The Lancet regional health. Europe · 2026
Contributions of diet and lifestyle to sex differences in ischaemic heart disease burden in Central Europe: an analysis of the Global Burden of Disease Study 2023.
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Bugiardini Raffaele, Rahaman Tania, Badimon Lina, Cenko Edina, Anand Sonia S, Manfrini Olivia, Merkely Bela, Milicic Davor, Townsend Nick, Vaccarino Viola, Gulati Martha, Gale Chris P
Аннотация
BACKGROUND: Central Europe carries a substantial global burden of ischaemic heart disease (IHD). We aimed to quantify sex-specific differences in IHD case-fatality across 13 Central European countries and to examine the contribution of metabolic, behavioural, and dietary risk factors to these disparities.
METHODS: We analysed Global Burden of Disease (GBD) data on IHD from 1990 to 2023 across 13 Central European countries. Population-level case-fatality was assessed using sex-specific age-standardised mortality-to-prevalence ratios (MPRs). Mortality attributable to specific risk factors was normalised to prevalence to derive a case-fatality index (CFI). Z-scores (≥1.96) quantified the significance of sex differences. Associations with gross national income (GNI) per capita were evaluated using Pearson correlation.
FINDINGS: In 2023, there were 6.71 million prevalent IHD cases in the region, of whom 3.01 million (44.8%) were women. From 2011 to 2023, regional MPRs declined from 4.49% to 4.37% in men (2.6% relative decrease) and from 4.59% to 4.42% in women (3.7% relative decrease). However, statistically significant sex disparities persisted in 2023: women had higher MPRs in Croatia (Z = 5.55), Serbia (Z = 2.55), and Czechia (Z = 2.18), whereas men had higher MPRs in Poland (Z = -2.55). Higher GNI per capita was associated with lower MPRs (r = -0.76; p = 0.003). Elevated systolic blood pressure and physical inactivity were prominent (Z > 1.96) contributors to excess female case-fatality, while tobacco use disproportionately (Z > 2.58) affected men, particularly in Poland. Dietary risks contributed to sex disparities: women demonstrated higher CFIs for low intake of fruits, nuts/seeds, vegetables, and seafood omega-3 in several high-disparity countries, while male excess was limited to high sodium and low whole-grain intake in isolated settings.
INTERPRETATION: Despite overall improvements, significant sex inequalities in IHD case-fatality persist in Central Europe. Differential burdens of metabolic, behavioural, and dietary risks are associated with these disparities, underscoring the importance of sex-specific and country-specific prevention approaches to reduce avoidable cardiovascular mortality.
FUNDING: None.
METHODS: We analysed Global Burden of Disease (GBD) data on IHD from 1990 to 2023 across 13 Central European countries. Population-level case-fatality was assessed using sex-specific age-standardised mortality-to-prevalence ratios (MPRs). Mortality attributable to specific risk factors was normalised to prevalence to derive a case-fatality index (CFI). Z-scores (≥1.96) quantified the significance of sex differences. Associations with gross national income (GNI) per capita were evaluated using Pearson correlation.
FINDINGS: In 2023, there were 6.71 million prevalent IHD cases in the region, of whom 3.01 million (44.8%) were women. From 2011 to 2023, regional MPRs declined from 4.49% to 4.37% in men (2.6% relative decrease) and from 4.59% to 4.42% in women (3.7% relative decrease). However, statistically significant sex disparities persisted in 2023: women had higher MPRs in Croatia (Z = 5.55), Serbia (Z = 2.55), and Czechia (Z = 2.18), whereas men had higher MPRs in Poland (Z = -2.55). Higher GNI per capita was associated with lower MPRs (r = -0.76; p = 0.003). Elevated systolic blood pressure and physical inactivity were prominent (Z > 1.96) contributors to excess female case-fatality, while tobacco use disproportionately (Z > 2.58) affected men, particularly in Poland. Dietary risks contributed to sex disparities: women demonstrated higher CFIs for low intake of fruits, nuts/seeds, vegetables, and seafood omega-3 in several high-disparity countries, while male excess was limited to high sodium and low whole-grain intake in isolated settings.
INTERPRETATION: Despite overall improvements, significant sex inequalities in IHD case-fatality persist in Central Europe. Differential burdens of metabolic, behavioural, and dietary risks are associated with these disparities, underscoring the importance of sex-specific and country-specific prevention approaches to reduce avoidable cardiovascular mortality.
FUNDING: None.