cholesterol levels and a high Lp(a) (each P < 0.001) compared with
the two other samples. Striking differences were found for plasma
homocysteine (10.5 in Czechs versus 8.9 mumol/l in Bavarians, P < 0.001)
and for alpha-carotene (geometric mean in Czechs 16, Bavarians 21 and
Israelis 30 micrograms/l), beta-carotene (60, 110 and 102 micrograms/l),
and lycopene (84, 177 and 223 micrograms/l), respectively; all P-values
< 0.001). Adjustment for obesity or smoking did not change these
estimates. There were no differences in the levels of tocopherol and
retinol. CONCLUSIONS: Czech men had high levels of blood pressure,
triglycerides, fibrinogen and D-dimer but many other traditional risk
factors, as well as indicators of metabolic disorders and vitamins A and E,
did not differ between the study samples. The low levels of carotenoids and
high concentrations of homocysteine in Czech men seem to reflect their low
dietary intakes of fruit and vegetables. The results provide indirect
support for the importance of dietary factors in the East-West morbidity
and mortality divide.
ARTICLES
An ecological study of determinants of coronary heart disease rates: a comparison of Czech, Bavarian and Israeli men
Department of Epidemiology and Public Health, University College London, UK.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  J. Muller-Nordhorn, S. Binting, S. Roll, and S. N. Willich An update on regional variation in cardiovascular mortality within Europe Eur. Heart J., May 2, 2008; 29(10): 1316 - 1326. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. D Kark, R. Fink, B. Adler, N. Goldberger, and S. Goldman The incidence of coronary heart disease among Palestinians and Israelis in Jerusalem Int. J. Epidemiol., April 1, 2006; 35(2): 448 - 457. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J Muller-Nordhorn, K Rossnagel, W Mey, and S N Willich Regional variation and time trends in mortality from ischaemic heart disease: East and West Germany 10 years after reunification J. Epidemiol. Community Health, June 1, 2004; 58(6): 481 - 485. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. T. Mayne, B. Cartmel, H. Lin, T. Zheng, and W. J. Goodwin Jr Low Plasma Lycopene Concentration is Associated with Increased Mortality in a Cohort of Patients with Prior Oral, Pharynx or Larynx Cancers J. Am. Coll. Nutr., February 1, 2004; 23(1): 34 - 42. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. von Eckardstein, J.-R. Nofer, and G. Assmann High Density Lipoproteins and Arteriosclerosis : Role of Cholesterol Efflux and Reverse Cholesterol Transport Arterioscler. Thromb. Vasc. Biol., January 1, 2001; 21(1): 13 - 27. [Abstract] [Full Text] [PDF]
|
|