Okay, I was dishonest in the title of this post.  Not all Norwegians have heart disease.  But almost all Norwegian men are (if we believe the prevailing guidelines) at high risk for heart disease.

Like most Americans, I spend very little time thinking about Norwegians.  The great Chicago columnist Mike Royko once pointed that in the ethnic melting pot of Chicago, you can hear jokes about the Irish, Jews, Italians, Poles, African-Americans, Mexicans, Puerto Ricans, French, British, Russians and Germans.  He even remembered some jokes about Swedes.  But when he asked around, nobody could remember ever hearing a joke about Norwegians.  Royko even tracked down a Norwegian-American acquaintance who confirmed, “Naw, nobody tells jokes about us.  We’re too nice.”

I got thinking about the Norwegians this weekend while answering comments on my post about the Spanish Paradox.  I remembered logging a study about Norwegians and their risk of heart disease into my database and pulled it up.  Here are some quotes from the study:

Since the first US Framingham model for predicting heart disease risk was published in 1991, it has become ever more widely recommended that doctors in primary care carry out risk assessment by combining several risk factors for cardiovascular disease using algorithms. Until recently most risk equations have been derived from the Framingham study, but these calculations tended to overestimate risk in the European context.

Actually, the Framingham model is lousy at predicting heart disease in the American context as well.  But let’s move on.

A new European risk scoring system for cardiovascular disease, based on the first phase of the systematic coronary risk evaluation (SCORE) project, was presented in 2003. The system is based on a pooled dataset of cohort studies from 12 European countries, among these Norway, and offers a format for estimating fatal cardiovascular disease risk that is suitable for clinical practice.

After explaining those guidelines, the researchers report on the results of applying them to data collected from several thousand Norwegians.  Here’s what they found:

At age 40, 22.5% of women and 85.9% of men were at high risk of cardiovascular disease. Corresponding numbers at age 50 were 39.5% and 88.7%, and at age 65 were 84.0% and 91.6%.  At age 40, one out of 10 women and no men would be classified at low risk for cardiovascular disease.

Hmmm … people in Norway must be dropping like flies from heart disease, at least according to the prevailing guidelines for estimating heart-disease risk … you know, cholesterol levels and all that stuff.

Here again is the American Heart Association’s chart showing rates of cardiovascular disease around the world:

You’ll notice Norway is down toward the lower end of the scale – not as low as France or Spain, but lower than the U.S., U.K. or Germany.

For once, the researchers recognize that the current guidelines are poppycock.  They don’t put it quite that way, of course.  Their language is more academic and polite:

Implementation of European guidelines to prevent cardiovascular disease would label most people in an unselected Norwegian population at high risk of fatal disease from age 40

The validity of the evidence base of the guidelines is questionable and predicts practical and ethical dilemmas related to resource allocation and clinical counselling.

Any overestimation of a person’s risk for cardiovascular disease can have important implications. Apart from causing unnecessary concern, it undermines the patient’s informed choice for intervention. It is also likely to increase prescribing costs and affect life insurance premiums.

Yup.  First thing you know, your doctor is scaring the bejeezus out of you and talking you into taking statins.

Over the weekend, I also had a mini-debate on Twitter with someone who insisted the French paradox is probably a matter of genetics.  I pointed out that waves of French moved to England to become landowners after the Norman Conquest and that the French and English have been intermarrying for hundreds of years.  I doubt that there’s a big difference between French DNA and British DNA.  He didn’t buy it and tweeted a link to a document detailing the marked genetic differences among Europeans.  He apparently didn’t notice that the document he linked described differences among Europeans separated by the Alps for most of history.

Look at the AHA chart one more time.  Scotland and Ireland are near the top.  England and Wales are near the middle.  Now go find Australia.  I’ll give you minute …

… Find it?  Yup, Australia is near the bottom.  My Australian readers can correct me if I’m wrong, but I’m pretty sure we can’t explain away the “Australian Paradox” by suggesting Australians are genetically distinct from the Irish, Scots and Brits.

So we have the Spanish, who are in “poor cardiovascular health” according to current guidelines, but have a low rate of heart disease.  We have the Norwegians, nearly all of whom are at a high risk of heart disease according to current guidelines, but have a relatively low rate of heart disease.

