Biological mechanisms of disease and death in Moscow: rationale and design of the survey on Stress Aging and Health in Russia (SAHR)

Epidemiology of Cardiovascular Diseases in Regions of Russian Federation. Third survey (ESSE-RF-3). Rationale and study design

Previous studies have shown significant differences in the health status of the population depending on the place of residence. Despite the ongoing preventive measures, there is no improvement in the epidemiological situation in relation to noncommunicable diseases, including due to unfavorable living conditions. This study is a continuation of the following earlier studies: Epidemiology of Cardiovascular Diseases in Regions of Russian Federation (ESSE-RF) and ESSE-RF-2.

Aim. To assess the prevalence of cardiovascular diseases, various risk factors (RFs) of these diseases and their association in Russian regions with different economic, climate and geographic characteristics to determine the risk profile of the region and develop approaches to targeted prevention programs specific to the regions.

Material and methods. The study selected 30 regions representing each federal district of the Russian Federation. The survey of participants is carried out in three stages as follows: survey using an original modular questionnaire; measurements, including anthropometry, hand grip strength test, blood pressure and heart rate assessment; blood sampling, followed by biobanking and laboratory tests.

Conclusion. The results obtained will allow deepening knowledge about the RF profile specific to a particular region, evaluating the effectiveness of preventive programs, and planning new ones taking into account regional and socio-demographic characteristics. This will become the basis for a better understanding of the socio-economic burden of noncommunicable diseases and the economic damage of RFs.

Long-term trends in blood pressure and hypertension in Russia: an analysis of data from 14 health surveys conducted in 1975-2017

Background

Hypertension is recognized as an important contributor to high cardiovascular mortality in Russia. A comprehensive analysis of data from Russian studies that measured blood pressure in population-based samples has not been previously undertaken. This study aims to identify trends and patterns in mean blood pressure and the prevalence of hypertension in Russia over the most recent 40 years.

Methods

We obtained anonymized individual records of blood pressure measurements from 14 surveys conducted in Russia in 1975–2017 relating to a total of 137,687 individuals. For comparative purposes we obtained equivalent data from 4 surveys in the USA and England for 23,864 individuals. A meta-regression on aggregated data adjusted for education was undertaken to estimate time trends in mean systolic and diastolic blood pressure, the prevalence of elevated blood pressure (> 140/90 mmHg), and hypertension (defined as elevated blood pressure and/or the use of blood pressure-lowering) medication. A meta-analysis of pooled individual-level data was used to assess male-female differences in blood pressure and hypertension.

Results

During the period 1975–2017 mean blood pressure, the prevalence of elevated blood pressure and hypertension remained stable among Russian men. Among Russian women, mean systolic blood pressure decreased at an annual rate of 0.25 mmHg (p < 0.1) at age 35–54 years and by 0.8 mmHg (p < 0.01) at ages 55 and over. The prevalence of elevated blood pressure also decreased by 0.8% per year (p < 0.01), but the prevalence of hypertension remained stable. Mean blood pressure and prevalence of hypertension were higher in Russia compared to the USA and England at all ages and for both sexes.

Conclusions

In contrast to the generally observed downward trend in elevated blood pressure in many other countries, levels in Russia have changed little over the past 40 years, although there are some positive trends among women. Improved strategies to bring down the high levels of mean blood pressure and hypertension in Russia compared to countries such as England and the USA are important to further reduce the high burden of CVD in Russia.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12320-4.

Association of Vital Exhaustion with Risk Factors for Cardiovascular Diseases, Quality of Life and Lifestyle in 41-44-Year-Old Muscovite Men

