Open Access Study protocol

Determinants of cardiovascular disease and other non-communicable diseases in Central and Eastern Europe: Rationale and design of the HAPIEE study

Anne Peasey1*, Martin Bobak1, Ruzena Kubinova2, Sofia Malyutina3, Andrzej Pajak4, Abdonas Tamosiunas5, Hynek Pikhart1, Amanda Nicholson1 and Michael Marmot1

Author Affiliations

1 International Institute for Health and Society, Department of Epidemiology and Public Health, University College London, UK

2 Centre for Environmental Health, National Institute of Public Health, Prague, Czech Republic

3 Institute of Internal Medicine, Russian Academy of Medical Sciences, Novosibirsk, Russia

4 Department of Epidemiology and Population Studies, Institute of Public Health, Faculty of Health Care, Jagiellonian University Medical College, Krakow, Poland

5 Department of Population Studies, Institute of Cardiology of Kaunas University of Medicine, Kaunas, Lithuania

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BMC Public Health 2006, 6:255  doi:10.1186/1471-2458-6-255

Published: 18 October 2006



Over the last five decades, a wide gap in mortality opened between western and eastern Europe; this gap increased further after the dramatic fluctuations in mortality in the former Soviet Union (FSU) in the 1990s. Recent rapid increases in mortality among lower socioeconomic groups in eastern Europe suggests that socioeconomic factors are powerful determinants of mortality in these populations but the more proximal factors linking the social conditions with health remain unclear. The HAPIEE (Health, Alcohol and Psychosocial factors In Eastern Europe) study is a prospective cohort study designed to investigate the effect of classical and non-conventional risk factors and social and psychosocial factors on cardiovascular and other non-communicable diseases in eastern Europe and the FSU. The main hypotheses of the HAPIEE study relate to the role of alcohol, nutrition and psychosocial factors.

Methods and design

The HAPIEE study comprises four cohorts in Russia, Poland, the Czech Republic and Lithuania; each consists of a random sample of men and women aged 45–69 years old at baseline, stratified by gender and 5 year age groups, and selected from population registers. The total planned sample size is 36,500 individuals. Baseline information from the Czech Republic, Russia and Poland was collected in 2002–2005 and includes data on health, lifestyle, diet (food frequency), socioeconomic circumstances and psychosocial factors. A short examination included measurement of anthropometric parameters, blood pressure, lung function and cognitive function, and a fasting venous blood sample. Re-examination of the cohorts in 2006–2008 focuses on healthy ageing and economic well-being using face-to-face computer assisted personal interviews. Recruitment of the Lithuanian cohort is ongoing, with baseline and re-examination data being collected simultaneously. All cohorts are being followed up for mortality and non-fatal cardiovascular events.


The HAPIEE study will provide important new insights into social, behavioural and biological factors influencing mortality and cardiovascular risk in the region.