Cardiovascular disease prevention in eastern Europe.

During the last 30 y the region of highest premature cardiovascular mortality has shifted from the US and Finland to Central and Eastern Europe. Present male cardiovascular mortality in Latvia, Estonia, the Russian Federation, and Hungary has overtaken the maximum cardiovascular mortality reached in the US in the 1960s. This epidemic is only partially explainable by the high prevalence of the three traditional risk factors, i.e., hypercholesterolemia, hypertension, and smoking. The international WHO project MONICA, Finnish/Russian/Estonian, Swedish/Lithuanian, and US/Russian surveys have shown that there were no substantial differences between Eastern Europe and democratic countries regarding the prevalence of traditional risk factors with the significant exception of male smokers. The number of female smokers and plasma lipid levels (total and HDL-cholesterol and triacylglycerols) were even more favorable in East European. The intake of antioxidants from domestic and imported fruits, vegetables, vegetable oils, and nuts in most East European countries was substantially lower than in the West. The failure of economical and political systems to satisfy material and psychosocial population needs was probably an important factor in the cardiovascular disease epidemic in Eastern Europe. Antioxidant deficiencies, alcoholism, and psychosocial stress could become "new" cardiovascular risk factors in Eastern Europe. Smoking and alcoholism are definitely important risk factors, but additional local risk factors in Eastern Europe need to be identified with more specific target-prevention programs in individual Eastern Europe countries. This region is a prospective arena for research on additional lesser known cardiovascular risk factors, e.g., oxidative stress, chronic marginal deficiency of antioxidant vitamins (vitamin C, tocopherols, carotenoids) and low intake of folic acid and flavonoids.