Cardiovascular mortality and risk factors: Is Poland repeating the US experience of 30 years ago?

Background

Cardiovascular diseases (CVD) have been leading causes of death in the United States (US) and Poland. CVD and coronary heart disease (CHD) death rates have changed in both countries in recent decades. We examined these mortality trends in the two countries and considered their relations to contemporaneous changes in risk factor exposures.

Methods

Mortality and population data were obtained from the Polish Main Statistical Office (1970–96), the US Community Structures Project (1962–67), and the US National Center for Health Statistics (1968–2000). Best-fit, age-standardized, mortality rate trend curves for ages 35–64 years were generated with local regression and were quantified with piecewise log-linear regression. Contemporaneous risk factor exposures were obtained from published sources and from Pol-MONICA data.

Results

While mortality rates leveled and declined in the US, they increased in Poland resulting in Polish rates exceeding those of US Caucasians and approaching or exceeding those of African Americans. Increasing mortality rate trends in Poland reversed in 1991, and declined thereafter, especially for CHD. US mortality declines were accompanied by reductions in multiple risk factors. Decreased risk factor exposures were noted during CHD declines in Poland, but differed somewhat from the US experience.

Conclusions

The reversal of increasing CVD mortality rate trends in Poland during the 1990s is reminiscent of a similar reversal in the US 30 years earlier and was accompanied by reduced risk factor exposures in both countries. The similarity of experiences comparing the two countries demonstrates the importance of efforts to reduce population exposures to preventable risk factors.