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.

Time trends in smoking in Russia in the light of recent tobacco control measures: synthesis of evidence from multiple sources.

BACKGROUND: The study aims at identifying long-term trends and patterns of current smoking by age, gender, and education in Russia, including the most recent period from 2008 during which tobacco control policies were implemented, and to estimate the impact on mortality of any reductions in prevalence. We present an in-depth analysis based on an unprecedentedly large array of survey data. METHODS: We examined pooled micro-data on smoking from 17 rounds of the Russian Longitudinal Monitoring Study of 1996-2016, 11 other surveys conducted in Russia in 1975-2017, and two comparator surveys from England and the USA. Standardization by age and education, regression and meta-analysis were used to estimate trends in the prevalence of current smoking by gender, age, and educational patterns. RESULTS: From the mid-1970s to the mid-2000s smoking prevalence among men was relatively stable at around 60%, after which time prevalence declined in every age and educational group. Among women, trends in smoking were more heterogeneous. Prevalence more than doubled above the age of 55 years from very low levels (< 5%). At younger ages, there were steep increases until the mid-2000s after which prevalence has declined. Trends differed by educational level, with women in the lowest educational category accounting for most of the long-term increase. We estimate that the decline in male smoking may have contributed 6.2% of the observed reduction in cardiovascular deaths among men in the period 2008-16. CONCLUSIONS: The implementation of an effective tobacco control strategy in Russia starting in 2008 coincided with a decline in smoking prevalence among men from what had been stable, high levels over many decades regardless of age and education. Among women, the declines have been more uneven, with young women showing recent downturns, while the smoking prevalence in middle age has increased, particularly among those with minimal education. Among men, these positive changes will have made a small contribution to the reduction in mortality seen in Russia since 2005.

Know Your Heart: Rationale, design and conduct of a cross-sectional study of cardiovascular structure, function and risk factors in 4500 men and women aged 35-69 years from two Russian cities, 2015-18.

Russia has one of the highest rates of cardiovascular disease in the world. The International Project on Cardiovascular Disease in Russia (IPCDR) was set up to understand the reasons for this. A substantial component of this study was the Know Your Heart Study devoted to characterising the nature and causes of cardiovascular disease in Russia by conducting large cross-sectional surveys in two Russian cities Novosibirsk and Arkhangelsk. The study population was 4542 men and women aged 35-69 years recruited from the general population. Fieldwork took place between 2015-18. There were two study components: 1) a baseline interview to collect information on socio-demographic characteristics and cardiovascular risk factors, usually conducted at home, and 2) a comprehensive health check at a primary care clinic which included detailed examination of the cardiovascular system. In this paper we describe in detail the rationale for, design and conduct of these studies.

Alcohol and suicide in the Nenets Autonomous Okrug and Arkhangelsk Oblast, Russia.

BACKGROUND: High suicide rates in the Russian North are coupled with high alcohol consumption in the described populations. OBJECTIVE: To investigate the potential role of alcohol consumption on suicides in the Nenets Autonomous Okrug (NAO) in 2002-2012 and to compare this information with corresponding data from the neighboring Arkhangelsk Oblast (AO). DESIGN: Retrospective population-based mortality study. METHODS: Data from autopsy reports were used to identify 252 cases of suicide in the NAO and 1,198 cases in the AO in the period 2002-2012. Postmortem blood alcohol content (BAC) was available for 228 cases in the NAO and 1,185 cases in the AO. BAC as well as other selected variables were compared between the NAO and the AO among women and men, different age groups, ethnic groups, and selected variables of suicide. RESULTS: Alcohol was present in the blood of 74.1% of male and 82.9% of female suicide cases in the NAO, which was significantly higher than the proportions found in the AO (59.3% of male and 46.6% female cases). BAC<1.0‰ and between 2.0 and 3.0‰ were more frequently found among suicide cases in the NAO than those in the AO. CONCLUSIONS: Our findings specify that alcohol drinking may be an essential risk factor for suicide in the NAO, and that this factor may be of greater importance in the indigenous population of the NAO than among Russians in the AO.