(1) Background: Vital exhaustion (VE) is no less of an important risk factor (RF) for cardiovascular diseases (CVD) and cardiovascular events than the well-known RFs. Insufficient knowledge of the relationship between VE and CVD RF, quality of life, and lifestyle was the rationale for this study. (2) Methods: We examined 301 Muscovite men 41–44 years of age. The categorization of RFs for CVD was carried out in accordance with conventionally considered criteria. In order to evaluate the lifestyle and quality of life in study participants, we were offering them a self-filling questionnaire developed by I.A. Gundarov. The presence of VE signs was assessed using a 14-item short version of the Maastricht Vital Exhaustion Questionnaire scale (MVEQ). All study subjects were classified into three ordered groups depending on the distribution of VE indicators by tertiles: Group 1 consisted of men with a low VE (0–2 points), Group 2 included males with a medium VE score (3–5 points), and Group 3 comprised subjects with high VE scores (6–14 points). To analyze the obtained data, we used one-way analysis of variance (ANOVA), Pearson’s chi-squaredtest (χ²), Goodman and Kruskal’s gamma, and linear regression analysis. (3) Results: We established that every third male (36.8%) had VE signs, while 10.6% of men had high VE levels. With an increase of VE in men, the frequency of arterial hypertension (AH) was increasing as well, and it was significantly higher in men with a high VE compared to their peers with a low VE (48.4% versus 33%; p = 0.03). A significant linear relationship was discovered between VE levels and excessive alcohol consumption (p = 0.001). The strongest linear associations were found between the VE level, and both psychosocial stress indicator and the amount of consumed ethanol. Self-assessment of personal happiness, job and sleep satisfaction, residential living conditions, and spiritual needs, as well as psychosocial stress indicator, total amount of consumed ethanol, and muscle strength (hand-grip dynamometry), were independent determinants of the VE level, and, collectively, they explained 46.6% of its variability. The greatest contribution to VE was made by the personal happiness level, explaining 25.5% of its variability. The proportions of the VE variance uniquely explained by various factors were as follows: 9.3% by the psychosocial stress, 4.9% by job satisfaction, 2.8% by sleep satisfaction, 2.3% by total consumption of ethanol, 1.6% by muscle strength, 1.1% by living conditions in the residential neighborhood, and just 0.8% by spiritual needs. (4) Conclusion: High VE levels in 41–44-year-old men are associated with AH, sedentary behavior, excessive alcohol consumption, and lower values of most indicators of both lifestyle and quality of life.

Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF) study. Ten years later

The growing weight of noncommunicable diseases, primarily cardiovascular diseases (CVDs), is a great threat to the health of population worldwide, worsening the quality of life and reducing life expectancy. Realization of this threat led to initiation of epidemiological study by the Russian Ministry of Health to investigate the prevalence of CVDs and their risk factors, since it is CVDs that specify the high allcause mortality in Russia. In the modern history of epidemiology of non-infectious disease, the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF) study occupies a special place. This is the largest epidemiological study, which is considered as a continuation of preventive activity in order to obtain unbiased information on epidemiological characteristics of population in Russian regions. To conduct the study, the Research Organizing Committee of ESSE-RF study was created and a protocol was developed. All interested scientists and experts from following three centers took part in the work: National Medical Research Center for Therapy and Preventive Medicine, Almazov National Medical Research Center, National Medical Research Center of Cardiology. The Russian regions were justified and selected for participation. In 2012-2014 ESSE-RF study, 13 following Russian regions took part: Volgograd, Vologda, Voronezh, Ivanovo, Kemerovo, Tyumen Oblasts; Krasnoyarsk and Primorsky Krai; the Republic of North Ossetia (Alania); cities of Orenburg, Samara, St. Petersburg and Tomsk. All participated regions used a single study protocol, while biochemical parameters were determined in Federal centers using the same equipment and reagent kits. The paper presents some of the most interesting results that indicate a change in Russian epidemiological situation over the past few years. After the end of cross-sectional study, a field of priority research areas was formed in each center.

Conclusion. Epidemiological studies are the most important scientific tool for assessing the prevalence of diseases, their risk factors, as well as predicting adverse events. Based on the results obtained, healthcare system and medical community determine priorities and develop related strategies (population-based and high-risk strategies). For their implementation, a regulatory and legal framework is being created.

Prevalence, correlates, and mortality impacts of ventricular arrhythmia among older men and women: a population-based cohort study in Moscow

BACKGROUND

In Russia, cardiovascular disease (CVD) mortality is high and the mortality gap between men and women is large. Conventional risk factors cannot explain these phenomena. Ventricular arrhythmia (VA) is an important contributor to the death toll in community-based populations. The study examines the prevalence and the mortality impacts of VA in men and women and the role of VA in the male mortality excess at older ages.

METHODS

This is a secondary analysis of data from the Stress, Aging, and Health in Russia (SAHR) study that was fielded in 2007-9 in Moscow (1800 individuals, mean age 68.8 years), with mean mortality follow-up of 7.4 years (416 deaths, 248 CVD deaths). Indicators reflecting the frequency and the complexity of VA were derived from 24-h ambulatory ECG recordings. Other covariates were: socio-demographic characteristics, conventional risk factors, markers of inflammation, reported myocardial infarction, and stroke. The impacts of VA and other variables on CVD and all-cause mortality among men and women were estimated with the proportional hazard models. We assessed the contributions of VAs to the male-female mortality gap using hazard models that do and do not include groups of the predictors. Logistic models were used to assess the associations between VA and other biomarkers.

RESULTS

VAs were about twice as prevalent among men as among women. In both sexes, they were significantly associated with CVD and all-cause mortality independently of conventional risk factors. The highest hazard ratios (HRs) for CVD death were found for the runs of ventricular premature complexes (VPCs) HR = 2.45, 95% CI 1.63-3.68 for men and 2.75, 95% CI 1.18-6.40 for women. The mortality impacts of the polymorphic VPCs were significant among men only (HR = 1.50, 95% CI 1.08-2.07). VA indicators can potentially explain 12.3% and 9.1% of the male-female gaps in mortality from CVD and all causes, respectively. VAs were associated with ECG-registered ischemic problems and reported MI, particularly among men.

