It is widely believed that chronic stress can aggra-
vate the development of chronic diseases. However, the
reasons for the high cancer and CVD mortality in East-
ern Europe are (with the significant exception of male
smoking) not yet known. It is possible that in commu-
nist countries the effect of traditional risk factors has
been intensified unidentified factors. Hypothetically,
such factors can comprise psychosocial disorders, alco-
holism, environmental pollution and specific nutri-
tional deficiencies (e.g., very low intake of antioxidant
vitamins, folic acid, and bioflavonoids). Very low blood
levels ofantioxidants, especially ofvitamin Candsele-
nium, were found in various regions of Central and
Eastern Europe between 1970 and 1990.
Postcommunist period (after 1989). Thanks to its
geographical location, Central Europe was best pre-
pared for the democratic changes that occurred after
- After the collapse of communism, the decrease in
CVD mortality in politically and economically more
consolidated countries occured. The positive changes
in Central European countries can be explained by
higher consumption of healthful food, including a sub-
stantial increase in the consumption of fruit and vege-
tables, a decrease in butter and fatty milk consumption,
and an increase in the consumption of vegetable oils
and high-quality margarines. There was also a rapid
improvement in the availability and quality of modern
CVD health care.
Finnish and Russian epidemiologists compared
the plasma ascorbic-acid concentrations among men
in North Karelia (Finland) and in the neighboring
Russian district. Almost all Russian men had levels
suggesting a severe vitamin C deficiency, while more
than 95% Finns had normal vitamin C levels. Com-
parison of fifty-year-old men in Sweden and Lithuania
found significantly lower plasma concentrations of
some antioxidant vitamins (beta-carotene, lycopene,
gamma-tocopherol) in Lithuanian men. They also had
substantially lowered resistance of low-density lipo-
protein to oxidation than Swedish men. It is probable
that in Russia an imbalance arose in which factors
enhancing the production of free radicals (alcoholism,
smoking, and pollution) dominated protective antiox-
idant factors.
High prevalence of smoking and alcoholism has
also been an important factor in high CVD mortality
rates in Russia. A substantial proportion of CVD
deaths in Russia, particularly in the younger age
groups, have been sudden deaths due to cardiomyo-
pathies related to alcoholism. Alcoholism has evi-
dently played a key role in the extremely high
incidence of CVD mortality, as well as in the numbers
of accidents, injuries, suicides, and murders. There is
no way to determine a reliable estimation of the actual
consumption of alcohol in Russia, since alcohol is
being smuggled into the country on a large scale.Risks
Normalization in the Russian Federation will likely
be more difficult than in Central Europe. Trends in
lifestyle, smoking, food selection,alcohol consumption,
and other areas will be determined by both economic
and political factors. The successfulness of the economic
transformation, which provides hope for a sensible life,
will be a key factor in improving health status in post-
communist countries. A significant decrease in cardio-
vascular and cancer mortality in Central Europe
provides hope for the Russian Federation. Unfortu-
nately, differences in life expectancy between these
countries and Western Europe are still very great.Resources
OTHER
World Health Organization. ‘‘Health for All Database:
Mortality Indicators by Cause, Age, and Sex.’’ Avail-
able from<http://www.euro.who.int/hfadb>.Emil GintherChangeOne diet
Definition
The aim of ‘‘ChangeOne: Lose Weight Simply,
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forward plan for gradual, permanent weight loss. The
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