The role of pathogenic and protective dietary factors and non-traditional risk factors in the coronary epidemic of Central and Eastern Europe

The rising epidemic of coronary heart disease in the countries of the former Soviet bloc led us to evaluate pathogenic and protective dietary risk factors in 19 countries. Countries were placed into four groups based on cultural patterns (Central and Eastern Europe, Western Europe and the United States, Mediterranean, and Asian). Coronary mortality data were available for 16 countries. In all geographic groups women had approximately one-half the coronary mortality of men. The descending order of coronary mortality was Central and Eastern Europe, Western Europe and the United States, Mediterranean, and Japan. Ninety-four (in women) to ninety-six (in men) percent of coronary mortality could be explained by dietary folate, the Cholesterol-Saturated Fat Index, n-6 fatty acids, and the ratio of n-6 to n-3 fatty acids. Folate intake explained a large part of coronary mortality (61% for men and 54% for women). Findings from several studies suggest that women may cat healthier diets than men eat, which may contribute to women's lower coronary mortality when compared to men. While the role of non-traditional risk factors such as C-reactive protein, homocysteine, lipoprotein (a), and endothelial dysfunction is yet to be determined, a low folate intake in Central and Eastern Europe may be associated with higher homocysteine levels and increased coronary risk.