I’m thinking the problem is with the current guidelines.  Nice to see some researchers say as much.

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48 Responses to “All Norwegians Have Heart Disease”
  1. David says:

    Australians reported the following ancestry at the 2011 census: English (36.1% of the population), Irish (10.4%), Scottish (8.9%) or Welsh (0.57%). More information here http://en.wikipedia.org/wiki/Australians#Nationality

    “Australian”ancestry was noted by 35.4% of people, which is likely to be a mixed group of people, predominately from Britain and Ireland but will also include people like me – 4th generation Australian with no remaining connection to Russian/Polish origins. Lots of genetic overlap with the “motherland” nonetheless. Interesting that Australia is so near the bottom of the table – two thirds of our population is overweight or obese, seed oils and refined carbs are everywhere, saturated fat is regarded as a main cause of heart disease and demonized, 58% percent of the population is meant to be vitamin d deficient despite all the available sun. Paradox indeed……

  2. John says:

    Okay, you asked for it.
    ——————————————————————————————–
    The gods were sitting around one day playing pinochle. They heard a strange sound: “hoya, hoya, hoya.” It came from down below down below, and since it was a slow, hot summer day only good for napping, they looked. A human was paddling his canoe across a big lake with long, easy strokes, but he shot through the water like an arrow because he lived off the goodness of the land and he was strong and healthy.

    Bored out of their tree and not thinking right after splurging on hot fudge sundaes, the gods decided to have a little fun. “What do you think will happen if we remove half his brain?”

    “I don’t know,” said the second god. “Let’s try it.” So he waved his prescription pen, and half the human’s brain vanished.

    The human continued his effortless pace. “Hoya, hoya, hoya.”

    “Do it again,” said the first god, a freakish , elvish critter who constantly waved his Harvard degree at the other gods. The second god did.

    The human continued his effortless pace. “Hoya, hoya, hoya.”

    The gods looked at each other with astonishment. They hadn’t seen anything so weird since they learned to love hot fudge sundaes and their clothes started to shrink.

    “Don’t even ask,” the second God said. He was president of the ADA, the Air Diety Association. He couldn’t spell very well – writing hadn’t been invented yet – but he could read minds. Yes, they both really loved those sundaes and they both wanted to perform silly experiments on these human creatures. He waved his magic prescription pen and poof, the rest of the human’s brain vanished.

    The human kept on paddling like he owned that lake, but his voice changed: “ufta, ufta, ufta.” The gods shrugged and returned to their sundaes and pinochle.

  3. Marta says:

    My Father in Law is Norwegian and is 91 years old. His only problem is some arthritis in his left foot from dislocating all of the bones when he was 27. Sure likes his butter though!

  4. dave riley says:

    The “Australian Paradox” …?

    Death from heart disease has fallen by 5% over the last decade. … but why that should be so isn’t straightforward.

    [Link]

    Successful anti smoking campaigns.More agressive diabetes diagnosis and prevention. Better medication for hypertension and more considered medical interventions overall within a reasonably good(by world standards) but no longer totally free health care system..

    The ‘Australian diet’ is certainly better than what’s the norm in the US or UK. An efficient farming sector. Fresh produce. 4 growing seasons. Multicultural cuisine influences drawn from Asia and Europe. Melbourne is the second largest Greek city in the world. Large Middle Eastern concentration in western Sydney. The diet my parents grew up on is a thing of the past and our major dietary enemies today are imported franchisees like MacDonalds.

    We drink too much –mainly beer — but wine consumption — primarily locally grown wine — has exploded over the last 30 years.

    The incidences of obesity , like diabetes, is rising sharply but not as steeply as in Mexico or the US.

    Ours is still primarily a carb dense cuisine mainly based on wheat, but one of the most popular lunch time takeaways is sushi and aside from the franchisees the suburban restaurant mix is classic fish and chips, Indian, pizza, Chinese and Thai. Although the national ‘dish’ is a meat pie and tomato sauce.

    Some paradox.