CONCLUSIONS

VA indicators predicted mortality in older Muscovites independently of other risk factors, and have the potential to explain a non-trivial share of the excess male mortality. The latter may be related to more severe coronary problems in men compared to women.

Population norms of health-related quality of life in Moscow, Russia: the EQ-5D-5L-based survey

Purpose

To develop population norms for the EQ-5D-5L questionnaire based on a representative sample of Moscow citizens.

Methods

We used quota sampling accounting for sex, age group and administrative district of residence. Respondents in randomly selected outdoor and indoor locations were surveyed with the official Russian paper-and-pencil version of the EQ-5D-5L questionnaire and a set of socio-demographic questions. We estimated four types of EQ-5D results: the distribution of limitations according to EQ-5D-5L dimensions, the perception of the health-related quality of life (HRQoL) with a visual analogue scale (EQ VAS), the unweighted score for a respondent’s health state (Level Sum Score, LSS) and the Russian health preferences-based weighted score (EQ index). In order to estimate the EQ-5D-5L index, we used a newly developed Russian EQ-5D-3L value set, together with EuroQol Group cross-over methodology.

Results

A total of 1020 respondents (18–93 years old) from the general Moscow adult population completed the EQ-5D-5L questionnaire. HRQoL domains with the largest number of identified health limitations were pain/discomfort (48.6%) and anxiety/depression (44.1%). Two hundred seventy-nine respondents (27.0%) did not report any health restrictions. The mean EQ VAS and EQ-5D-5L index were 74.1 (SD 17.3) and 0.907 (0.106) respectively. Multivariate analysis showed that female sex, advanced age and lack of access to the Internet had a negative influence on HRQoL, whereas residence in certain districts had a positive impact.

Conclusions

The study provides population norms of health-related quality of life in Moscow, measured according to the EQ-5D-5L questionnaire. These reference values can be used to optimise the effectiveness of resource allocation in healthcare.

Electronic supplementary material

The online version of this article (10.1007/s11136-020-02705-0) contains supplementary material, which is available to authorised users.

Atrial fibrillation among Russian men and women aged 55 years and older: prevalence, mortality, and associations with biomarkers in a population-based study

Objective

To examine the prevalence of atrial fibrillation (AF), its impacts on cardiovascular disease (CVD) and all-cause mortality, and the associations between AF and inflammatory and serum biomarkers in a population-based sample of Muscovites.

Methods

The study is a secondary analysis of data from the Stress, Aging and Health in Russia (SAHR) survey that includes information on 1800 individuals with an average age of 68.5 years at baseline, and on their subsequent mortality during 7.4 years on average. AF is detected by 12-lead electrocardiogram (ECG) and 24-hour Holter monitoring. The statistical analysis includes proportional hazard and logistic regression models.

Results

Of the 1732 participants with relevant Holter data, AF was detected in 100 (74 by ECG and Holter, 26 by Holter only). The prevalence of AF was 5.8% for men and 7.4% for women. The fully adjusted model showed strongly elevated hazard of CVD and all-cause mortality in men and women with long non-self-limiting AF (LAF). LAF was found to be negatively associated with elevated total and low-density lipoprotein cholesterol and to be positively associated with elevated markers of inflammation in women.

Conclusions

The study assessed for the first time the prevalence and the risks of death related to AF among older Russians. LAF was shown to be a strong and independent predictor of CVD and all-cause mortality. AF is unlikely to contribute to the large excess male mortality in Russia. The finding that one-quarter of AF cases were detected only by Holter monitoring demonstrates the usefulness of diagnostics with prolonged ECG registration.

Association of the Level Healthcare Resource Consumption and Frequency of Temporary Disability Cases with Cardiovascular Risk Factors Based on Data of Population Study in Russian Federation

Aim. To analyze the associations of health care system resources utilization and temporary disability (TD) with the main cardiovascular risk factors (RF) at the population and individual level in working age population based on ESSE-RF study data.

Material and methods. The analysis was based on ESSE-RF study data. Standard epidemiological survey methods and evaluation criteria were used. Analysis of probability and number of outpatient visits, hospitalizations, ambulance calls and TD was conducted by using hurdle model. Hypertension, obesity, hypercholesterolemia, hyperglycemia and tobacco consumption were independent variables.

