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CVD and metabolic syndrome
High burden of cardiovascular disease and risk profile in an elderly eastern German general population—potential explanation for an east–west gradient of cardiovascular mortality: The CARLA Study 2002–2006
  1. K. H. Greiser1,
  2. A. Kluttig1,
  3. B. Schumann1,
  4. O. Kuss1,
  5. J. A. Kors2,
  6. K. Werdan3,
  7. C. A. Swenne4,
  8. J. Haerting1
  1. 1
    Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
  2. 2
    Department of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands
  3. 3
    Department of Internal Medicine III, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
  4. 4
    Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands

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    Background

    For cardiovascular diseases (CVD), an east-west mortality gradient across Europe has been described, which could not fully be explained by established risk factors. Likewise, the cause of the higher CVD mortality in eastern as compared to western Germany has not yet been elucidated due to the scarcity of population-based data on CVD morbidity and risk factors.

    Objective

    To provide data on the distribution of CVD and its risk factors in an elderly general population in eastern Germany as compared to a western German population.

    Methods

    Cross-sectional data of 1779 East German participants of the population-based CARLA Study aged 45–83 at baseline were used to calculate sex- and age-specific means of risk factors, disease prevalence, and expected 10-year risk of fatal CVD to be compared with the data of 4261 participants of the south-west German KORA study. Risk of fatal CVD was calculated using the Systematic Coronary Risk Evaluation (SCORE) Germany algorithm which is based on sex, age, systolic blood pressure (SBP), current smoking, and cholesterol levels.

    Results

    There were no clear differences in age-specific mean body mass index (BMI) and smoking prevalence between CARLA and KORA subjects (except for higher smoking prevalence in 45–54 year old CARLA subjects), and only a slightly higher predicted 10-year CVD mortality in CARLA as compared to KORA subjects. Mean 10-year risk of fatal CVD in CARLA increased from 0.57% (95% CI 0.39 to 0.75%) in 45–49 year-old to 3.5% (3.0 to 3.9%) in 60–64 year-old women as compared to 0.37% (0.33 to 0.41%) and 2.91% (2.71 to 3.12%) in KORA respectively. However, the prevalence of diabetes and hypertension, and mean SBP were considerably higher in CARLA subjects across all sex–age-groups as compared to KORA subjects. For example, the prevalence of hypertension in CARLA increased from 55.4% (48.6 to 63.3%) in 45–54 year-old to 84.2% (79.3 to 89.2%) in 65–74 year-old women, while it was 36.7% (32.3 to 41.1%) to 61.5% (56.5 to 66.5%) in KORA, respectively. The prevalence of diabetes across 10-year age-groups in CARLA women increased from 4.9% (1.9 to 7.9%) in the 45–54 year-old to 19.1% (13.8 to 24.5%) in the 65–74 year-old as compared to 2.4% (1.0 to 3.8%) to 8.1% (5.3 to 10.9%) in KORA, respectively. Moreover, within narrow categories of BMI, CARLA subjects consistently showed a considerably higher waist-to-hip-ratio than KORA subjects.

    Conclusions

    Our results support the hypothesis that an especially high prevalence of diabetes and hypertension and other components of the metabolic syndrome may explain the excess CVD mortality in eastern Germany which is not accurately reflected in SCORE.

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