Wiener klinische Wochenschrift

, Volume 120, Issue 21–22, pp 684–692 | Cite as

Differences in risk factors for coronary heart disease in patients from continental and Mediterranean regions of Croatia

  • Mijo BergovecEmail author
  • Željko Reiner
  • Davor Miličić
  • Hrvoje Vražić
Original Article


BACKGROUND: There are few data on differences in exposure to risk factors for coronary heart disease (CHD) in relation to geographic areas, especially areas with large differences in terms of continental and Mediterranean climates. To study these differences in Croatia, we analyzed data from the Treatment and Secondary Prevention of Ischemic Coronary Events in Croatia V (TASPIC-CRO V) study, which recruited Croatian CHD patients in two principal regions (Mediterranean and continental) of the country. METHODS: A total of 31 Croatian research centers participated in the study. We collected information on personal details, demographic characteristics and risk factor exposure from the hospital medical records of 3054 CHD patients. Risk factors included history of cigarette smoking, hypertension, hyperlipidemia (total cholesterol, triglycerides, HDL-cholesterol and LDL-cholesterol) and diabetes type 2. RESULTS: Both univariate and multivariate analyses showed that the prevalence of hypertension in examined CHD patients was significantly higher in the continental part of Croatia than in the Mediterranean part (univariate analysis: P < 0.001; multivariate analysis: P = 0.003). Multivariate analysis revealed a higher prevalence of decreased HDL-cholesterol in continental Croatia (P = 0.006) and a higher prevalence of smokers in coastal Mediterranean Croatia (P = 0.007). A significant difference in total cholesterol levels was noted between hospitalized CHD patients in two Mediterranean subregions (P < 0.001). No significant differences between continental and coastal Mediterranean parts of Croatia were found for other CHD risk factors. CONCLUSIONS: Higher prevalences of both hypertension and decreased HDL-cholesterol were recorded in hospitalized CHD patients in the continental part of Croatia, but in coastal Mediterranean Croatia there was higher prevalence of smokers. Differences in total cholesterol, LDL-cholesterol and triglycerides between hospitalized CHD patients in continental and coastal Mediterranean Croatia did not follow the expected continental–Mediterranean pattern.


Coronary heart disease Cardiovascular risk factors Diet Mediterranean life style Hypertension Cholesterol 

Unterschiede in den Risikofaktoren für koronare Herzkrankheit bei kroatischen Patienten von kontinentalen und mediterranen Regionen


HINTERGRUND: Bezüglich der Abhängigkeit der Prävalenz der koronaren Herzkrankheit (KHK) von geographisch vorgegebenen Risikofaktoren liegen bisher nur spärliche Daten vor. Ein möglicher Einfluss des mediterranen Klimas im Vergleich zum kontinentalen Klima wurde bisher nur wenig untersucht. Wir analysierten die Daten der Secondary Prevention of Ischemic Coronary Events in Croatia V (TASPIC-CRO V) Studie, um mögliche Einflüsse zu erkennen. Die Studie inkludierte kroatische KHK-Patienten aus zwei Regionen – einer mediterranen und einer kontinentalen Region. METHODEN: Die Studie wurde an 31 kroatischen Forschungs-Zentren durchgeführt. Wir erhoben aus 3054 medizinischen Krankengeschichten von KHK-Patienten die Personaldaten, die demographischen Charakteristika und die Exposition zu bekannten Risikofaktoren wie Zigarettenkonsum, Hypertonie, Hyperlipidämie (Gesamtcholesterin, Triglyzeride, HDL-Cholesterin, LDL-Cholesterin) und dem Vorliegen von Typ II Diabetes mellitus. ERGEBNISSE: Sowohl die univariate als auch die multivariate statistische Analyse zeigten, dass die Prävalenz einer Hypertonie bei den untersuchten KHK-Patienten in der kontinentalen Region signifikant höher als in der mediterranen Region war (univariate Analyse: P < 0,001; multivariate Analyse: P = 0,003). Die multivariate Analyse zeigte eine höhere Prävalenz eines erniedrigten HDL-Cholesterins im kontinentalen Teil Kroatiens (p = 0,006) und eine höhere Prävalenz von Rauchern bei den Patienten an der mediterranen Küste (P = 0,007). In zwei mediterranen Subregionen wurde im Bezug auf das Gesamtcholesterin von hospitalisierten KHK-Patienten ein signifikanter Unterschied (P < 0,001) erhoben. Die anderen untersuchten Parameter unterschieden sich nicht signifikant. SCHLUSSFOLGERUNGEN: Es wurde eine erhöhte Prävalenz sowohl der Hypertonie als auch eines erniedrigten HDL-Cholesterins in hospitalisierten KHK-Patienten in der Region im Landesinneren im Vergleich zur Küstenregion Kroatiens gefunden. An der mediterranen Küste war dafür die Prävalenz von Rauchern höher. Die von uns bei hospitalisierten KHK-Patienten gefundenen Unterschiede des Gesamtcholesterins, LDL-Cholesterins und der Triglyzeride zwischen der mediterranen und der kontinentalen Region Kroatiens entsprechen nicht dem erwarteten Kontinent-Mittelmeer-Schema.