Results. A total of 21923 individuals aged 25-64 years were included: men – 8373 (38%) and women – 13550 (62%). The probability of outpatient visits significantly determined in group with tobacco consumption and with hypercholesterolemia for men, and for women – in the smoking group, with obesity and with hyperglycemia. Numbers of outpatient visits has doubled for patient with hyperglycemia. The numbers of outpatient visits were higher among women smokers compared to non-smokers. Chance to be hospitalized significantly associate with smoking, obesity, hypercholesterolemia for men and with obesity, hyperglycemia – for women. Hypercholesterolemia was associated with a smaller number of inpatient treatment cases among men. The probability of ambulance calls increased for smoking men, for male group with hypertension, hypercholesterolemia, obesity and with hyperglycemia, at the same time, the likelihood increased in female group with hypertension, hyperglycemia, smoking and with obesity. In addition, numbers of ambulance calls were higher in 1.55 times for women with obesity (p<0.05).

Conclusion. So, there is a significant association of probability of using and consumption level of healthcare recourse with the RF depending on the type of medical care, sex and RF.

Handgrip strength and its prognostic value for mortality in Moscow, Denmark, and England

Background

This study compares handgrip strength and its association with mortality across studies conducted in Moscow, Denmark, and England.

Materials

The data collected by the Study of Stress, Aging, and Health in Russia, the Study of Middle-Aged Danish Twins and the Longitudinal Study of Aging Danish Twins, and the English Longitudinal Study of Ageing was utilized.

Results

Among the male participants, the age-standardized grip strength was 2 kg and 1 kg lower in Russia than in Denmark and in England, respectively. The age-standardized grip strength among the female participants was 1.9 kg and 1.6 kg lower in Russia than in Denmark and in England, respectively. In Moscow, a one-kilogram increase in grip strength was associated with a 4% (hazard ratio [HR] = 0.96, 95% confidence interval [CI]: 0.94, 0.99) reduction in mortality among men and a 10% (HR = 0.90, 95%CI: 0.86, 0.94) among women. Meanwhile, a one-kilogram increase in grip strength was associated with a 6% (HR = 0.94, 95%CI: 0.93, 0.95) and an 8% (HR = 0.92, 95%CI: 0.90, 0.94) decrease in mortality among Danish men and women, respectively, and with a 2% (HR = 0.98, 95%CI: 0.97, 0.99) and a 3% (HR = 0.97, 95%CI: 0.95, 0.98) reduction in mortality among the English men and women, respectively.

Conclusion

The study suggests that, although absolute grip strength values appear to vary across the Muscovite, Danish, and English samples, the degree to which grip strength is predictive of mortality is comparable across national populations with diverse socioeconomic and health profiles and life expectancy levels.

Serum nitrite and nitrate levels, NOx, can predict cardiovascular mortality in the elderly in a 3-year follow-up study

Nitric oxide (NO) is an important functional regulator that contributes to progression of various cardiovascular diseases. We studied associations between nitric oxide metabolites, nitrite and nitrate (NOx), and cardiovascular mortality in a prospective 3-year follow-up cohort study in 1,869 elderly patients aged over 55 years. The Cox proportional hazard regression model was adjusted for multiple factors including sex, age, risk corresponding to preexisting cardiovascular conditions, and serum inflammatory markers (C-reactive protein, interleukin-6, fibrinogen, and leucocytes count). During the follow-up period, there were a total of 348 deaths including 216 deaths unrelated to cardiovascular events and 132 cardiovascular deaths. Cox regression adjusted for factors related to cardiovascular disease risks and inflammatory markers showed a significant association between high levels of serum nitric oxide metabolites, NOx, and increased cardiovascular mortality (hazard ratio 2.21; 95% confidence interval 1.13-4.31) but there was no association with non-cardiovascular mortality. Analysis of adjusted hazard ratios demonstrates that association of serum nitric oxide metabolites with cardiovascular mortality was independent of levels of inflammatory markers. Thus, elevated concentrations of serum nitric oxide metabolites are a predictor of cardiovascular mortality and may be used as an integral marker of cardiovascular death. © 2016 BioFactors, 43(1):82-89, 2017.

Why are well-educated Muscovites more likely to survive? Understanding the biological pathways

There are large socioeconomic disparities in adult mortality in Russia, although the biological mechanisms are not well understood. With data from the study of Stress, Aging, and Health in Russia (SAHR), we use Gompertz hazard models to assess the relationship between educational attainment and mortality among older adults in Moscow and to evaluate biomarkers associated with inflammation, neuroendocrine function, heart rate variability, and clinical cardiovascular and metabolic risk as potential mediators of that relationship. We do this by assessing the extent to which the addition of biomarker variables into hazard models of mortality attenuates the association between educational attainment and mortality. We find that an additional year of education is associated with about 5% lower risk of age-specific all-cause and cardiovascular mortality. Inflammation biomarkers are best able to account for this relationship, explaining 25% of the education-all-cause mortality association, and 35% of the education-cardiovascular mortality association. Clinical markers perform next best, accounting for 13% and 23% of the relationship between education and all-cause and cardiovascular mortality, respectively. Although heart rate biomarkers are strongly associated with subsequent mortality, they explain very little of the education-mortality link. Neuroendocrine biomarkers fail to account for any portion of the link. These findings suggest that inflammation may be important for understanding mortality disparities by socioeconomic status.

