Cardiovascular Risk Factors in Old and New Europe

1. Cardiovascular Risk Factors inOld and New Europe Andrzej Rynkiewicz I Department of Cardiology Medical University of Gdańsk Poland

2. EU Brussles 2000 Gdańsk Shipyard 1980 Lech Walesa description of cardiovascular risk factors in his characteristic style „At my age one has too much what’s useless and too little what’s needed”

3. 1st May 2004 15 Old + 10 New European Union Members

4. „You’re thinking of Europe as Germany and France. I don’t. I think that’s old Europe. If you look at the entire NATO Europe today, the center of gravity is shifting to the east and there are a lot of new members.” U.S. Defense Secretary Donald Rumsfeld

5. The average life span at birth 79 78 77 74 64 47 27 Greek- 1900 1950 2000 Old New USA Roman Europe Futterman L. Am J Crit Care 9,2000

6. The average life span at birth, May 2004 82 78 78 76 76 70 Old New Old New USA USA males females

7. Gaine of life expectancy at birth 1960 - 2000 7,8 6,9 4,2 Old New USA

8. Life expectancy at age 65, Europe 2000 Females Males 19,2 19,4 16,8 16,3 15,9 13,2 USA Old New Old New USA OECD Health Data 1998

9. MONICA coronary risk-factor score males 7,43 7,37 7,27 7,18 6,90 6,70 1980s 1990s 1980s 1990s 1980s 1990s females 6,53 6,47 6,45 6,26 6,10 5,70 1980s 1990s 1980s 1990s 1980s 1990s Old Europe New Europe USA Edt H.Tunstall-Pedoe, MONICA Monograph 2003

10. Blood cholesterol, adults aged 35-64, latest avaliable data, MONICA mmol/l Old New USA Old New USA Male Female Tolonen H et al. Int J Epid 2004

11. Percentage of adults aged 35-64 with blood cholestrol levels >=7.8 mmol/l, MONICA Project populations MEN WOMEN 16 14 12 10 % 8 6 4 2 0 Iceland Italy-Friuli France-Lille China-Beijing New Zealand Belgium-Ghent Czech Republic Australia-Perth Poland-Warsaw Spain-Catalonia France-Toulouse Belgium-Charleroi Germany-Bremen Lithuania-Kaunas Denmark-Glostrup Switzerland-Ticino Italy-Area Brianza France-Strasbourg Australia-Newcastle Yugoslavia-Novi Sad Finland-North Karelia Finland-Turku/Loimaa Sweden-Gothenburg United Kingdom-Belfast Finland-Kuopio Province Canada-Halfax County United States-Stanford United Kingdom-Glasgow Germany-East Germany Russia-Moscow (control) Germany-Augsburg (rural) Switzerland-Vaud/Fribourg Sweden-Northern Sweden Germany-Augsburg (urban) Russia-Novosibirsk (control) Poland-Tarnobrzeg Voivodship WHO MONICA Project database www.heartstats.org

12. Systolic blood pressure levels, adults aged 34-65, latest avaliable data, Monica mmHg Old New USA Old New USA Male Female Evans A et al. Int J Epid ;30 (supl1):s35

13. Population attributable risks associated with other riskfactors Hypertension (%) Diabetes (%) Abdominal obesity (%) All psycho social (%) Lipids (%) Yusuf S., INTERHEART Lancet 364,937,2004

14. Population attributable risks associated with riskfactors All lifestyles (%) All nine risk factors (%) INTERHEART Lancet 2004

15. Potential years of life lost by CVD (implicite life expectancy of 70) Old Europe New Europe 1993 Female 1970 1993 Male 1970 PYLL per 100000

16. Potential years of life lost, 2000(implicite life expectancy of 70) Old Europe New Europe Male Female PYLL per 100000

17. BMI adults aged 34-65, latest avaliable data, MONICA Project Old New USA Old New USA Female Male Evans A et al. Int J Epid ;30 (supl1):s35

19. Estimated prevalence of diabetes 2003 and 2025 % Old New USA USA Mexican International Diabetes Federation 2003

20. Alcohol consumption, adults aged 15 years and above 2001 Litres pure alcohol per person per year Old New Irland Czech Republic http:/www.who.dk/hfadp

21. Percentage of total energy from fruit and vegetables, 2001 % Old New Greece Slovenia http://www.faostat.fao.org

22. Percentage of total energy from saturated fat, 1998 % USA Old New http://www.heartstat.org, data from FAO

23. Prevalence of smoking, adults aged 15 and over, latest available year % Old New Sweden Czech Republic USA http://www.faostat.fao.org

24. CAD mortality rates, Europe 2000 Age standarised death rate per 100 000 Old New USA Old New USA Male Female

25. Cardiovascular risk factors Patients with CAD Total cholesterol mmol/l, median HDL cholesterol mmol/l, median Triglycerides mmol/l, median Glucose mmol/l, median Euroaspire II Eur Heart J 2001, 22, 554-72

26. Cardiovascular risk factors Patients with CAD Diastolic BP mmHg, median Systolic BP mmHg, median Bodymass index Kg/m2, median Euroaspire II Eur Heart J 2001, 22, 554-72

27. Health care costs of CVD per capita 2003 CVD health care cost in EU 105 billion €in 2003 € EURO Old New Germany USA http://www.heartstats.org/eucosts

28. Seven years ago, cardiac services were in a terrible state. Patients could wait years for diagnosis and then more than two years for surgery. We had one of the highest heart disease death rates in the developed world and heart services lagged behind health systems on other countries. There were social, ethnic and geographical inequalities in who developed and who died from the disease. Old or New Europe ?

29. Seven years ago, cardiac services were in a terrible state. Patients could wait years for diagnosis and then more than two years for surgery. We had one of the highest heart disease death rates in the developed world and heart services lagged behind health systems on other countries. There were social, ethnic and geographical inequalities in who developed and who died from the disease. John Reid Secretary of State for Health UK, 2004