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The term Baltic States typically refers to three north-central European counties located on the eastern edge of the Baltic
Sea—Lithuania, Latvia, and Estonia (from south to north). Together these countries represent a population of 6.57 million
in 2012.1, 2, 3
The Baltic States regained independence in 1990-1991 and began to emerge as an attractive clinical research market. Entering
the European Union in 2004, the states harmonized their legislation with international clinical trial law and established
a friendly environment for clinical trials. This again contributed a significant breakthrough to the clinical research in
Baltic States. During the last decade the region authorized an average of 80 new clinical trial applications per country,
per year and still has a potential for growth.
Population
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There are nine cities in the Baltic States with a population exceeding 100,000 people and approximately 68% of the Baltic
population is considered as urban. By the end of 2011 the titular nationalities of Lithuania, Latvia, and Estonia accounted
83.9%, 62.1% and 69.0%, respectively, of each country's population. Russians are by far the largest ethnic minority in the
Baltics, accounting 26.9% of Latvian population and 25.5% of Estonia's. Russians in Lithuania account a relatively small etching
group of 5.4%. Other notifiable ethnic groups include Poles, Belarusians, and Ukrainians, together accounting 7.3% of the
Baltic population.1, 2, 3
The Baltic States have a significant incidence of oncological and cardiovascular diseases. The environmental burden of these
diseases is also above the average world rate given by the World Health Organization.4, 5 The region has one of the highest cardiovascular mortality rates in the European Union—the situation is worse in Bulgaria
and Romania.6 Furthermore, similar to most of the Central and Eastern European countries the Baltics States can offer a considerably large
pool of treatment-naïve subjects.
Of all the medicines consumed by Lithuanians, Latvians, and Estonians in 2010, 40.9% were cardiovascular drugs. Other notifiable
anatomical therapeutic chemical groups include: alimentary tract and metabolism (13.8%), nervous system (11.3%), blood and
blood forming organs (8.3%), musculoskeletal (8.1%), and respiratory (7.1%) systems.4, 5
One of the dominant motives for a patient to participate in a clinical trial is a physician's recommendation. In the Baltics
physician/patient relations are characterized by a high level of patient's trust and respect for the physician. A study conducted
at the Lithuanian University of Health Sciences evaluated patients' opinions on clinical trials. The study revealed that over
90.7% of respondents trusted in their physicians and that trust significantly increased the possibility of a patient participating
in a clinical trial in the future.7
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