Sex Differences in Biological Markers of Health in the Study of Stress, Aging and Health in Russia

BACKGROUND

The apparent contradiction that women live longer but have worse health than men, the so called male-female health-survival paradox, is very pronounced in Russia. The present study investigates whether men in Moscow are healthier than women at the level of biomarkers, and whether the associations between biomarkers and subjective health have sex-specific patterns.

MATERIALS

Previously collected data in the study of Stress, Aging, and Health in Russia (SAHR, n = 1800) were used to examine sex differences in biomarkers and their associations with physical functioning and self-rated health.

RESULTS

The present study found mixed directions and magnitudes for sex differences in biomarkers. Women were significantly disadvantaged with regard to obesity and waist circumference, whereas men had a tendency toward higher prevalence of electrocardiographic abnormalities. No sex differences were indicated in the prevalence of immunological biomarkers, and mixed patterns were found for lipid profiles. Many biomarkers were associated with physical functioning and general health. Obesity and waist circumference were related to lower physical functioning among females only, while major Q-wave abnormalities with high probabilities of myocardial infarction and atrial fibrillation or atrial flutter were associated with physical functioning and self-rated health among males only.

CONCLUSION

No clear patterns of sex differences in prevalence of high-risk levels of biomarkers suggest that the male-female health-survival paradox is weaker at the level of health biomarkers. We found some evidence that certain biomarkers reflecting pathophysiological changes in the organism that do not possess acute health risks, but over many years may lead to physical disability, are associated with physical functioning and self-rated health in women, whereas others reflecting more serious life-threatening pathophysiological changes are associated with physical functioning and self-rated health in men.

Correlations of psycho-physiological parameters influencing the physical fitness of aged women

Regular assessment of psycho-physiological parameters in aged subjects helps to clarify physical and mental conditions which are important in the prevention of health-endangering events to assure a healthy aging. Thirty older care female residents consented voluntarily to participate in the study. The somatic and psycho-physiological parameters recorded were handgrip force, disjunctive reaction time, balance control and whole body movement coordination, the electrocardiogram and heart rate variability. Significant correlations were found between (a) reaction time and balance control efficiency (r = -0.567, p < 0.009), (b) reaction time and movement coordination accuracy (r = -0.453, p < 0.045), (c) cardiac state and movement coordination accuracy (r = 0.545, p < 0.016), (d) cardiac stress and cardiac state (r = -0.495, p < 0.031), and (e) cardiac stress and force (r = -0.822, p < 0.045). In conclusion, for the aim of establishing basic battery tests for assessing psycho-physiological condition of physical fitness our results emphasize the importance of systematic physical activity, endurance and strength training supporting muscle force, balance control and whole-body movement coordination, in addition to improving the cardiac stress index level. The strong interrelation among these parameters allows the drawing of a more complete view regarding the health condition of aged individuals.

Serum nitrate and nitrite levels in patients with hypertension and ischemic stroke depend on diet: a multicenter study

OBJECTIVES

Nitric oxide, NO, is the key vasorelaxing agent produced by vascular endothelium. Stable end products of NO oxidation, nitrate and nitrite (NOx), are considered as markers of endothelial dysfunction associated with hypertension. Our goal was to compare NOx levels in patients with hypertension on controlled low nitrate diet with NOx levels in general population without dietary restrictions.

PATIENTS AND METHODS

The study included 1005 participants split into 8 groups: healthy subjects (n=28) and patients with moderate (n=37) and malignant hypertension (n=24) on low nitrate diet; healthy subjects (n=9) and patients with stroke (n=44) on low nitrate diet; normotensive subjects (n=354) and patients with elevated blood pressure (n=430) and severe hypertension (n=79) without dietary restrictions.

RESULTS

In groups with controlled low NOx diet, patients with moderate and malignant hypertension had significantly (p<0.01) higher serum NOx versus healthy subject (66.9±18.8μM and 75.3±22.7μM versus 52.8±28.8μM, respectively). Patients with stroke had significantly (p=0.02) higher serum NOx levels versus corresponding group of healthy subjects (106.3±58.4μM versus 71.2±18.1μM, respectively). In the absence of dietary control, differences in serum NOx levels between normotensive subjects and patients with elevated blood pressure and severe hypertension were not significant (p>0.1).

CONCLUSION

Differences in serum NOx concentrations are associated with severity of hypertension only in patients on low nitrate diet. The highest concentrations of NOx were observed in patients with stroke. In the absence of dietary control, NOx levels were not associated with presence or severity of hypertension.