  5. Walter B says:

    Last time I saw a doctor, for a physical, (I needed medical clearance to get SCUBA certified) was about 1985 IIRC. If I’d gone for one up until about 3 years from now I would have definitively have been put on statins and probably an even more horrid diet that I was eating at the time.

  6. Marilyn says:

    It’s a bit hard to tell, but it looks as if the Nowegians have more heart fatalities, but fewer deaths overall than the French. I don’t know what kind of paradox that would give you.

    Did you mean Norman Conquest, rather that “Normal”?

    I guess it would be a bit insulting to my British friends to label a conquest “normal.”

  7. js290 says:

    It’s logically incorrect, and therefore also scientifically incorrect, to build a model around the data collected. See “Texas Sharpshooter Fallacy.” If a model cannot predict the data that’s being collected, that model can’t predict anything. The model “works” until it doesn’t. When it doesn’t work, It fails spectacularly, which are then called “paradoxes.” For another example, see anthropological climate change.

    Don’t get me started on that one.

  8. Australian paradox? Vitamin D, cobber!

  9. That HUNT2 is a very good study design. I just wrote an article on another paper from them. I hope its ok to put it here :-).

    http://mostlyvegpaleo.blogspot.in/2013/01/the-hunt2-study-is-cholesterol-bad-for.html

    I appreciate the information.

  10. Z says:

    Ugh, I’m currently facing a rather horrible decision. I need to pass a Cat 1 Medical to get my dream job but one of the criteria is to ‘score’ well in a test similar to this: http://www.cvdcheck.org.au/. I have high (by statin company thinking) LDL and therefore high Total Cholesterol. In fact, my TC has increased the last 6 months because my HDL has increased. My Trigs/HDL ratio is almost exactly 1 which is excellent from what I have been reading.

    So now I pretty much have to bite the bullet and go on statins to have any chance of passing the medical. They may or may not kick in in time for the reduction I need. If they do, I would stop taking them as soon as I passed. I would, however, face future medicals to keep my job.

    Seriously, this is such a horrible feeling. Should I take a drug that I don’t believe I need, that I indeed think will harm me for a life changing job? Argghhh.

    Yee-ikes. No idea what to do there.

  11. Jesrad says:

    “The validity of the evidence base of the guidelines is questionable”

    My, such careful choice of word for stating that the guidelines belong in the loony bin of crackpot science.

    Now excuse me while I go die from a fictional heart attack from all the saturated fat (coco oil) I had in my morning coffee. Again.

  12. Pat says:

    Canada is Norway! Except that our first few waves of Europeans were French, English, Scottish, and Irish. French from Northern France, mostly, by the way.
    On a fat and food note, I went to a wine and cheese class at the LCBO last night – our instructor told us that there are some very nice cheeses made from raw milk available in Canada, both made here and imported – but you won’t get them in the US because of regulations against the use of raw milk in cheese. Four of the six cheeses we tried were from unpasteurized milk: Blanc Bleu du Rizet, which was a surface ripened unpasteurized goat’s milk cheese, not at all like feta, delicious, Brie de Meaux, soft ripened unpasteurizd cow’s milk, Reblochon de Savoie, washed rind unpasteurizd cow’s milk, and Ossau Iraty, unpasteurizd sheep’s milk. And speaking of risk factors, the first cheese, Brillat-Savarin (Lincet, moulé à la louche) was a fresh (unripened) cheese , a pasteurized cow’s milk curd with added cream – try 75% butterfat. Delicious! And yes, the wines were delicious too. And we were still “legal” at the end, we weren’t guzzling.
    Real food is much more fun.

    The laws are strange. We’re able to buy raw-milk cheese here, but ONLY if we request it ahead of time. We can’t just walk up to the booth at the farmer’s market and buy it.

  13. Charles-André Fortin says:

    Nice to know, that since I’m FRENCH Canadian I’m protect by my gene… What a bunch of bulls***. Next time show him the Province of Quebec VS the rest of Canada stats. And guest what it’s about the same… Well that twitter guy didn’t look really far.

