ORIGINAL ARTICLES
Cardiovascular diseases (CVD) occupy a leading position in the structure of all-cause mortality. Prospective and interventional studies have identified the major risk factors for CVD and shown their associations with the risk of cardiovascular outcomes and all-cause death. The impact on the individual risk of death may vary by age, sex, study design, and may be population-specific. We aimed to study the contribution of major CVD risk factors to the 15-year risk of all-cause death in the Russian (Siberian) population cohort aged 45–69 years.
Material and methods. A random population sample (men and women 45–69 years old, n = 9360) was examined at baseline in 2003–2005 (Novosibirsk, Russian branch of the HAPIEE project) and re-examined twice in 2006–2008 and 2015–2018. Current analysis included individuals without baseline CVD (n = 8087), the average follow-up period – 15.6 (SD 0.69) years. The fatal events were registered based on death certificates from the Population Registration Bureau (ZAGS), and using the data received at serial examinations and postal interview. We analyzed the association between CVD risk factors and all-cause death using multivariate Cox regression.
Results. In a cohort aged 45–69, in the adjusted model, 15-year risk of all-cause death was positively associated with age (HR = 1.08; 95 % CI 1.07–1.09), male sex (HR = 1.46; 95 % CI 1.24–1.71), hypertension (HT) (HR = 1.39; 95 % CI 1.25–1.55), smoking (HR = 2.37; 95 % CI 2.08–2.70), high WHR (HR = 1.19; 95 % CI 1.06–1.33), and type 2 diabetes (T2DM) (HR = 1.52; 95 % CI 1.34–1.73), and it was negatively associated with elevated total cholesterol (TC) or LDL-C in blood. In age- and sex-adjusted model, the risk was additionally associated with high triglycerides (HTG), obesity and elevated fasting plasma glucose (FPG). In men, the risk of death was independently associated with age, HT, smoking, low HDL-C, high WHR, and T2DM. In women, the risk of death was independently associated with age, HT, T2DM smoking, and, in age-standardized models, obesity, high WHR, and hyperglycemia.
Conclusions. In a population cohort of 45 years and older, among CVD risk factors male sex, HT, smoking, central obesity, and T2DM independently contributed to the risk of all-cause death. Among lipid parameters, low HDL-C and high TG levels increased the risk of death in men. Associations between cardiovascular risk factors and the risk of all-cause death in older people have the patterns specific for older age; these features are important to take into account in a strategy to reduce mortality in the population.
Purpose of the study. analysis of the prevalence of the main risk factors for the development of chronic NCDs in the unorganized population of the Altai Territory aged 25–64 years.
Materials and methods. The study involved 1,103 people aged 25–64 years, selected by random sampling from the population of the Altai Territory. The survey was conducted using a standard questionnaire. During the study, the blood pressure level, height, and weight of respondents were measured.
Results. The study involved 1103 people, of whom 33.4 % were men (n = 368), women – 66.6 % (n = 735). Smoking was registered in 21.5 % (n = 234), among men – 45.7 % (n = 166), among women – 9.4 % (n = 68). IBP of salt was detected in 58.9 % (n = 650), among men – 63.6 % (n = 234), among women – 56.6 % (n = 416). Consumption of less than 5 servings of fruits and/or vegetables on average per day was noted in 55.7 % (n = 597), among men – 67.6 % (n = 244), among women – 49.6 % (n = 353). NFA occurs in 19.9% (n = 218), among men – 19.4 % (n = 71), women – 20.1 % (n = 47). Obesity occurs in 34.9 (n = 349), among men – 22.3 % (n = 73), women – 41% (n = 276). High blood pressure among all respondents was 50.3 %; in men this risk factor was lower than among women (45.4 % and 52.8 %, respectively).
Conclusions. For the first time, the features of the main risk factors for the development of chronic non-diseases were studied in an unorganized sample of the region’s population aged 25–64. Residents of the region have a high incidence of salt IBP, NPOF and elevated blood pressure. The ESSE-RF study made it possible to identify gender and territorial characteristics of our region. Thus, the study demonstrated that both sexes have NPOF and salt IBP, but smoking was more common among men, and high blood pressure among women. This study is the starting point for epidemiological studies in the Altai region and can serve as a guide for further monitoring of the prevalence of risk factors and the effectiveness of preventive programs.