Variations in suicide method and in suicide occurrence by season and day of the week in Russia and the Nenets Autonomous Okrug, Northwestern Russia: a retrospective population-based mortality study.

BACKGROUND: Suicide is an important world health issue, especially in territories inhabited by indigenous people. This investigated differences in suicide rates, suicide methods, and suicide occurrence by month and day of the week among the indigenous and non-indigenous populations of the Nenets Autonomous Okrug (NAO) and to compare the findings from the NAO with national Russian statistics. METHODS: In this retrospective population-based mortality study we investigated all suicides that occurred in the NAO in 2002-2012 (N = 252). Suicide method and the month and day of the week suicide occurred was taken from autopsy reports and disaggregated by ethnic group (indigenous and non-indigenous) and sex. Data from the NAO were then compared with national data from the Russian Federal Statistics Service (Rosstat). RESULTS: Hanging was the most common suicide method in the NAO in both indigenous and non-indigenous populations. The proportion of suicides by hanging among males was lower in the NAO than in national data (69.3 vs 86.2 %), but the inverse was true for females (86.5 vs 74.9 %). Suicide by firearm and by cutting was significantly higher among the indigenous population in the NAO when compared with national data. Peaks in suicide occurrence were observed in May and September in the NAO, whereas national data showed only one peak in May. Suicide occurrence in the indigenous population of the NAO was highest in April, while the non-indigenous population showed peaks in May and September. Suicide occurrence in the NAO was highest on Fridays; in national data this occurrence was highest on Mondays. CONCLUSIONS: We showed different relative frequencies of suicide by hanging, cutting, and firearm, as well as different suicide occurrence by month and day of the week in the NAO compared with Russia as a whole. These results can be used to plan suicide prevention activities in the Russian Arctic.

Suicides in the indigenous and non-indigenous populations in the Nenets Autonomous Okrug, Northwestern Russia, and associated socio-demographic characteristics.

BACKGROUND: To describe suicide rates in the indigenous and non-indigenous populations of the Nenets Autonomous Okrug (NAO) in 2002-2012, as well as associated socio-demographic characteristics. STUDY DESIGN: Retrospective population-based mortality study. METHODS: Data from autopsy reports were used to identify 252 cases of suicide in the NAO in 2002-2012. Data on socio-demographic characteristics of these cases were obtained from passports and medical records at local primary health care units, and were then linked to total population data from the Censuses in 2002 and 2010. Suicide rates for the indigenous Nenets population and the non-indigenous population were standardized to the European standard population. The rates were also estimated according to different socio-demographic characteristics and compared by calculating relative risks. RESULTS: The crude suicide rates were 79.8 per 100,000 person-years (PYs) in the Nenets population and 49.2 per 100,000 PYs in the non-indigenous population. The corresponding standardized estimates were 72.7 per 100,000 PYs and 50.7 per 100,000 PYs. The highest suicide rates in the Nenets population were observed in the age group 20-29 years (391 per 100,000 PYs), and in females aged 30-39 years (191 per 100,000 PYs). Socio-demographic characteristics associated with high suicide rates in the Nenets population were age 20-39 years, male, urban residence, having secondary school or higher education, being an employee or employer, and being single or divorced. Males aged 20-29 years, and females aged 30-39 and aged 70 years and above had the highest suicide rates in the non-indigenous population (137.5, 21.6 and 29.9 per 100,000 PYs, respectively). The elevated suicide rates observed in the non-indigenous population were associated with male sex, rural residence, secondary school education, being an employee or employer, and being single or divorced. CONCLUSIONS: Suicide rates in the NAO were substantially higher among the indigenous Nenets population than the non-indigenous population, and were associated with different socio-demographic characteristics.

Road traffic fatalities in Arkhangelsk, Russia in 2005-2010: reliability of police and healthcare data.