  14. Tom Welsh says:

    While I heartily agree with the main thrust of your post (who can argue with facts and logic? I’m not a politician or a government scientist) I must take issue with your description of the “waves of French” who migrated to England. I think you will find that recent research shows the genetic makeup of the English population has been remarkably stable since Roman times. It seems likely that only a few thousand French people settled in England in medieval times, and even the famous Anglo-Saxon invasions which were supposed to have virtually wiped out or displaced the entire ancient British population hardly changed the genetic pool.

    Just saying.

    I found one article describing measuring genetic differences by measuring rH factors (if memory serves). The French/British difference in that measure at least was almost nil, whereas the differences between Eastern and Western Europeans were large.

  15. Beowulf says:

    If there are more paradoxes than useful applications of the theoretical model, you’d think the scientists/government would discard the model. Mark Twain’s quote comes to mind: “It is very difficult to make a man understand something when his salary depends on him not understanding it.”

    Indeed. Even one paradox should make honest scientists question the hypothesis.

  16. Lobstah says:

    Great article. We need many many more like this. The medical community at large is just regurgitating the same stuff, over and over and over. It feels like this is just starting to crack the veneer.
    One of my favorite movie lines is from Men In Black, when after discovering that aliens DO in fact exist, says “Why don’t you just tell people. People are smart.”
    and Jones responds: “Oh noo noo noooooo….a PERSON is smart. People are stupid.”

    Jim

  17. David says:

    Sounds like last night’s conversation I had with this girl on Facebook who “comes from a family of doctors” as “Europe isn’t up to date” on medical research to suggest they are generally healthier than Americans. I actually met some people from France the other night at my French friend’s birthday party and they said how the food back in France is so rich an delicious yet considered healthy until they got here and said how different American food is.

    Different as in “full of garbage.”

  18. Patricia Hennesey says:

    Tom – “The laws are strange. We’re able to buy raw-milk cheese here, but ONLY if we request it ahead of time. We can’t just walk up to the booth at the farmer’s market and buy it.” Here (Ottawa) the instructor just went to a cheese store near his house and bought the cheese. No fuss.
    Charles-André – just think how healthy Québecois would be if they gave up smoking! All those lovely Oka cheeses. And there is a great little winery north of St. André-Avelin.

  19. @B

    “It is very difficult to make a man understand something when his salary depends on him not understanding it.”

    that’s from Upton Sinclair — not Mark Twain

    Cheers

  20. SB says:

    Here in Michigan, at a market in Detroit, we can buy raw milk cheddar. Extremely tasty. No “ordering ahead of time”.

    Since ordering ahead of time is required by law here, I assume people in Michigan who don’t order ahead are dropping like flies. Politicians would never pass a useless regulation.

  21. Trouble is POLITICIANS look at the risk data and then try to base policy on those so called risk factors.

    Swedes may have to pay tax for meat

    They are using global warming as the fall guy but I’m sure the health professionals will jump on the bandwagon and join in with “Eating red meat substantially raises risk of heart disease and cancer.

    Oh, boy. If the planet warms up, they’ll say the tax wasn’t stiff enough. If the planet cools down, they’ll hold it up as evidence that the tax worked.

  22. Leah says:

    Interesting TidBit of information, my husband grew up in France, when he moved to the US in his twenties he slowly started seeing his weight and cholesterol creep up, 10 years later he has seen his weight increase 50 pounds, and high cholesterol levels steadily increase, the only thing that really changed were his age and the fact that he was living and eating in the US. His diet of eating cheese, meat, butter, vegetables, etc hasn’t changes so much except for the type of food, unprocessed, grassfed, and raw dairy in France, he used to eat. Something to think about….

  23. Re: raw milk cheese.

    Cheddar and other cheeses made with raw milk are generally “legal” in some fashion because they are aged. I guess any of the things that give the regulators the vapors would manifest themselves during the aging period. The soft, fresh (unaged) cheeses tend to be outlawed by the nannie-staters.

    [The upside is that the fresh cheeses tend to be easier to make at home. I make haloumi at home with fresh raw milk for about 1/4 of what it costs at the store, plus I can get a small batch of ricotta from the leftover whey. Haloumi is a brined Greek cheese that doesn't melt in a frying pan or on the grill. It browns like French toast.]

    Cheers!

    Perhaps a guest post sharing your recipe?