Purpose of the study: To establish over half a century (1977–2022) trends in morbidity, mortality, mortality from acute myocardial infarction (AMI) in people aged 25–64 years and the influence of psychosocial factors (PSF) on the risk of developing AMI in Russia/Siberia with positions of the international programs of the World Health Organization (WHO) Register of Acute Myocardial Infarction (RAMI), MONICA.
Material and methods. The study under the “RАMI” program began on 01/01/1977 in Oktyabrsky, and on 01/01/1981 – in the Leninsky and Kirovsky districts of Novosibirsk among people aged 25–64. In these same areas, since 1983, Institute of internal and preventive medicine, as a WHO center, has been implementing the MONICA program. Differences in AMI case-finding programs have not been identified. Both programs continue to operate to this day. All cases of acute MI for the entire study period were coded as ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation myocardial infarction (NSTEMI). For prehospital deaths, the variable “died outpatients from AMI (DOPAMI)” was introduced. Random representative samples of people aged 25–64 years (n = 4800) were examined in the Oktyabrsky district at standard epidemiological screenings (1984, 1988, 1994), where trait anxiety (A) was studied using the Spielberger test (the presence of levels of population stress); Social support was determined using the Berkman – Syme test. To determine the risk of developing AMI depending on HR for 20 years, all new cases of AMI were recorded in the studied sample of three screenings that did not have CVD at the time of examination. Statistical analysis was performed using the free software computing environment R (v.3.6.3).
Results. The incidence of AMI per 1000 residents of people aged 25–64 years in Russia/Siberia, according to international AMI programs, MONICA, is one of the highest in the world and is relatively stable throughout the entire half-century observation period, with the exception of some years of growth due to socio-economic instability in society, and is twice as high as Rosstat data. Mortality per 100,000 inhabitants from AMI resembles the dynamics of incidence, with the exception of 1977–1978 – a decrease. For the first time, in our study, a significant decrease in mortality and mortality of patients with AMI in 1978 compared to 1977 was obtained due to a decrease in inpatient mortality and mortality as a result of work under the WHO AMI program. For the first time, in our study, the cause of death in excess of the population in Russia was determined in the period 1988, 1993–1994, 1998 – these are acute cardiovascular diseases, not alcohol consumption. Prehospital mortality and mortality prevail throughout all years of observation and are 2–3 times higher than in-hospital mortality and are based on sudden death. Mortality, like morbidity, for RАMI is 2 times higher than according to official statistics. For the first time, our study showed that the increase in morbidity and mortality from AMI in Russia is associated with psychosocial factors.
Conclusions. It has been established that the morbidity, mortality and mortality rates of the population from AMI in Russia/Siberia are one of the highest in the world and are relatively stable throughout the entire half-century observation period, with the exception of some years of growth due to socioeconomic instability in society. Prehospital mortality and mortality prevail throughout all years of observation and are 2–3 times higher than hospital mortality. Indicators of morbidity, mortality and lethality of the population from AMI, when increasing, are the main markers of increasing social stress in the population.
Aim. To assess the association between levels of alcohol consumption and lipid metabolism parameters among adult men.
Materials and methods. The study included 881 men aged 35–69 from the general population of Arkhangelsk, who participated in the 2015–17 Know Your Heart study, and 161 men who received inpatient treatment for alcohol-related diagnoses (narcology patients). Participants were divided into five levels of alcohol consumption: non-drinkers, non-problem (infrequent moderate consumption), hazardous (frequent consumption in doses hazardous to health), harmful (prenosological), and narcology patients. Using multivariate linear regressions, we analyzed differences between these groups in atherogenic lipid fractions (total cholesterol [TC], triglycerides [TG], low-density lipoprotein [LDL], apolipoprotein B [ApoB], remnant cholesterol, and non-HDL cholesterol, lipoprotein(a)) (Lp(a)), antiatherogenic lipid fractions (high-density lipoprotein [HDL], apolipoprotein A1 [апо A1]), and in ApoB/апо A1 ratio.