PURPOSE: To estimate and compare reliability of traffic mortality data of the police and the healthcare sector in Arkhangelsk, Russia. METHODS: The study matched traffic mortality data of the police and the regional healthcare statistics centre for the period from 2005 to 2010. Individual investigations of unmatched cases were performed, and the underlying causes of the non-matches were established. The obtained distribution of non-matches by causes served as basis for estimating the true numbers of traffic fatalities in the two sources, in appliance with corresponding fatality definitions and registration rules. A data accuracy index (DAI) was calculated for each source by using an adapted version of the formula for calculating accuracy of a diagnostic test. This was used as a measure for data reliability. Time trends in annual DAIs were estimated for each source by χ(2)-test for linear trend. RESULTS: During the 6-year period, the police and the healthcare statistics centre registered 217 and 237 traffic fatalities in Arkhangelsk, respectively. Matching of data from the two sources resulted in 162 matched cases, 55 unmatched cases in the police data, and 75 unmatched cases in the healthcare data. More than a half (56%) of the non-matches were attributed to incompatibility of the definitions in the two data registration systems; 39% were attributed to failures in the healthcare data. Other non-matches were due to scarce identifying information (2%) or were not classifiable (2%). None of the non-matches were clearly attributable to failures in the police data. The 6-year DAI was 98% for the police data and 80% for the healthcare data. The DAI for the police data was stable over 2005-2010 (ranging from 96% to 100%). The DAI for the healthcare data increased from 66% in 2005 to 98% in 2010 (Ptrend<0.001). CONCLUSION: The findings suggest that traffic mortality data of the police were more reliable, compared to the healthcare data. However, reliability of the healthcare data was improving during the study period.

Road traffic crashes with fatal and non-fatal injuries in Arkhangelsk, Russia in 2005-2010.

The study investigated trends in traffic crashes with fatal and non-fatal injuries in Arkhangelsk, Russia in 2005-2010. Data were obtained from the road police. Negative binomial regression with time regressor was used to investigate trends in monthly incidence rates (IRs) of crashes, fatalities, and non-fatal injuries. During the six-year period, the police registered 4955 crashes with fatal and non-fatal injuries, which resulted in 217 fatalities and 5964 non-fatal injury cases. The IR of crashes with fatal and non-fatal injuries per total population showed no evident change, while the IR per increasing total number of motor vehicles decreased on average by 0.6% per month. Pedestrian crashes constituted 51.8% of studied crashes, and pedestrians constituted 54.6% of fatalities and 44.5% of non-fatal injuries. The IRs of pedestrian crashes and non-fatal pedestrian injuries per total population decreased on average by 0.3% per month, and these were the major trends in the data.

Explaining reduction of pedestrian-motor vehicle crashes in Arkhangelsk, Russia, in 2005-2010.

OBJECTIVE: To explain a reduction in pedestrian-motor vehicle crashes in Arkhangelsk, Russia, in 2005-2010. STUDY DESIGN: Retrospective ecological study. METHODS: For 2005-2010, police data on pedestrian-motor vehicle crashes, traffic violations, and total motor vehicles (MVs) were combined with data on changes in national road traffic legislation and municipal road infrastructure. Negative binomial regression was used to investigate trends in monthly rates of pedestrian-motor vehicle crashes per total MVs and estimate changes in these rates per unit changes in the safety measures. RESULTS: During the 6 years, the police registered 2,565 pedestrian-motor vehicle crashes: 1,597 (62%) outside crosswalks, 766 (30%) on non-signalized crosswalks, and 202 (8%) on signalized crosswalks. Crash rates outside crosswalks and on signalized crosswalks decreased on average by 1.1% per month, whereas the crash rate on non-signalized crosswalks remained unchanged. Numbers of signalized and non-signalized crosswalks increased by 14 and 19%, respectively. Also, 10% of non-signalized crosswalks were combined with speed humps, and 4% with light-reflecting vertical signs. Pedestrian penalties for traffic violations increased 4-fold. Driver penalties for ignoring prohibiting signal and failure to give way to pedestrian on non-signalized crosswalk increased 7- and 8-fold, respectively. The rate of total registered drivers' traffic violations per total MVs decreased on average by 0.3% per month. All studied infrastructure and legislative measures had inverse associations with the rate of crashes outside crosswalks. The rate of crashes on signalized crosswalks showed inverse associations with related monetary penalties. CONCLUSIONS: The introduction of infrastructure and legislative measures is the most probable explanation of the reduction of pedestrian-motor vehicle crashes in Arkhangelsk. The overall reduction is due to decreases in rates of crashes outside crosswalks and on signalized crosswalks. No change was observed in the rate of crashes on non-signalized crosswalks.