Latent time-varying factors in longitudinal analysis: a linear mixed hidden Markov model for heart rates

Longitudinal data are often segmented by unobserved time-varying factors, which introduce latent heterogeneity at the observation level, in addition to heterogeneity across subjects. We account for this latent structure by a linear mixed hidden Markov model. It integrates subject-specific random effects and Markovian sequences of time-varying effects in the linear predictor. We propose an expectationŰ-maximization algorithm for maximum likelihood estimation, based on data augmentation. It reduces to the iterative maximization of the expected value of a complete likelihood function, derived from an augmented dataset with case weights, alternated with weights updating. In a case study of the Survey on Stress Aging and Health in Russia, the model is exploited to estimate the influence of the observed covariates under unobserved time-varying factors, which affect the cardiovascular activity of each subject during the observation period.

CORONARY HEART DISEASE IN PERSONS OLDER THAN 55 YEARS. PREVALENCE AND PROGNOSIS

Aim. To study prevalence of various types of coronary heart disease (CHD) and their prognostic value in men and women older than 55 y.o.

Material and methods. We used the data from selections of previously diagnosed persons. Totally 1875 included, with response at 64% level. All persons were questionnaired by the standard survey, that included social and demographic data, anamnesis, Rose questionnaire, behaviour. All patients underwent ECG 12 leads. ECG analysis was done with Minnesota conding system.

Results. Every 4th male and every 3rd female revealed angina pectoris by the Rose questionnaire, and 9,5% men and 2,7% women had anamnesis of infarction. Ischemic changes on ECG more often in women — 15,6% vs. 10,0% (p<0,001); and infarction itself 2 times more often affects men — 7,1% vs. 3,2% (p<0,001). For men rhythm disorders are more common, i.e. left bundle branch block (p<0,03). Overall CHD prevalence does not significantly differ between genders and is 34,6% for men and 36,0% for women. The most severe forms in account of life threatening are rhythm disorders, ischemic changes and atrial fibrillation. At the same time, for cardiovascular mortality all parameters were significant, including heart failure. By the severity of prognosis all values are spread with the same manner as for general mortality.

Conclusion. CHD in older age is highly prevalent and very diverse. In women less severe forms are marked comparing to men. Epidemiologic criteria for CHD on ECG can be regarded as diagnostic and as candidates for patients stratification by the mortality risk from cardiovascular diseases and from all causes. 

Sex differences in health and mortality in Moscow and Denmark

In high income countries females outlive men, although they generally report worse health, the so-called male-female health-survival paradox. Russia has one of the world's largest sex difference in life expectancy with a male disadvantage of more than 10 years. We compare components of the paradox between Denmark and Moscow by examining sex differences in mortality and several health measures. The Human Mortality Database and the Russian Fertility and Mortality Database were used to examine sex differences in all-cause death rates in Denmark, Russia, and Moscow in 2007-2008. Self-reported health data were obtained from the Study of Middle-Aged Danish Twins (n = 4,314), the Longitudinal Study of Aging Danish Twins (n = 4,731), and the study of Stress, Aging, and Health in Russia (n = 1,800). In both Moscow and Denmark there was a consistent female advantage at ages 55-89 years in survival and a male advantage in self-rated health, physical functioning, and depression symptomatology. Only on cognitive tests males performed similarly to or worse than women. Nevertheless, Muscovite males had more than twice higher mortality at ages 55-69 years compared to Muscovite women, almost double the ratio in Denmark. The present study showed that despite similar directions of sex differences in health and mortality in Moscow and Denmark, the male-female health-survival paradox is very pronounced in Moscow suggesting a stronger sex-specific disconnect between health indicators and mortality among middle-aged and young-old Muscovites.

Socioeconomic inequalities in all-cause mortality in the Czech Republic, Russia, Poland and Lithuania in the 2000s: findings from the HAPIEE Study

BACKGROUND

Relatively large socioeconomic inequalities in health and mortality have been observed in Central and Eastern Europe (CEE) and the former Soviet Union (FSU). Yet comparative data are sparse and virtually all studies include only education. The aim of this study is to quantify and compare socioeconomic inequalities in all-cause mortality during the 2000s in urban population samples from four CEE/FSU countries, by three different measures of socioeconomic position (SEP) (education, difficulty buying food and household amenities), reflecting different aspects of SEP.

METHODS

Data from the prospective population-based HAPIEE (Health, Alcohol, and Psychosocial factors in Eastern Europe) study were used. The baseline survey (2002-2005) included 16 812 men and 19 180 women aged 45-69 years in Novosibirsk (Russia), Krakow (Poland), Kaunas (Lithuania) and seven Czech towns. Deaths in the cohorts were identified through mortality registers. Data were analysed by direct standardisation and Cox regression, quantifying absolute and relative SEP differences.

