Social factors and increase in mortality in Russia in the 1990s: prospective cohort study.

OBJECTIVE: To determine the association between social factors and the increase in mortality in Russia in the 1990s. DESIGN: Prospective population cohort study. SETTING: Saint Petersburg, Russia. PARTICIPANTS: Two cohorts of men aged 40-59 years randomly selected from district voting list: 3907 screened in 1975-7 and 1467 in 1986-8. MAIN OUTCOME MEASURES: Education, various health related measures, alcohol intake. Mortality in subsequent 10 years. RESULTS: There was no recorded increase in mortality in men with university degrees. The relative risk in the second cohort compared with the first was 0.92 (95% confidence interval 0.67 to 1.24). For participants with only high school education it was significantly higher in the second cohort (1.32, 1.02 to 1.71). The most pronounced differences were found among participants with the lowest level of education, in which the relative risk was 1.75 (1.44 to 2.12). The same pattern held for coronary vascular disease and cancer mortality. CONCLUSION: In Russia men in the lower socioeconomic groups were most affected by the sharp increases in mortality in the 1990s.

The total and HDL-cholesterol levels in populations of St. Petersburg (Russia) and Leipzig (Germany).

BACKGROUND AND AIM: In the early 90s an increase in coronary heart disease (CHD) mortality in post-communist countries was observed. Based on the lipid theory of the pathogenesis of atherosclerosis, we looked to see whether these changes were accompanied by changes in blood lipid profiles and how lipid levels are related in a post-communist country with a relatively high standard of living (East Germany) and a country still facing economic troubles (Russia). METHODS AND RESULTS: This investigation was conducted in 1995-1997 by a cooperative program between the Department of Clinical Chemistry and Pathobiochemistry, University of Leipzig, Leipzig, Germany and the Department of Biochemistry, Institute for Experimental Medicine, St. Petersburg, Russia. The Russian part of the study included 1646 subjects and the German part 3189 subjects. The blood lipids were measured using a dry-chemistry analyzer (Reflotron). Russian and German males had almost the same level of total cholesterol with a significantly lower level of HDL-C in Russians. A significantly lower level of HDL-C was also observed in Russian females. Differences were in range 2-3 mg/dl for males and 8-13 mg/dl for females. In St. Petersburg, almost 40% of all screened young males (age < 30 yr) had hypoalphacholesterolemia. In the St. Petersburg study carried out in 1986-1988, in age group 40-49 years around 6% of those screened had HDL-C lower than 35 mg/dl. In 1995-1997 this number increased to 36%. The number of subjects with HDL-C less than 30 mg/dl in 1986-1988 was only 2.4% and in 1995-1997, 12.3%. CONCLUSION: There is a dramatic decrease in HDL-C in the Russian population, probably due to the socioeconomic factors which began to develop after the fall of communist.

Blood pressure and heart rate response during exercise in men and women in the USA and Russia lipid research clinics prevalence study.

Examination of blood pressure (BP) and heart rate (HR) measurements at rest and during exercise in samples of USA and Russian middle-aged men and women show significant differences between countries for both genders. Russian men had higher resting systolic blood pressure (SBP) than USA men but lower SBP at both stages of exercise. Russian women had significantly higher resting SBP than USA women at rest and also during exercise. Russian men and women had significantly lower HR at rest and during exercise than USA men and women. Differences between countries were also noted for mean body weight, height, lipid levels, percentages of smokers and several other variables, and it was postulated that differences in these factors might be responsible in part for differences in SBP and HR during exercise. After adjustment for these variables, differences in SBP during exercise between USA and Russian men remained, but differences between USA and Russian women disappeared. For both genders, differences in HR during exercise remained after adjustment. Mortality analyses in USA and Russian men indicated that stage 2 SBP response during exercise was generally not a significant mortality risk factor after adjustment for age, BMI, TC, smoking and resting SBP. In a similar model, stage 2 HR response during exercise was also a non-significant risk factor in mortality.

Correlates of mortality in Russian and US women. The Lipid Research Clinics Program.

Associations between selected risk factors and 7-year all-cause mortality were studied in 2,187 Russian women and 2,146 US women who were screened as part of a US-Russian collaborative program. The US women were screened during the period 1972-1976, while the Russian women were screened from 1978 to 1982. Cigarette smoking and elevated systolic blood pressure were associated with increased mortality in both samples. High density lipoprotein (HDL) cholesterol was inversely related to mortality in US women, but there was no association of HDL cholesterol with mortality in Russian women. Prevalent angina and electrocardiographic abnormalities were associated with mortality in both samples, but the relations achieved statistical significance only in the Russian sample. The problems of cigarette smoking and elevated blood pressure should be addressed with public health measures in both countries. The absence of an association between HDL cholesterol and mortality in the Russian sample should be investigated further.

PIP: Associations between selected risk factors and 7-year all-cause mortality were studied in 2187 Russian women and 2146 US women who were screened as part of the US-Russian collaborative program conducted at 9 sites during the period 1972-1976. Cholesterol and triglycerides were measured in males and females aged birth to 99 years. US women between 40 and 69 years of age were examined during the period 1972-1976. In Russia, women aged 20-69 years were screened on a single occasion during the years 1978-1982. Russian women aged 40-69 years were included in this report. The proportional hazards model was used to assess the associations between mortality and the risk factors. 4% of the Russian women and 22% of the US women reported taking hormones. In the US sample, the only statistically significant interaction was that between hormone use and high density lipoprotein (HDL) cholesterol. Cigarette smoking and elevated systolic blood pressure were associated with increased mortality in both samples. Although the associations of prevalent angina and electrocardiographic abnormalities were similar in magnitude, they were significant only in the Russian sample, while cigarette smoking was significant only in the US sample. The major difference in the 2 samples related to HDL cholesterol, where there was a strong negative association in the US women and no association in the Russian women. Although it was relatively weak, there was also a statistically significant association between triglycerides and mortality in the US sample. HDL cholesterol was inversely related to mortality in US women, but there was no association of HDL cholesterol with mortality in Russian women. The noticeable differences between the samples were the higher systolic blood pressure, body mass index, and prevalence of angina and electrocardiographic abnormalities in the Russian women, and the much higher prevalence of current cigarette smoking in the US women. The respective public health services should address smoking and elevated blood pressure.

Variants of the course of ischaemic heart disease, its incidence and the level of main risk factors. Results of a two-stage screening trial in a male population.

The study presents the results of follow-up of a male population born between 1916-1935, living in a city district of Leningrad in 1975. The first epidemiological examination, designed to detect ischaemic heart disease (IHD) and its risk factors included 3,907 men. Repeated screening using the same protocol was conducted, at a 7-8 year interval, in 2,160 men. During the first screening, IHD was diagnosed in 461 persons; in 34.5% of them, according to the results of the second screening, IHD had a "stable course"; in 24.3% the second screening did not confirm the presence of IHD and 18.0% died of IHD complications in the meantime. A group of new non-fatal cases of IHD has been identified (13.9%). An analysis of the association between the course of IHD and the presence of risk factors has shown that while, in the group without the three main risk factors, the incidence was 6.0 +/- 2/1000 man-years, the respective figure was 41.2 +/- 7.3 in the group with the three risk factors present.