Results. Compared with non-problem drinkers, hazardous drinkers had higher mean levels of HDL by 0.22 mmol/L, HDL by 0.07 mmol/L, and ApoB by 0.04 g/L. Among harmful drinkers, mean HDL was higher by 0.15 mmol/L and апо A1 by 0.08 g/L, but the ApoB/апо A1 ratio was lower by 0.06. Among narcology patients, mean TC levels were lower by 0.42 mmol/L, LDL by 0.41 mmol/L, ApoB by 0.09 g/L, ApoB/апо A1 by 0.08, and non-HDL by 0.45 mmol/L, but TG was higher by 0.15 mmol/L. Lp(a) in this group was higher by 0.29 mg/dl only after adjustment for markers of liver function. Non-drinkers had on average lower levels of TC by 0.29 mmol/L, HDL by 0.11 mmol/L, and апо A1 by 0.08 g/L.
Conclusions. Compared with non-problem drinkers, hazardous drinkers had elevated levels of both atherogenic and antiatherogenic lipid fractions, hazardous drinkers had only elevated levels of antiatherogenic fractions, and narcology patients had the lowest levels of atherogenic lipid fractions but elevated TG levels. Therefore, lipid profiles may reflect the level of alcohol consumption, which should be taken into account when assessing cardiovascular risk.
High prevalence of cardiovascular morbidity and mortality in the Russian population dictates the need to identify and prevent risk factors for these diseases from adolescence. Objective: to study the prevalence and long-term trends in cardiometabolic risk factors in an adolescent population sample of Novosibirsk (1989–2024).
Methods. In 1989–2024, cross-sectional population studies of random representative samples of schoolchildren aged 14–18 of both sexes were conducted in Novosibirsk with an interval of 5 years. 8 screenings were conducted. A total of 5106 adolescents (43–46 % boys) were examined. Approval was received from the Local Ethics Committee of the Research Institute of Preventive and Internal Medicine – Branch of the Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences; all children and their parents signed informed consent for the examination. The program was uniform for all screenings and included a survey using a standard questionnaire, 2-fold measurement of blood pressure, anthropometry (height, body weight, chest, waist and hip circumferences), and a biochemical blood test for lipid profile. The levels of cardiometabolic risk factors were assessed in accordance with the latest Russian and international recommendations. Statistical data processing was performed using the SPSS for Windows 13 package.
Results. The prevalence of hypercholesterolemia in adolescents in Novosibirsk over 35 years decreased from 22.3 to 3.0 % in boys and from 31.8 to 10.6 % in girls (p < 0.001). The highest prevalence of hypertension in adolescents was observed in 1989, then by 1994 its levels decreased and remained relatively stable until a decrease in 2014 with a subsequent increase, especially among boys, the prevalence of hypertension among whom in 2024 reached the 1989 level (17.3 % and 16.9 %, respectively). The greatest decrease in the frequency of excessive weight in adolescents relative to 1989 was observed in 1999: in boys – 2.7 times, in girls – 3.2 times. Since 2003, there has been a consistent increase in the prevalence of overweight among adolescents, primarily among boys, and by 2014 it exceeded the baseline values of the 1989 screening by 8 % in boys (21.6 versus 13.9 % (p < 0.01)) and by 3 % in girls (14.3 versus 11.5 % (p = 0.05)). At subsequent screenings, the frequency of overweight remained unchanged. The frequency of smoking among adolescents of both sexes decreased almost 10-fold from 1989 to 2024: from 45 % in 1989 to 5.5 % in 2024 among boys, and from 19 % to 2% among girls (p < 0.01), however, an increase in electronic smoking was noted. Over the past 5 years (2019–2024), the use of electronic cigarettes and gadgets among boys has doubled (from 6 up to 12 %) and three times among girls (from 3 to 9 %). The prevalence of reduced physical activity among adolescents remained high throughout the period, but in the last 15 years it has clearly decreased among boys (62 % in 2009 versus 37 % in 2024 (p < 0.01). Since 2009, screen time has increased: from 18 hours/week in 2009 for boys and 15 for girls to 30 hours/week in 2014 and remained at the same level in 2019. In 2024, screen time of the computer decreased, but phone time increased, which in total did not exceed the figures for 2014 and 2019 (33–35 hours/ week).