RESULTS

Mortality inequalities by the three SEP indicators were observed in all samples. The magnitude of inequalities varied according to gender, country and SEP measure. As expected, given the high mortality rates in Russian men, largest absolute inequalities were found among Russian men (educational slope index of inequality was 19.4 per 1000 person-years). Largest relative inequalities were observed in Czech men and Lithuanian subjects. Disadvantage by all three SEP measures remained strongly associated with increased mortality after adjusting for the other SEP indicators.

CONCLUSIONS

The results emphasise the importance of all SEP measures for understanding mortality inequalities in CEE/FSU.

Perceived stress and biological risk: is the link stronger in Russians than in Taiwanese and Americans?

Allostatic load theory implies a relationship between exposure to psychological stress and multi-system physiological dysregulation. We used data from population-based samples of men and women in Russia (Moscow; n = 1800; age, mean 68.6 years), Taiwan (n = 1036; 65.6 years) and the United States (US; n = 1054; 58.0 years) -- which are likely to vary widely with respect to levels of stress exposure and biological markers -- to determine the magnitude of the association between perceived stress and physiological dysregulation. The measure of overall dysregulation was based on 15 markers including standard cardiovascular/metabolic risk factors as well as markers of inflammation and neuroendocrine activity. Subjective psychological stress was measured by the perceived stress scale. Only the Moscow sample demonstrated a positive association with overall dysregulation in both sexes. In the US, we found an association among women but not men. Among the Taiwanese, who report the lowest perceived stress, there was no association in women but an unexpected inverse relationship in men. The effects also varied across system-level subscores: the association with perceived stress was most consistent for standard cardiovascular/metabolic factors. Perceived stress was associated with inflammation and neuroendocrine activity in some samples. Although the evidence that perceived stress is the primary source of physiological dysregulation is generally modest, it was stronger in Russia where the level of perceived stress was particularly high. For Russia only, we had information about heart function based on a 24 h ambulatory electrocardiogram; perceived stress was consistently associated with heart rate dysregulation in Russian men and women.

To what extent do biomarkers account for the large social disparities in health in Moscow?

The Russian population continues to face political and economic challenges, has experienced poor general health and high mortality for decades, and has exhibited widening health disparities. The physiological factors underlying links between health and socioeconomic position in the Russian population are therefore an important topic to investigate. We used data from a population-based survey of Moscow residents aged 55 and older (n = 1495), fielded between December 2006 and June 2009, to address two questions. First, are social disparities evident across different clusters of biomarkers? Second, does biological risk mediate the link between socioeconomic status and health? Health outcomes included subscales for general health, physical function, and bodily pain. Socioeconomic status was represented by education and an index of material resources. Biological risk was measured by 20 biomarkers including cardiovascular, inflammatory, and neuroendocrine markers as well as heart rate parameters from 24-h ECG monitoring. For both sexes, the age-adjusted educational disparity in standard cardiovascular risk factors was substantial (men: standardized β = -0.16, 95% CI = -0.23 to -0.09; women: β = -0.25, CI = -0.32 to -0.18). Education differences in inflammation were also evident in both men (β = -0.17, CI = -0.25 to -0.09) and women (β = -0.09, CI = -0.17 to -0.01). Heart rate parameters differed by education only in men (β = -0.10, CI = -0.18 to -0.02). The associations between material resources and biological risk scores were generally weaker than those for education. Social disparities in neuroendocrine markers were negligible for men and women. In terms of mediating effects, biological risk accounted for more of the education gap in general health and physical function (19-36%) than in bodily pain (12-18%). Inclusion of inflammatory markers and heart rate parameters-which were important predictors of health outcomes-may explain how we accounted for more of the social disparities than previous studies.

Prevalence, components, and correlates of metabolic syndrome (MetS) among elderly Muscovites

The goal of this study is to estimate the prevalence of MetS, together with its components and correlates, among elderly Russians. Our population-based sample included randomly selected residents of Moscow aged 55 and older: 955 women with an average age of 67.6, and 833 men with an average age of 68.9. MetS was defined according to National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATPIII). The prevalence of MetS was found to be 41.7% in women and 26.8% in men. It tended to decrease with age in men, but not in women. MetS was inversely related to education in women, but not in men. The most prevalent individual components of MetS were as follows: hypertension (64.4%), abdominal obesity (55%), and decreased high density lipoprotein cholesterol (HDL C) (46%) for women; and hypertension (71%) and fasting hyperglycemia (35.2%) for men. An elevated level of triglycerides (TG) was the rarest MetS component, affecting 23.5% of women and 22.1% of men. The higher female prevalence of MetS was attributable to abdominal obesity. MetS was found to be associated with markers of insulin resistance (IR), low-grade inflammation, and insufficient fibrinolysis. Although the metabolic burden is an important contributor to high levels of ill-health and cardiovascular mortality among elderly Russians (especially women), it does not explain why cardiovascular mortality is much higher in Russia than in other industrialized countries.

