1. W.Z. CO 2006 1 Dramatic changes in structure of fat consumption and CVD What can we learn from CVD trends in CEE: case of Poland Dubai, January 7, 2006 Witold Zatoński, M.D., POLAND Supported by European Commission grant no 2003121

2. W.Z. CO 2006 2

3. 3 History After 1945 two simultaneous phenomenon:   Infection diseases, infant mortality, maternal mortality decline   Non-communicable diseases + injury increase

4. W.Z. CO 2006 4 Mortality rates from all causes Poland and UK Males 0-14 Males 15-59

5. W.Z. CO 2006 5 PROBABILITY OF DYING BY REGION, 1990 (data adapted from Murray and Lopez, 1994) EME - Established Market Economies POL - Poland CHN - China LAC - Latin America and the Caribbean OAI - Other Asia and Islands MEC - Middle Eastern Crescent IND - India SSA - Sub-Saharan Africa

6. W.Z. CO 2006 6 Male deaths at age 15-59 1960-1990 Lung cancer Injuries Cardiovascular diseases

7. W.Z. CO 2006 7 Mortality rates from cardiovascular diseases, Poland and Finland 1959-1991 Males, age 45-64Females, age 45-64

8. W.Z. CO 2006 8 Economical and political transformation in central Europe. A health miracle. Democracy is healthier

9. W.Z. CO 2006 9 Premature mortality, Poland 1962-2002 age group 20-64 MalesFemales

10. W.Z. CO 2006 10 Premature mortality in selected countries 1959-2002 Males, age 45-64

11. W.Z. CO 2006 11 Premature mortality in selected countries 1959-2002 Females, age 45-64

12. W.Z. CO 2006 12 Mortality trends in Poland 1959-2002 Males, age 45-64 Females, age 45-64

13. W.Z. CO 2006 13 Unexpected phenomenon of transition period in CEE countries is rapid decrease in premature mortality due to CVD

14. W.Z. CO 2006 14 Standardized incidence rates from myocardial infarction population of Warsaw at age 35-64 ( Pol-Monica Warsaw) Source: Stefan Rywik „Czy zmienia się zagrożenie chorobami układu krążenia w Polsce? na przykładzie populacji Warszawy w średnim wieku”

15. W.Z. CO 2006 15 Cardiovascular diseases mortality, Poland 1963-2002 Males, age 20-44Males, age 45-64Males, age 65+ Females, age 20-44Females, age 45-64 Females, age 65+

16. W.Z. CO 2006 16 Changes in standardized mortality rates from cardiovascular diseases, Poland 1990-2002 (expressed as a percentage, 1991=100%) age 20-44 age 45-64age 65 and over malesfemales

17. W.Z. CO 2006 17 Standardizet mortality rates from cardiovascular diseases by place of living, all age,Poland 1985-2002 femalesmales

18. W.Z. CO 2006 18 CVD mortality by education in Poland 1994 to 2002* femalesmales *age 45-64

19. W.Z. CO 2006 19 Cardiovascular diseases mortality, Poland and Finland 1963-2002 Males, age 20-44Males, age 45-64Males, age 65+ Females, age 20-44 Females, age 45-64 Females, age 65+

20. W.Z. CO 2006 20 Mortality trands from cardiovascular diseases, selected countries 1959-2002 Males, age 45-64 Females, age 45-64

21. W.Z. CO 2006 21 „Natural” experiment in Poland

22. W.Z. CO 2006 22 Polyunsaturated / saturated fatty acids ratio in Poland, 1950-1999

23. W.Z. CO 2006 23 Consumption of vegetable oils in Poland in 1970-2000 (kg/capita/year) Source: National Food and Nutrition Institute, Poland

24. W.Z. CO 2006 24 Consumption of vegetable oils and butter in Poland in 1970-2000 (kg/capita/year) Source: National Food and Nutrition Institute, Poland

25. W.Z. CO 2006 25 Structure of vegetable oils consumption in Poland in 2002

26. W.Z. CO 2006 26 Risk of ischaemic heart diseases* according to polyunsaturated / saturated fatty acids ratio (in NHS**) Poland 1990 Poland 1992 Poland 1994 Poland 1996 1 Predicted RR for Poland **W.Willett at al., Nurses Health Study - Personal Comunication *IHS + atherosclerosis and arterial diseases at age 45-64 0.8

27. W.Z. CO 2006 27 Consumption of exotic fruit in Poland, 1983-2002 (kg/capita/quarter)

28. W.Z. CO 2006 28 Fruits consumption in Poland in 1990-2002 Annual increase since 1990: 4%

29. W.Z. CO 2006 29 Vegetable consumption in Poland in 1990-2002 Stable trend since 1990

30. W.Z. CO 2006 30 Smoking prevalence. Adults (>15) in Poland in 1980-2002 Males: annual decline since 1989: 1.9% Females: stable trend since 1982

31. W.Z. CO 2006 31 Prevalence of tobacco smoking by age groups, males, Poland, 1974-2004

32. W.Z. CO 2006 32 Prevalence of tobacco smoking by age groups, females, Poland, 1974-2004

33. W.Z. CO 2006 33 Medical service

34. W.Z. CO 2006 34 Premature mortality time trends, Russia, Poland and Lithuania in 1980-2002 Males aged 15-59

35. W.Z. CO 2006 35 Life Expectancy at Birth in selected countries