Cardiovascular Disease in Central and East Europe

Abstract

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 socioeconomic 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.