Diet and Coronary Heart Disease Risk in Europe
Daan Kromhout.
Division of Public Health Research, National Institute of Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, The Netherlands.
Within Europe large differences exist in coronary heart disease mortality. There is a clear west-east pattern with a five-fold higher range in Eastern European countries. Between 1970 and 1992 large changes occurred in coronary heart disease mortality in different European countries. In Eastern European countries large increases were noted e.g. an annual increase of more than 6%/year in Romania. In contrast coronary heart disease mortality rates decreased in most Northern, Western and Southern European countries. The largest decrease of more than 2%/year was observed in Belgium. In the context of this symposium the question is of interest what the dietary determinants of coronary heart disease risk are. There is experimental, clinical and epidemiologic evidence that oxidised LDL plays a major role in the development of atherosclerosis and its clinical complications. Saturated fatty acids with 12-16 carbon atoms are the most important determinants of LDL cholesterol. The LDL lipoprotein fraction can be oxidised by e.g. smoking. Oxidative damage of LDL lipoproteins can be prevented by nutritive e.g. vitamin E and non-nutritive e.g. flavonoids, antioxidants. The Seven Countries Study has shown that at the population level saturated fat, cigarette smoking and flavonoids are important determinants of long-term coronary heart disease mortality. There is also evidence from primary and secondary intervention trials that a reduction in saturated fat, stopping with smoking and an increased consumption of fatty fish, vegetables and fruits reduced coronary heart disease and all cause mortality. It may therefore be concluded that diet is an important determinant of coronary heart disease risk.