Injury prevention and safety promotion course in a Russian Master of Public Health programme.

The Global Burden of Disease Studies describe and emphasise injury as a major and increasing component in the panorama of global ill health. Russia has the one of the highest injury rates in Europe. When a Master in Public Health programme was planned and started in 2007 in Arkhangelsk, Russia, under the auspices of University of Tromsø, Norway, a course on Injury Prevention and Safety Promotion was included. A take-over programme (training-the-trainers) was implemented within the course. The present paper describes the course content, the students and their background, the training-the-trainers programme, the evaluation procedure and its results. So far, 53 students have passed the course, 77% being female. The majority of students were medical doctors (51%), psychologists (11%), pedagogues (9%), dentists (6%) and nurses (6%). The take-over programme has functioned well by gradually using students of excellence as teachers. In 2012, the take-over programme is completed and only Russians teach. Evaluation by students of the course content, organisation and pedagogic approach was useful for improvements.

Determinants of cardiovascular and all-cause mortality in northwest Russia: a 10-year follow-up study.

PURPOSE: To study conventional and novel risk factors associated with high cardiovascular disease (CVD) and all-cause mortality in Russia. METHODS: A prospective cohort study of 3704 adults was performed in Arkhangelsk. The baseline examination was conducted in 1999-2000. The average follow-up was 10.2 years. Information on lifestyle and marital, educational, and psychosocial status was self-reported in a questionnaire. Data on risk factors were collected in a medical examination that included the drawing of blood samples. RESULTS: By October 2010 a total of 147 male and 95 female deaths had occurred. In 59 male and 20 female deaths in which a diagnosis was made by a forensic pathologist, the autopsy data were studied to extract information on post-mortem blood alcohol concentration. A positive blood alcohol concentration was found in 21 (36%) male and 6 (30%) female forensic autopsies. Women reporting consumption of at least 80 g of alcohol monthly and consumption of 5 or more alcohol units during one drinking episode had a greater risk of cardiovascular death than abstainers; relative risk (RR) was 5.06 (95% confidence interval [95% CI], 1.54-16.7) and 3.21 (95% CI, 1.07-9.58), respectively. ApoB/ApoA1-ratio was the strongest predictor of CVD and all-cause death in men (RR, 7.62; 95% CI, 3.15-18.4; and RR, 4.39; 95% CI, 2.22-8.68, respectively) and CVD death in women (RR 3.12; 95% CI, 1.08-8.98). Men who were obese and had obtained a university education had a 40% lower risk of all-cause death. Low serum albumin was associated with high mortality in both genders. CONCLUSIONS: Hazardous alcohol consumption is an independent risk factor of CVD mortality in women. The mechanisms behind its damaging effect are not yet clear. Nutritional factors such as serum albumin are important predictors of all-cause mortality in both genders.

Premature cardiovascular mortality and alcohol consumption before death in Arkhangelsk, Russia: an analysis of a consecutive series of forensic autopsies.