  24. Phyllis Mueller says:

    @ Z– If you decide to lower your cholesterol, you may want to check out “Prescription for Drug Alternatives” by Balch et al. I remember reading a section on red yeast rice for lowering cholesterol that included a case study about someone who was taking it to get a lower cholesterol number when applying for life insurance. I think it mentioned a time frame. The paperback book is available on Amazon and there’s a Kindle version.

    I also remember hearing about a product called (I think) Cholestar, a “natural” cholesterol-lowering combination that includes red yeast rice, among other things.

  25. Z says:

    @ Phyllis

    Thanks for the info! I shall do some research on it.

    Cheers!

  26. gallier2 says:

    red yeast rice is the same thing as statins. The specific poison (HmG-COA reductase inhibator) was discovered in red yeast rice.

    The thing is, there is in general no point in reducing “cholesterol”. High cholesterol is not a illness, it’s a lab value.

  27. Loket says:

    “Naw, nobody tells jokes about us. We’re too nice.”

    This is blatantly untrue, Swedes maintain a set of jokes about Norwegians.

    “How do you sink a Norwegian submarine?

    - You swim down and knock on the hatch”

    “What does the sign at a Norwegian roundabout say?

    - Eight laps maximum. ”

    Hey, I didn’t say they were *good* jokes…

    I guess it’s natural to make jokes about your near-neighbors … although come to think of it, I don’t remember any jokes about Canadians.

  28. P. says:

    What, you’ve never heard an Ole and Lena joke? :)
    http://en.wikipedia.org/wiki/Ole_and_Lena

    Those were all new to me. Still laughing …

  29. Phyllis Mueller says:

    @ gallier2 – I think you are correct, and I agree with you. (Z probably does as well.) But that’s not the issue here, any more than it was for the fellow in the case study in the book who was applying for life insurance and needed to pass a physical.

    @ z – You also might want to check the People’s Pharmacy website for additional suggestions.

  30. JayMan says:

    I am the person from the infamous mini Twitter debate.

    My main point was that heredity could be a significant contributor to the observed differences in heart health, especially when you notice that the countries listed cluster neatly by ethnicity (Slavs -> Celts -> Germanics/Anglos -> Mediterranean -> East Asian) – which a few exceptions, as Mr. Naughton points out.

    The evidence for genetic differences between the various European nations can be seen here and here. I’ll ask you to pay close attention to the PCA maps. Note that the different nations make very distinct clusters, with very little overlap. In other words, they are genetically distinct populations (despite being highly related). (For a little info on how to read these maps, please see here).

    If the process which Mr. Naughton describes made the English and French similar in the way he thinks, you wouldn’t be able to separate them into two discrete lumps genetically!

    As for Australia, strictly speaking, Australia is likely genetically different from its source countries because selective forces operated on who immigrated to Australia (as well who remained there and left descendants). The U.S. and Canada both have amassed important genetic differences from the British Isles (and France), which will be the subject of a future post of mine.

    That said, whether or not heredity is relevant with the observed difference in Australia is not clear. But, that’s besides the point, DNA does not have to be the sole factor in the observed differences.

    That said, I did look at the Quebecois, and they DO have lower obesity and CVD rates than most Canadians (if not quite as extreme). The Quebecois, however, are not genetically representative of all French (having descended from a founding population of 2,600 individuals from a few specific regions of France).

    I would just like to point out that this is a fascinating discovery, and it would seem to be important to look at ALL potential causes, including heredity.

    Thanks for stopping by, Jay. I tried to read that second map when you linked to it on Twitter, but it’s unreadable on my screen … too tiny and fuzzy, even when I click it for the full version.

    I suspect that if the French and Brits traded diets, we’d be talking about the “British Paradox” in 20 years or so. But of course our susceptibility to various diseases is always a combination of genes and gene expression. I like the way Mark Sisson puts it: genetics loads the gun, but diet pulls the trigger.

  31. Charles-André Fortin says:

    You could also say that in Quebec the maximum you’re gonna pay for your medication by month is 80,25$ or 963$ a year no matter what. That alone is a big factor. Now if we look at some of the richest province of Canada (Alberta, British Colombia, Ontario) they got these number of occurrence by 100 000 people (183, 226, 200) Compare to the 191 for Quebec and you find that these number to be relatively close.