Gender specifics of the association between blood fibrinolytic activity and cardiovascular disease or diabetes mellitus in a cohort of Muscovites aged 55 years or older

Aim. To investigate potential gender differences in the association between plasma fibrinolytic activity (FLA) and atherosclerotic pathology in elderly people. Material and methods. This analysis was performed as a part of the prospective population-based cohort study “Stress, Ageing, and Health in Russia”. The study included randomly selected Moscow residents of both genders and age of ≥55 years (n=1863; 889 men and 974 women). Based on the levels of blood FLA (time of spontaneous lysis of euglobin blood fraction, or euglobin lysis time, ELT), all participants were divided into three groups: with normofibrinolysis (ELT 180-260 minutes), hypofibrinolysis (ELT >260 minutes), and hyperfibrinolysis (ELT <180 minutes). Results. In this cohort of elderly Muscovites, the association between FLA and the presence of cardiovascular disease (CVD) or Type 2 diabetes mellitus (DM-2) differed in men and women. The link between hypofibrinolysis, atherogenic changes in lipid profile, or high fasting levels of insulin and arterial hypertension (AH), myocardial infarction (MI), or DM-2 was present only in men. In women, either reduced or increased FLA was not related to DM-2. Men with hyperfibrinolysis demonstrated lower odds of AH and DM-2, while women with hyperfibrinolysis had lower odds of AH, coronary heart disease, or angina. Conclusion. In elderly people, high FLA appears to provide protection against atherothrombotic pathology, regardless of gender. Low FLA was associated with higher odds of CVD and DM-2 in men only.

Association between C-reactive protein and blood pressure in a cohort of elderly Muscovites: epidemiological study data

Background. The elevation of blood pressure (BP) affects the development of vascular inflammation. At the same time, it has been suggested that inflammation itself could be an independent risk factor (RF) of arterial hypertension (AH) development. Aim. To investigate whether the association between increased levels of C-reactive protein (CRP) and AH is independent from classical RFs. Material and methods. The data were obtained during a crosssectional survey of 1876 Muscovites (47,9% men) aged ≥55 years, who participated in the prospective study “Stress, Ageing, and Health in Russia”. In all participants, socio-demographic characteristics, health behaviours, parameters of anthropometry and rest electrocardiography (ECG) were assessed. The levels of BP and blood lipids were also measured. The outcome variable was an increase in CRP levels (>3 mg/l). Statistical methods included logistic regression; the risk estimates were presented as odds ratios (OR) and 95% confidence intervals (CI). Results. There was a positive link between AH and CRP levels of >3 mg/l. After adjustment for age and sex, OR of increased CRP levels in hypertensive participants vs. their AH-free peers was 1,688 (95% CI 1,323-2,154; p=0,0001). In the final model (adjustment for age, sex, educational level, smoking, alcohol consumption, abdominal obesity, high atherogenicity index, and coronary heart disease, CHD), this effect remained statistically significant (OR 1,450; 95% CI 1,127-1,864; p=0,004). Conclusion. In elderly Muscovites, a positive association between increased CRP levels and the elevation of BP was independent from RFs and CHD.

C-reactive protein and sociodemographic parameters in Moscow residents aged 55 years and older

Aim.High-sensitive C-reactive protein (hsCRP) is currently regarded as an important marker of cardiovascular disease (CVD). The aim of the study was to assess the population characteristics of hsCRP in the sample of Moscow residents aged 55 years and older.Material and methods.The analysis included 1851 people (response rate 65 %), who participated in the SAHR (Stress, Aging, and Health in Russia) study.Results.The hsCRP levels were similar in men and women, with the right-skewed distribution. The hsCRP values ranged from 0,5 to 69,5 mg/dl in men (median 1,5 mg/l), and from 0,5 to 75 mg/l in women (median 1,5 mg/l). The mean hsCRP levels were slightly higher in men than in women (3,4±0,19 vs. 3,1±0,15, respectively;р=0,36). Overall, there was no marked age-related dynamics of hsCRP levels in men or women. The prevalence of high hsCRP levels (>3 mg/l) non-significantly increased from 31,2 % in the youngest age group to 36,2 % in those aged 75 years and older. Acute inflammation (hsCRP levels >10 mg/l) was registered in 85 participants (4,5 %), including 42 men and 43 women. After adjustment for age and gender, the lower education level remained a significant predictor of hsCRP elevation.Conclusion.No clear associations between hsCRP and age or gender were observed. However, participants with university and secondary education had significantly lower hsCRP concentrations, compared to their peers with education level lower than secondary.