BACKGROUND: High cardiovascular diseases (CVD) mortality among the middle aged is a major cause of reduced life expectancy in Russia, especially among men. Hazardous alcohol consumption is suspected to be a powerful contributing factor. METHODS: All men (1099) and women (519) aged 30-70 years who died between 1 January 2008 and 31 August 2009 from CVD in the city of Arkhangelsk, north-west Russia, were included. CVD mortality was stratified by age, gender and diagnosis. For the cases diagnosed by forensic pathologists, the blood alcohol concentration (BAC) was determined. The forensic autopsy rate was 72% for men and 62% for women. RESULTS: Age-standardized CVD mortality rate (all age groups) in men was higher than in women. The largest male-female ratio (4.3) was observed in the age group of 50-59 years. Alcoholic and unspecified cardiomyopathies were the most dominant of CVD mortalities in women, and second in men aged <50 years; they accounted for 50 and 25% of deaths, respectively. About one-third of men and women who died from CVD aged <60 years had consumed alcohol shortly before death. This occurred most frequently among the diagnostic groups 'other acute or subacute cardiac ischaemia', 'atherosclerotic heart disease' and 'cardiomyopathies'. Alcohol was more likely to be found at autopsy in men than in women (odds ratio 1.55; 95% confidence interval 1.14-2.10). No difference was found for those who died from myocardial infarction, cerebrovascular diseases and cardiomyopathies. Of the deceased, <1% had a BAC of ≥ 4 g/l. CONCLUSIONS: A high proportion of subjects who died from CVD in Arkhangelsk consumed alcohol shortly before death. It was highest among males aged 50-59 years. The largest gender difference in mortality, highest absolute number of premature CVD deaths, and the highest proportion of alcohol-positive autopsies occurred among them. Since associations with alcohol consumption varied considerably between the types of CVD diagnoses, this observation should be taken into account when planning future research. Our study does not provide evidence that cardiovascular deaths are misclassified cases of acute alcohol poisoning.

Metabolic syndrome in Russian adults: associated factors and mortality from cardiovascular diseases and all causes.

BACKGROUND: Metabolic syndrome (MetS) is a cluster of four major obesity-related risk factors for cardiovascular disease (CVD). Russia has one of the highest CVD mortality in the world, but its association with MetS remains unknown. Also little is known about factors associated with MetS and its components in Russia. METHODS: Data on 3555 adults aged 18-90 years were collected in a cross-sectional study in 2000. MetS was defined by the International Diabetes Federation (IDF) and National Cholesterol Education Program (NCEP) criteria. Sex-specific associations between the IDF-defined MetS, its components, and life-style, socio-economic factors and laboratory indicators, were analysed using multivariable Poisson regression. Vital status of the study participants was identified by July 2009. Sex-specific associations between MetS and stroke, Coronary Heart Disease (CHD), CVD and all-cause death, were studied by Poisson regression adjusted for age, smoking, alcohol and history of CVDs. RESULTS: After adjustment for all studied factors except BMI, age, serum GGT, C-reactive protein and AST-to-ALT ratio were associated with MetS in both genders. Additionally, MetS was associated with sedentary lifestyle in women and with smoking in men. In the same regression model drinking alcohol 2-4 times a month and consumption of five or more alcohol units at one occasion in men, and drinking alcohol 5 times or more a month in women were inversely associated with MetS. After a 9-year follow-up, MetS was associated with higher risk of death from stroke (RR = 3.76, 95% CI:1.35-10.46) and from either stroke or myocardial infarction (MI, RR = 2.87, 95% CI:1.32-6.23) in men. No associations between MetS and any of the studied causes of death were observed in women. CONCLUSION: Factors associated with MetS in both genders were age, GGT, C-reactive protein, and AST-to-ALT ratio. Moderate frequency of alcohol consumption and binge drinking in men and higher leisure time physical activity in women, were inversely associated with MetS.Positive associations between MetS and mortality were only observed for deaths from stroke and either stroke or MI in men.

Prevalence of the metabolic syndrome and its components in Northwest Russia: the Arkhangelsk study.

