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Publications

Journal Article Ahead of print

PubMed: 42850062 DOI: 10.1093/cvr/cvag222

Unequal survival after ischaemic heart disease in Eastern Europe: a sex-specific GBD 2023 analysis.

Cardiovasc Res

Authors: Raffaele Bugiardini, Veaceslav Sirbu, Olivia Manfrini, Lina Badimon, Edina Cenko, Davor Milicic, Nick Townsend, Martha Gulati, Tania Rahaman, Andrejs Erglis, Olivija Dobiliene, Chris P Gale

Affiliations

  • Department of Medical and Surgical Sciences, University of Bologna, Italy.
  • IRCCS Azienda Ospedaliero-Universitaria di Bologna Sant'Orsola Hospital, Bologna, Italy.
  • Medical School UVic-UCC and Iris-CC, Vic; CiberCV, Institute Carlos III, Madrid; and Cardiovascular Research Foundation for Health and Innovation, Barcelona, Spain.
  • University of Zagreb School of Medicine, Zagreb, Croatia.
  • School for Policy Studies, University of Bristol, UK.
  • The Davis Women's Heart Center, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, USA.
  • Latvian Cardiology Center, Paul Stradins Clinical University Hospital, Riga, Latvia.
  • Department of Ischaemic Heart Disease, Lithuanian University of Health Sciences, Lithuania.
  • Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.

Abstract

AIMS

Sex disparities in ischaemic heart disease (IHD) outcomes are well documented in Western Europe, but remain poorly characterized across Eastern Europe, a region marked by substantial mortality inequalities. We aimed to determine whether population-level case fatality among individuals living with IHD differed by sex in Eastern Europe and to identify modifiable risk factors associated with disparities.

METHODS AND RESULTS

We analysed sex-specific estimates from the Global Burden of Disease 2023 study for seven Eastern European countries. Age-standardized IHD mortality and prevalence rates were combined to derive mortality-to-prevalence ratios (MPRs) as a measure of population-level case fatality. Risk factor-attributable mortality was similarly normalized to prevalence. Estonia, which had the lowest MPRs (men 3.00%; women 1.77%), served as the benchmark for Z-score analyses (|Z| ≥ 1.96 = P < 0.05). In 2011, women in 5 of 6 countries had higher MPRs than Estonian women (Z = 2.25-4.35), whereas men showed excess MPRs in only 3 countries (Z = 2.29-3.18). By 2023, all 6 countries showed higher female MPRs than Estonia (Z = 3.27-5.14). In men, excess MPRs persisted in Latvia, the Russian Federation and Ukraine (Z = 2.48-3.16) and emerged in Belarus (Z = 4.79) but remained non-significant in Lithuania and the Republic of Moldova.Female-specific benchmark signals were observed for high fasting plasma glucose in Belarus and the Republic of Moldova, and for high systolic blood pressure in Lithuania, the Republic of Moldova, and the Russian Federation.

CONCLUSIONS

Pronounced sex disparities in IHD population-level case fatality persist across Eastern Europe. Lithuania and the Republic of Moldova showed the most consistent female disadvantage. Excess female population-level case fatality was most consistently associated with key modifiable risk factors.

MeSH

Diabetes Mellitus, Hypertension, Mortality, Heart Diseases, Heart, Prevalence, Sex Characteristics, Sex, Risk Factors, Sex Differences