    If you want to have fun you can look the stat at : http://www.statcan.gc.ca/pub/84f0209x/84f0209x2008000-fra.pdf

    Sorry I got no idea if there is an english version

    To quote Steve Martin: “Those French … it’s like they have a different word for EVERYTHING.”

  32. gallier2 says:

    Sorry I got no idea if there is an english version

    Replace the -fra in your link by -eng and voilà la version anglaise. ;-)

  33. JayMan says:

    I’ve made a new post on this topic. Please see here:

    A Fat Problem With Heart Health Wisdom « JayMan’s Blog

    Nice analysis, Jay. I still some paradoxes within the paradoxes, however. The Australians vs. the U.K. is one, Sweden vs. Scotland is another … if I remember correctly, both are Celtic people. I’ve read of specific genetic anomalies that make some groups of Italians almost completely immune from heart disease or Asian Indians particularly vulnerable to it. I’m curious if you’ve heard of anything along those lines that would explain (or contribute to) us seeing a high rate of heart disease in Ireland and a low rate in Sweden, or a high rate in Argentina, but a low rate in Spain and Italy, the ancestral countries of so many Argentinians.

  34. Marilyn says:

    I was looking for information about red yeast rice for “Z” and Phyllis Mueller. Gallier2 provided the necessary information. But as I was searching, I came across this:

    http://www.americanscientist.org/issues/page2/2008/5/statins-from-fungus-to-pharma

    Get a load of the propaganda in the opening paragraphs.

  35. Charlie says:

    If you need to reduce cholesterol for insurance, peace of mind or some other silly reason the best natural way seem to be Sytrinol is safer Nicotinic Acid and more effective and safer than Red Yeast.

    http://www.nutritionreview.org/library/sytrinol.php

    http://sytrinol.net/pdf/benefitchartsytrinol2.jpg

  36. Charles-André Fortin says:

    Nice article JayMan but I still think LOW INCOME (%) is a better risk factor to predicted cardiovascular death. In Quebec medication Insurance are Mandatory since 1997 and that not the case in any other province. We pay less for medication more in taxes.

    If you got access to medication you are less likely to die from chronic disease. I think it is a simple as that.

  37. CU says:

    How strange that numbers 1 and 2, Japan and France, have low fat/high carb and high fat/moderate carb diets, respectively.

    Having been in both countries I believe that part of the success is that they less than us.

    I believe low sugar intake helps too.

  38. smgj says:

    Hi – a Norwegian here.

    Marilyn said:
    It’s a bit hard to tell, but it looks as if the Norwegians have more heart fatalities, but fewer deaths overall than the French.

    It’s probably because our long country and widespread population. If someone get a heart attack it’s often a long way to hospitable and help.
    Doctor’s in Norway usually uses LDL and triglycerides to check health risk, and rely less on HDL and total cholesterol … yet. But they are “learning” too. Last year the drugstores drove a campaign “less than 5″ (total cholesterol) and free tests. Fortunately that drove a discussion about how useful that number is instead of gaining momentum. And I have not seen that marketing stunt repeated.

  39. Somethiing to keep in mind when making an argumennt for the significance of genetic effects is that these would have to manifest over a period of several thousands of years at a minimum.

    When we see, as well documented by Taubes, et al, the cv and other health markers of distinct population groups change markedly (generally for the worse as indiginous diets are exchanged for “civilized” foods) over the course of just a few generations, that is pretty clear refutation of genetics.

    It does make a case for Epigenetics – the relatively recent idea that environment, particularly in the womb, can have a significant effect on gene expression. So, for example, the high-carb SAD influencing supression/expression of insulin response in newborns seems more plausible than babies now eat more, exercise less, and watch too much tv.

    Cheers

  40. JayMan says:

    “Nice analysis, Jay.”

    Thanks!

    “Sweden vs. Scotland is another … if I remember correctly, both are Celtic people.”

    The Scots are descended from the original Gaels and Picts of Britain augmented with the Anglo-Saxons and then later the Vikings (mostly Danes), however, the latter two groups being Germanic and they mostly settled in England.