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  1. Croatian National Institute of Public Health (2004) Croatian Health Service Yearbook. Croatian National Institute of Public Health, Zagreb, pp 7, 66–68Google Scholar
  2. World Health Organization (2003) The World Health Report 2003 – Shaping the Future. World Health Organization, GenevaGoogle Scholar
  3. Kannel WB, Dawber TR, Kagan A, Revotskie N, Stokes J (1961) Factors of risk in the development of coronary heart disease – six-year follow up experience: The Framingham study. Ann Intern Med 55: 33–50PubMedGoogle Scholar
  4. Keys A, Menotti A, Karvonen MJ, Aravanis C, Blackburn H, Buzina R, et al (1986) The diet and 15-year death rate in the seven countries study. Am J Epid 124: 903–915Google Scholar
  5. Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al (2004) Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 364: 937–952PubMedCrossRefGoogle Scholar
  6. Iestra JA, Kromhout D, van der Schouw YT, Grobbee DE, Boshuizen HC, van Staveren WA (2005) Effect size estimates of lifestyle and dietary changes on all-cause mortality in coronary artery disease patients: a systematic review. Circulation 112: 924–934PubMedCrossRefGoogle Scholar
  7. Tucker KL, Hallfrisch J, Qiao N, Muller D, Andres R, Fleg JL (2005) Baltimore Longitudinal Study of Aging. The combination of high fruit and vegetable and low saturated fat intakes is more protective against mortality in aging men than is either alone: the Baltimore Longitudinal Study of Aging. J Nutr 135: 556–561PubMedGoogle Scholar
  8. Dauchet L, Ferrières J, Arveiler D, Yarnell JW, Gey F, Ducimetière P, et al (2004) Frequency of fruit and vegetable consumption and coronary heart disease in France and Northern Ireland: the PRIME study. Br J Nutr 92: 963–972PubMedCrossRefGoogle Scholar
  9. Park D, Desai P, Aiyengar J, Balladur A (1998) Geographic differences in the characteristics of coronary artery disease in India. Int J Cardiol 67: 187–189PubMedCrossRefGoogle Scholar
  10. Trichopoulou A, Bamia C, Trichopoulos D (2005) Mediterranean diet and survival among patients with coronary heart disease in Greece. Arch Intern Med 165: 929–935PubMedCrossRefGoogle Scholar
  11. Fidanza F, Alberti A, Lanti M, Menotti A (2004) Mediterranean diet score: correlation with 25-year mortality from coronary heart disease in the Seven Countries Study. Nutr Metab Cardiovasc Dis 14: 397PubMedCrossRefGoogle Scholar
  12. Knoops KT, de Groot LC, Kromhout D, Perrin AE, Moreiras-Varela O, Menotti A, et al (2004) Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. JAMA 292: 1433–1439PubMedCrossRefGoogle Scholar
  13. Panagiotakos DB, Pitsavos C, Polychronopoulos E, Chrysohoou C, Zampelas A, Trichopoulou A (2004) Can a Mediterranean diet moderate the development and clinical progression of coronary heart disease? A systematic review. Med Sci Monit 10: RA193–198PubMedGoogle Scholar
  14. Leonhauser IU, Dorandt S, Willmund E, Honsel J (2004) The benefit of the Mediterranean diet – considerations to modify German food patterns. Eur J Nutr 43 [Suppl 1]: I/31–38Google Scholar
  15. Kok FJ, Kromhout D (2004) Atherosclerosis – epidemiological studies on the health effects of a Mediterranean diet. Eur J Nutr 43 [Suppl 1]: I/2–5Google Scholar
  16. Trichopoulou A, Costacou T, Bamia C, Trichopoulos D (2003) Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 348: 2599–2608PubMedCrossRefGoogle Scholar
  17. Panagiotakos DB, Pitsavos C, Chrysohoou C, Stefanadis C, Toutouzas P (2002) Primary prevention of acute coronary events through the adoption of a Mediterranean-style diet. East Mediterr Health J 8: 593–602PubMedGoogle Scholar
  18. Menon V, Rumsfeld JS, Roe MT, Cohen MG, Peterson ED, Brindis RG, et al (2006) Regional outcomes after admission for high-risk non-ST-segment elevation acute coronary syndromes. Am J Med 119: 584–590PubMedCrossRefGoogle Scholar