Conclusions. Based on population screening of adolescents conducted in Novosibirsk over 35 years, the prevalence and long-term trends of cardiometabolic risk factors (arterial hypertension, dyslipoproteinemia, overweight and obesity, smoking and low physical activity) were identified.
Purpose of the study: to determine associations of the prevalence of coronary heart disease and some psychosocial risk factors (negative affective states) among men 25–64 years old in the open population of a mid-urban city in Western Siberia.
Material and methods. A cross-sectional study with a response rate of 85.0 % was conducted on a representative sample of men 25–64 years old in the city of Tyumen (n = 1000). To determine the levels of personal anxiety, depression, hostility, vital exhaustion, and sleep quality, the standard WHO MONICA-MOPSY questionnaire was used.
Results. In the open population of a mid-urban city in Western Siberia, psychosocial risk factors for CVD are significantly common in men aged 25–64 years: personal anxiety (92.4 %), depression (23.6 %), sleep disturbance (50.9 %), hostility (70.0 %), vital exhaustion (54.5 %). Frequency of detection of high gradations of psychosocial risk factors for CVD – personal anxiety (36.6 %), depression (4.6 %), sleep disorders (9.5 %), hostility (46.4 %), vital exhaustion (15.9 %) – increases with age, reaching a maximum in the sixth decade of life. In men 25–64 years old in a mid-urban city in Western Siberia with the presence of IHD, high levels of PSF are more common than in persons without IHD – personal anxiety (OR 4.07), depression (OR 21.07), sleep disorders (OR 5.05) , hostility (OR 2.71), vital exhaustion (OR 6.02); with the presence of «definite» IHD – significantly more often – personal anxiety (OR 9.51), depression (OR 39.84), sleep disturbance (OR 5.28), hostility (OR 4.65), vital exhaustion (OR 14. eleven).
Conclusions. Thus, analysis of the definition of psychosocial risk factors associated with the prevalence of coronary heart disease in men 25–64 years old seems necessary to use when developing a preventive program to reduce high cardiovascular risk in the open population of a mid-urban city in Western Siberia, focused primarily on regulation of psychological parameters.
The purpose of this study was to create a scoring scale for assessing the 10-year risk of cardiovascular events for middle-aged and elderly people with type 2 diabetes mellitus (DM).
Material and methods. The analysis included data from 314 people with T2DM: 142 men, 242 women, the average age for both sexes was 60.81 ± 6.38 years. The baseline survey was carried out within the framework of the HAPIEE project; the observation period lasted from 2003–2005. to December 31, 2013 and averaged 10 years. Persons who had myocardial infarction and/or cerebral stroke before the examination were excluded from the analysis. Non-fatal cardiovascular (CV) diseases and CV death were established in accordance with the codes of the International Classification of Diseases, 10th revision. As part of the study, two groups were formed: the main group, which included people with T2DM who “developed CV events” over 10 years of observation – 50 (15.9 %) people, and a comparison group – people with T2DM who “did not develop CV events” during the observation period (264 people). Anthropometric indicators, blood pressure, socio-demographic data, and some biochemical parameters were determined. To analyze the association of the studied factors with the risk of CV events, multivariate stepwise Cox regression analysis was used.
Results. As a result of multivariate Cox regression analysis, associations with the risk of developing CV diseases were obtained for the following factors: gender (men), age (≥ 55 years), heart rate (≥ 80 beats/min), SBP (≥ 150 mmHg), marital status single, education (not higher). Individuals with a score above 9 are considered to be at high 10-year risk of cardiovascular events.
Conclusions. A model has been created that predicts the risk of developing CV events in relation to individuals with T2DM living in a large industrial city in Western Siberia. Based on the data obtained, it will be possible to select priority preventive areas and therapeutic interventions.
