Widening gap of stroke between east and west - Eight-year trends in occurrence and risk factors in Russia and Sweden

Background and Purpose-Stroke is declining in most of the western and north ern European countries, whereas no such decline is seen in eastern Europe. The aim of this study was to investigate trends in stroke attack rates and 28-day case fatality and risk factor levels in Novosibirsk, Siberia, and no rthern Sweden during 1987-1994. Methods-Within the World Health Organization Multinational Monitoring of Tr ends and Determinants in Cardiovascular Disease (MONICA) Project, acute str oke events and 28-day case fatality were registered in a standardized way i n men and women aged 35 to 69 years. Cardiovascular risk factors were monit ored in randomly selected men and women in the group aged 35 to 64 years in 1985-1986 and 1994-1995. Results-Stroke attack rates increased significantly from 430 per 100 000 to 660 (P=0.005) in men in Novosibirsk and from 298 to 500 (P=0.02) in women. In northern Sweden, stroke attack rates varied between 244 and 303 per 100 000 in men and from 117 to 157 in women, with a small increasing trend in women (P=0.03), The mortality rates were 5 times higher in Novosibirsk, and the case fatality was significantly lower in northern Sweden (P=0.0001). T he risk factor surveys showed significantly higher blood pressure, overweig ht, and more smoking men in Novosibirsk, while northern Sweden had higher c holesterol levels and more smoking women. Most risk factors showed stable o r improving patterns overtime. Conclusions-Large differences in both attack rates and case fatality accoun t for the large and widening gap in stroke mortality between Russia and Swe den. A higher prevalence of hypertension in Russia may explain much of the differences in stroke occurrence. In Russia, a marked increase in attack ra tes has occurred despite stable or improving patterns of conventional cardi ovascular risk factors.