  19. Pitsavos C, Panagiotakos DB, Chrysohoou C, Skoumas J, Papaioannou I, Stefanadis C, et al (2002) The effect of Mediterranean diet on the risk of the development of acute coronary syndromes in hypercholesterolemic people: a case-control study (CARDIO2000). Coron Artery Dis 13: 295–300PubMedCrossRefGoogle Scholar
  20. Pitsavos C, Panagiotakos DB, Chrysohoou C, Kokkinos PF, Skoumas J, Papaioannou I, et al (2002) The effect of the combination of Mediterranean diet and leisure time physical activity on the risk of developing acute coronary syndromes, in hypertensive subjects. J Hum Hypertens 16: 517–524PubMedCrossRefGoogle Scholar
  21. Giugliano D, Esposito K (2008) Mediterranean diet and metabolic diseases. Curr Opin Lipidol 19: 63–68PubMedGoogle Scholar
  22. Gillum RF, Mussolino M, Madans JH (2000) The relation between fish consumption, death from all causes, and incidence of coronary heart disease. The NHANES I Epidemiologic Follow-up Study. J Clin Epidemiol 53: 237–244PubMedCrossRefGoogle Scholar
  23. EUROASPIRE II Group (2001) Lifestyle and risk factor management and use of drug therapies in coronary patients from 15 countries: Principal results from EUROASPIRE II Euro Heart Survey Programme. Eur Heart J 22: 554–572CrossRefGoogle Scholar
  24. Reiner Z, Mihatov S, Milicic D, Bergovec M, Planinc D (2006) Treatment and secondary prevention of ischemic coronary events in Croatia. Eur J Cardiovasc Prev Rehabil 13: 646–654PubMedCrossRefGoogle Scholar
  25. Uemura K, Pisa Z (1988) Trends in cardiovascular disease mortality in industrialized countries since 1950. World Health Stat Q 41: 155–178PubMedGoogle Scholar
  26. Bergovec M, Mihatov S, Prpic H, Rogan S, Batarelo V, Sjerobabski V (1992) Acute myocardial infarction among civilians in Zagreb city area. Lancet 339: 303PubMedCrossRefGoogle Scholar
  27. Bergovec M, Heim I, Vasilj I, Jembrek-Gostovic M, Bergovec M, Strnad M (2005) Acute coronary syndromes and the 1992–1995 War in Bosnia and Herzegovina: a 10-year retrospective study. Mil Med 170: 431–434PubMedGoogle Scholar
  28. Babic-Banaszak A, Kovacic L, Kovacevic L, Vuletic G, Mujkic A, Ebling Z (2002) Impact of war on health related quality of life in Croatia: population study. Croat Med J 43: 396–402PubMedGoogle Scholar
  29. Turek S, Rudan I, Smolej-Narancic N, Szirovicza L, Cubrilo-Turek M, Zerjavic-Hrabak V, et al (2001) A large cross-sectional study of health attitudes, knowledge, behaviour and risks in the post-war Croatian population (The first Croatian Health Project). Coll Antropol 25: 77–96PubMedGoogle Scholar
  30. Reiner Z (2003) Kardiovaskulare Risikofaktoren in Kroatien. In: Schwandt P, Haas GM (eds) Prevention von Herzinfarkt und Schlaganfall. Stiftung zur Prävention der Arteriosklerose, München, pp 68–70Google Scholar
  31. Reiner Z, Tedeschi-Reiner E (2006) Atherosclerosis – a paradox of eastern European countries. Atherosclerosis 7: 461Google Scholar
  32. Ulmer H, Diem G, Bischof HP, Ruttmann E, Concin H (2001) Recent trends and sociodemographic distribution of cardiovascular risk factors: results from two population surveys in the Austrian WHO CINDI demonstration area. Wien Klin Wochenschr 113: 573–579PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Mijo Bergovec
    • 1
    Email author
  • Željko Reiner
    • 2
  • Davor Miličić
    • 3
  • Hrvoje Vražić
    • 1
  1. 1.Cardiology Division, Department of Internal MedicineUniversity Hospital DubravaZagrebCroatia
  2. 2.Department of Internal MedicineUniversity Hospital Center ZagrebZagrebCroatia
  3. 3.Department of Cardiovascular DiseasesUniversity Hospital Center ZagrebZagrebCroatia

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