In recent years, new epidemiological and genetic data have been obtained on the role of triglycerides (TG) and remnant cholesterol (RC) triglyceride-rich lipoproteins in increasing the residual risk of atherosclerosis-associated cardiovascular diseases (ACCD) in metabolic disorders. The aim of the study was to study the associations of different levels of triglycerides and RC triglyceriderich lipoproteins with metabolic syndrome (MS) and type 2 diabetes mellitus (TDM2) in the Siberian population.
Material and methods. The research was carried out on the materials of the international epidemiological project HAPIEE (n = 9360 people) in people aged 45–69 years. In accordance with the protocol, a questionnaire, anthropometry, and biochemical research were conducted. Abdominal obesity (AO) was found with a waist circumference of ≥ 94 cm in men and ≥ 80 cm in women. MS was diagnosed according to the criteria of the IDF (2005), TDM2 – at fasting glucose levels ≥ 7.0 mmol/l (WHO, 1999, ADA, 2013), hypertriglyceridemia (hyperTG) – according to the definitions of NCEP ATP III, 2002 and the Russian Clinical Guidelines on lipid metabolism disorders, 2023. RC levels are calculated using the formula: total cholesterol (TC) – HDL cholesterol – LDL cholesterol mmol/L. The triglyceride-glucose index (TyG) was determined by the formula: TyG = ln [Fasting triglycerides (mg/dl) x Fasting glucose (mg/dl)/2].
Results. Median values and prevalence of various levels of TG have been determined (<1.7; ≥ 1.7 < 2.3; ≥ 2.3 < 5.6; ≥ 5.6 mmol/l). An increase in the prevalence of MS and TDM2 has been shown depending on the levels of hyperTG. High values of RC in AO, MS, and TDM2 were revealed in men and women: 0.68; 0.76; 0.90 and 0.68; 0.79 and 0.93, respectively. In 60 % of men and 80 % of women, RC was ≥ 0.5 mmol/l. An increase in RC was shown from values of 0.51–0.54 mmol/l at TG < 1.7 mmol/l to higher values of 1.26–1.29 at TG ≥ 2.3 < 5.6 mmol/l. The frequency of AO, MS, TDM2 in quintiles (Q) of RC increases linearly from Q1 to Q5. It is shown that from Q1 to Q5 TyG, the levels of RC increase in each subsequent quintile: from 0.36–0.38 in Q1 to 1.1–1.12 mmol/l in Q5.
Conclusions. The medians and prevalence of various levels of TG and RC in MS and TDM2 and without metabolic disorders were determined. RC values increase from mild to moderate and high hypertriglyceridemia.
LITERATURE REVIEWS
The article provides an overview of the National Recommendations on healthy nutrition available in Europe, Asia (China), the USA and the Russian Federation, assesses the compliance of the presented guidelines with the principles of a healthy diet according to the recommendations of the World Health Organization, and analyzes their role in the prevention of the development of non-infectious diseases, including number of diseases of the cardiovascular system. A search of relevant literature for the review was conducted in PubMed (www.pubmed.gov) using English keywords (“national dietary guidelines”, “WHO diet”, “FBDG”, “dietary guidelines”, “cardiovascular factors”), the website of the National Project of the Russian Federation “Healthy Nutrition” (https://здоровое-питание.рф), eLIBRARY.RU (https://elibrary.ru/defaultx.asp) using keywords in Russian (“ESSE-RF”, “risk factors for non-infectious diseases”, “nutrition”). Publications published between 1995 and 2022 were considered. The review included the National Recommendations in force for 2023, as well as the results of cohort and multicenter studies, the purpose of which was to assess the impact of current recommendations on the development of traditional cardiovascular risk factors, associated clinical conditions (myocardial infarction, stroke, etc.), as well as the impact on general mortality. Publications with completely duplicate data and conclusions were excluded, and in case of partial overlap, both sources were indicated. As a result, a list was compiled of articles, newsletters, and links with up-to-date information on the National Guidelines.
ISSN 2949-3633 (Online)