BACKGROUND: The metabolic syndrome (MetS) is a cluster of risk factors associated with morbidity from cardiovascular disease (CVD) and associated mortality. Russia has one of the highest CVD mortality rates in the world. However, the prevalence of MetS in Russia remains largely unknown. The aim of this study is to estimate the prevalence of MetS and its components in an urban Russian setting. METHODS: Altogether, 3705 Russian adults aged 18-90 years were enrolled in a cross-sectional study in Arkhangelsk (Northwest Russia). All subjects completed a questionnaire and underwent a physical examination. Blood samples were taken and analyzed in TromsØ, Norway. Three separate modified definitions of MetS were used, namely, the National Education Cholesterol Education Program Adult Treatment Panel III (NCEP), the American Heart Association/National Heart, Lung and Blood Institute (AHA/NHLBI) and the International Diabetes Federation (IDF). To ensure comparability of the findings, the prevalence data were standardized using world and European standard populations and Russian population. RESULTS: The age-standardized (Segi's world standard population) prevalence rates of the MetS among women were 19.8% (95% CI: 18.1-21.5), 20.6% (95% CI: 18.9-22.3) and 23.1% (95% CI: 21.3-24.9) by the NCEP, AHA/NHLBI and IDF criteria, respectively. The corresponding rates for men were 11.5% (95% CI: 10.1-12.9), 13.7% (95% CI: 12.2-15.2) and 11.0% (95% CI: 9.7-12.4). Among subjects with MetS, central obesity was more common among women, while elevated triglycerides and blood glucose were more common among men. Almost perfect agreement was found between the NCEP and AHA/NHLBI criteria (kappa = 0.94). There was less agreement between the used definitions of MetS in men than in women. CONCLUSIONS: While the prevalence of MetS among Russian women is comparable to the data for Europe and the U.S., the prevalence among Russian men is considerably lower than among their European and North-American counterparts. Our results suggest that MetS is unlikely to be a major contributor to the high cardiovascular mortality among Russian men. Further studies of MetS determinants and associated cardiovascular risk are needed for a better understanding of the mechanisms leading to the exceptionally high cardiovascular mortality in Russia.

Addiction and suicidal behavior in acute psychiatric inpatients.

OBJECTIVE: This study aims to evaluate the relationship of alcohol/drug use and effect severities to the degree of suicidality in acutely admitted psychiatric patients. Both degree of substance dependency and degree of substance-induced syndrome were analyzed. In addition, length of stay, involuntary status, and against medical advice discharge status were determined as they related to these variables. METHODS: Structured clinical admissions and discharge ratings were gathered from 10,667 consecutive, single-case individual records, from an urban acute care county psychiatric hospital. RESULTS: Data indicate that of the most severely suicidal group, 56% had substance abuse or dependence, 40% were rated as having half or more of their admission syndrome substance induced, and most had nonpsychotic diagnoses. There was an inverse relationship between degree of substance problem and length of stay. Although these patients more commonly left against medical advice, and were readmitted more frequently, they were less likely to be involuntarily committed. CONCLUSIONS: A large, potentially lethal, and highly expensive subgroup of patients has been characterized, which might be called the "New Revolving Door acute psychiatric inpatient." This group, which uses the most expensive level of care in the mental health system but is substantially addiction related, poses special challenges for inpatient psychiatric units, addiction treatment providers, and health care planners.

C-reactive protein and alcohol consumption: Is there a U-shaped association? Results from a population-based study in Russia. The Arkhangelsk study.

BACKGROUND: Little is known about association between markers of inflammation and alcohol consumption in Russian population where binge drinking pattern is prevalent. METHODS AND RESULTS: C-reactive protein was measured by a highly sensitive particle-enhanced immunoturbidimetric assay (hsCRP) in 1963 men and 1734 women, aged 18-90 years, in a population-based cross-sectional study. Total alcohol consumption consisted mainly of binge vodka intake. A revealed U-shaped association between hsCRP and total alcohol intake was due to high hsCRP levels in ex-drinkers. Ex-drinkers of both sexes were older and reported more diseases than non-abstainers. This U-shaped association became non-significant in both sexes after adjustment for age, BMI, smoking status, diabetes mellitus and cardiovascular medication. When analysis was performed separately only for non-abstainers, hsCRP showed a positive linear association with total weekly alcohol consumption and with weekly vodka consumption in both sexes. CONCLUSIONS: The U-shaped association between hsCRP and weekly alcohol consumption was due to higher hsCRP levels in ex-drinkers than in non-abstainers. Factors other than the current level of alcohol consumption might be responsible for high hsCRP levels in ex-drinkers. When abstainers were excluded from analyses, the results indicated a pro-inflammatory effect of binge alcohol consumption in non-abstainers.