    “I’ve read of specific genetic anomalies that make some groups of Italians almost completely immune from heart disease or Asian Indians particularly vulnerable to it. I’m curious if you’ve heard of anything along those lines that would explain (or contribute to) us seeing a high rate of heart disease in Ireland and a low rate in Sweden, or a high rate in Argentina, but a low rate in Spain and Italy, the ancestral countries of so many Argentinians.”

    Yeah, that is definitely an interesting one. The Spanish and Italians did make up the bulk of immigration to Argentina, and genetic analysis indicates that most “European” Argentinians are, genetically, truly mostly European in ancestry (>80%). There are important regional genetic differences in Spain and Italy that may be relevant? It seems that, as far Italian migrants, the pre-1900 waves came mostly from Northern Italy, but since then it was primarily Southern Italians.

    However, judging from this neat little map, there doesn’t seem to be much regional variation in either Spain or Italy in terms of heart mortality. Indeed, most of the variance seems to move along a NE to SW axis in Europe.

    One possibility for Australia and Argentina is that those data points are faulty is some way (sometimes the simplest explanation…)?

    Oh well, the paradoxes continue!

    Power to the Paradoxes!

  41. JayMan says:

    Additionally, about the seemingly anomalously high rates of CVD in Greece (and perhaps much of Eastern Europe), see here. Greeks, along with many Slavic countries smoke a lot. In the case of Greece, cigarettes per capita is considerably higher than Spain or Italy. One imagine that this plays a role in the differing CVD rates there? (Of course, smoking can’t be the sole problem, because smoking rates are low in Scandinavia despite higher CVD rates compared to SW Europe).

    And then we have the Japanese — heavier smokers than Americans, but less heart disease. Same goes for the French and the Kitavans. So many possible variables.

  42. Ken says:

    Hi Tom, interesting. It’s just observational association, but I think the Australians eat a lot of pastured animal meat (even though they eat a fair amount of carb’s too).
    Michael Rose, the evolutionary biologist (of fruit-fly fame), claims that European nordic people (very much including Celts such as Irish and Scots) have a particularly low tolerance for carb’s as they age. This matches my own experience (I am roughly half Scots). The extremely high rates of CVD and T2DM in Newfoundland and Prince Edward Island (Rose is Canadian, but from BC I believe — but his friend, the interviewer, is from PEI) are supportive of this hypothesis. But I find it compelling because it is derived from Rose’s core scientific expertise and based upon the lack of much generational exposure to dietary carbohydrate in the northern Europeans vs. others from more moderate climates in Europe and Asia.
    Rose explains his ideas in some depth at http://55theses.org/ .
    Jibes pretty well with the Euro data you present, if we assume that the Irish and Scots are eating a lot more carb’s than the Norwegians (and I think they are, in addition to the Canadian Celtic maritime provinces).

    I think that makes perfect sense. People ate fewer carbohydrates in northern climates. That’s why when people point to the Kitavans, I point out that I’m not a Kitavan.

  43. Katherine says:

    Isn’t the Scottish national food deep-fried candy bars?

    I’m not sure, but I know I’ve never heard anyone suggest going out on Saturday night for Scottish food.

  44. Lorne Marr says:

    There seems to be a lot of ongoing discussion about the health benefits / negative effects of milk. Maybe that could play a part?

    I’m not really an expert (err), but I seem to recall something about the northern european states having less milk consumption when compared to America or Middle Europe.

    Coincidence?

    Weston A. Price wrote about people who consumed a lot of milk but had very low rates of disease.

  45. pam says:

    @Z,

    maybe a “temporary vegan fast” would help?
    or seaweed/iodine, niacine?
    regards

  46. smgj says:

    Well – one problem we have here in northern Europe is little sun and mostly inside work – and sunscreen. Which leads to a population with very low vitamin d levels on the whole.
    Low vitamin D would make it easier for all sorts of inflammatory illnesses to take hold.

  47. John Perkins says:

    Very catchy title and at first I thought it was an ignorant blanket statement. But the article was very helpful and eye opening. If men don’t be careful with what they eat and and strive for a healthy lifestyle, we can all be in risk of heart disease.

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