An ecological study of determinants of coronary heart disease rates: a comparison of Czech, Bavarian and Israeli men

Background The large differences in cardiovascular disease rates between Ea stern 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 4 5-64 years selected from three cities representing populations with differe nt 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 fo llowed the same study protocol. Lifestyle, anthropometry and biochemical ri sk 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 preval ence of coronary heart disease in study samples, were highest in Czech, int ermediate in Bavarian and low in Israeli men. This pattern was replicated a cross the three samples by mean blood pressure (P < 0.001), cigarette smoki ng (not significant), triglycerides (P < 0.05), fibrinogen or D-dimer level s (P ( 0.05). On the other hand, the prevalence of diabetes and obesity wer e similar; total and high density lipoprotein (HDL)-cholesterol, apolipopro tein B, lipoprotein (Lp(a)) and glucose did not differ between Czech and Ba varian men; and Czechs had particularly low levels of serum insulin and fac tor VIIc. Israelis had low fasting glucose and total cholesterol, as well a s HDL-cholesterol levels and a high Lp(a) teach P < 0.001) compared with th e two other samples. Striking differences were found for plasma homocystein e (10.5 in Czechs versus 8.9 mu mol/l in Bavarians, P < 0.001) and for alph a-carotene (geometric mean in Czechs 16, Bavarians 21 and Israelis 30 mu g/ l), beta-carotene (60, 110 and 102 mu g/l), and lycopene (84, 177 and 223 m u g/l, respectively; all P-values < 0.001). Adjustment for obesity or smoki ng 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, fib rinogen and D-dimer but many other traditional risk factors, as well as ind icators of metabolic disorders and vitamins A and E, did not differ between the study samples. The low levels of carotenoids and high concentrations o f homocysteine in Czech men seem to reflect their low dietary intakes of fr uit and vegetables. The results provide indirect support for the importance of dietary factors in the East-West morbidity and mortality divide.