Heart Disease: A Global History Lesson

Coronary Heart Disease (CHD) is projected to be the leading global cause of death and disability by 2020. Currently, cardiovascular disease is the main cause of death in industrialized nations. The significant risk factors for cardiovascular disease include cholesterol, blood pressure, smoking, and physical inactivity. Today I will focus on the utter importance of our diet by observing trends in three different countries over the past couple decades: Poland, the Czech Republic, and China. In each case we will see the relationship between the food we eat and socioeconomic forces, as well as the profound effect these forces have on our health, both positive and negative.

Poland 1991-1998

From 1960 to 1991 mortality from diseases of the circulatory system in Poland was high and increasing, heart disease roughly doubled over this time period. Since 1991, however, the fall in death rate due to heart disease has been larger than that previously observed in any country during peacetime. In 1994, the percentage fall of people aged 45-64 was 26% for men and 25% for women for ischaemic heart disease. What could account for this sudden and dramatic drop in heart disease? The most striking change was the switch from animal to vegetable fats and increased supplies of fresh foods. Consumption of fresh fruits and vegetables has been associated with reduced risk of circulatory disease. This change in fat consumption in Poland has been a consequence of market conditions. In 1989, general purchasing power fell and the withdrawal of large consumer subsidies, especially for foods of animal origin, reduced purchasing power for those foods sharply. The market shifted towards vegetable fats and the production of margarine with low contents of trans fats. It is important to note that mortality changes appeared immediately after dietary changes, suggesting just how quickly dietary changes can affect our health. In this example we see how socioeconomic forces at least temporarily have led to better health through a shift in diet to fresh foods.

Czech Republic 1990-2000

Substantial cholesterol-concentration decrease has resulted from changes in the Czech population’s diet over the past decade. From 1989 to 1997, consumption of beef and pork decreased 32%, whereas the consumption of fish increased 70%. Butter consumption dropped 64%, while vegetable oil increased 136%, and consumption of fruits and vegetables increased 28%. This occurred as the result of the centralized government abolishing subsidies for meat and dairy products. These changes also occurred through federal health-promotion activities to alter lifestyles that were promoted in the new political atmosphere. Increased intake of fresh fruits and vegetables and vegetable fat also increased the intake of dietary antioxidants, thus preventing low-density lipoprotein oxidation. Dietary changes produced a significant 10% decrease in total cholesterol concentration in the adult Czech population. This is another amazing example of the importance of our diet and the forces behind the food we eat.

China 1984-1999

In Beijing between 1984 and 1999, Coronary Heart Disease mortality rates increased by 50% in men and 27% in women aged 35 to 74 years. The biggest contribution to this change is the extreme increase in cholesterol. This trend is consistent with the observed changes from a traditional to a Western diet, such as a 5-fold increase in consumption of red meat, eggs, and oils between 1978 and 1992, along with declines in fruit and vegetable intake. Mortality increases occurred relatively quickly after the cholesterol increases. Another example of the rapid response our bodies have to our diet and cholesterol intake. Increases were also observed in obesity and diabetes. The 16 million diabetics in China are projected to more than double by 2025, to 38 million. Beijing and the other large cities are leading dramatic socioeconomic trends with profound effects on health. Primary prevention, particularly for diet and smoking, could potentially reverse these alarming trends.

Similar trends have occurred throughout the world, including Norway during WWII, as well as in Australia, New Zealand, and the United States during the 60’s and 70’s. Aside from the obvious suggestions this data provides for our diet, I hope it will open the door to begin considering the complexity of the socioeconomic and marketing forces that impact what we are eating here in the United States. Who tells us that excessive dairy does a body good? That red meat makes a body strong? Who profits from it? Who suffers from it?