Possible causes of differences in coronary heart disease mortality between Lithuania and Sweden: The LiVicordia study

While coronary heart disease (CHD) mortality is declining in Western Europe, an opposite development has been seen in Central and Eastern Europe. For example, in 1994 the incidence of CHD mortality for middle-aged men was fourfold greater in Lithuania compared to Sweden. The LiVicordia study investigated possible causes of this difference by comparing coronary heart disease risk factor profiles of 50-year-old men randomly sampled from the populations of Vilnius, Lithuania and Linkoping, Sweden. Men from Vilnius had higher blood pressure and lower LDL cholesterol than men from Linkoping. No differences in cigarette smoking prevalence were found. However, men in Vilnius showed several signs of an unfavorable oxidative state, such as shorter lag phase of LDL oxidation and lower serum levels of lipid soluble antioxidant vitamins. Vilnius men also reported more signs of psychosocial stress, more job strain and social isolation, less coping and self-esteem, and more vital exhaustion and depression than their counterparts in Sweden. In a standardized stress test, no differences were found in cardiovascular reactivity. However, men from Vilnius had an attenuated cortisol response to stress. This response was related to current cigarette smoking and high scores on a scale of vital exhaustion. In conclusion, traditional risk factors could not explain the fourfold difference in CHID mortality between middle-aged men from Vilnius and Linkoping. Possible alternative explanations are factors related to oxidative and psychosocial stress.