Social and lifestyle determinants of depression, anxiety, sleeping disorders and self-evaluated quality of life in Russia--a population-based study in Arkhangelsk.

BACKGROUND: The paper investigates social and lifestyle determinants of depression, anxiety, sleeping disorders and self-evaluated low quality of life in a population sample from the northwest of Russia. METHODS: Altogether 1968 men and 1737 women aged 18-90 years participated in a population-based study in Arkhangelsk, Russia, in the period 1999-2000. Depression, anxiety, and sleeping disorders were evaluated by a questionnaire with the formulations that have been previously used in population studies in Northern Norway. Alcohol dependence was diagnosed by the Alcohol Use Disorders Identification Test (AUDIT). Quality of life was evaluated by a 10-score Cantril Ladder. A score lower than five was defined as low quality of life. Relations between depression, anxiety, and sleeping disorders and socioeconomic/lifestyle factors were tested by logistic regression analyses. RESULTS: Women reported significantly higher prevalence of depression, anxiety and/or sleeping disorders than men: 68.7% and 32.3%, respectively. Depression, anxiety, sleeping disorders and low quality of life were positively associated with self-evaluation of nutrition as "poor", low consumption of food, and with low-paid professional status. Depression and sleeping disorders were associated with smoking, hazardous level of alcohol drinking and alcohol dependence. Anxiety and low quality of life were associated with alcohol dependence. Depression, anxiety, sleeping disorders and low quality of life had a strong positive association with circulatory diseases and gastrointestinal diseases, the association remained significant after adjustment for smoking and alcohol variables. CONCLUSIONS: A considerable part of the examined Russian population experienced depression, anxiety, and sleeping disorders that were strongly positively associated with poor nutrition, low socioeconomic status and adverse health behaviors (alcohol use disorders, smoking).

Alcohol consumption and its relation to risk factors for cardiovascular disease in the north-west of Russia: the Arkhangelsk study.

BACKGROUND: To explore indicators and levels of alcohol consumption in a Russian population, and to elaborate these in relation to risk factors for cardiovascular disease. METHODS: A total of 1963 men and 1734 women, aged 18-75 years, consecutively recruited at their compulsory annual medical check-up at the Semashko outpatient clinic, Arkhangelsk, participated in a cross-sectional health survey. The survey comprised a physical examination, a six-page questionnaire on health and lifestyle, and blood tests. RESULTS: Gamma-glutamyltransferase (GGT) levels in both sexes were more than twice as high as found in comparable studies. Elevated GGT-levels were 4-5 times more frequent than found in Norwegian studies. Alcohol Use Disorder Identification Test (AUDIT) identified up to 75% of male workers and 47% of female workers as hazardous or harmful alcohol drinkers. The traditional risk factors for cardiovascular disease were significantly higher in subjects with a high level of GGT. CONCLUSION: The findings indicate an extremely high level of alcohol consumption in this population. Elevation in GGT was significantly associated with increased risk for cardiovascular disease.

Long-term effect of brief intervention in at-risk alcohol drinkers: a 9-year follow-up study.

AIMS: In 1986, 338 men and women attending a general population screening study were identified as at-risk alcohol drinkers and randomly assigned into three groups. Two groups received slightly different, brief interventions; a third group served as control. After 1 year there was a 50% reduction in alcohol intake in the intervention groups and a 20% increase in the control group. Controls then received advice to reduce their drinking. This study evaluates outcomes 9 years after these interventions. METHODS: In a survey in the same city in 1995 (over 27 000 participants), 247 subjects (73.1%) from the 1986 study, were re-assessed. Serum gamma-glutamyltransferase (GGT) was examined and compared with values in 1986. A 'pseudo-control' group was established to compare 'treated' and 'untreated'. RESULTS: After 9 years, the original study groups displayed significant mean reduction in GGT. The reductions achieved in the three groups did not significantly differ from each other. However, the reductions were significantly greater than that in the 'pseudo-control' group. CONCLUSION: The impact of brief intervention appears to be long lasting. At 9 years follow-up, the at-risk drinkers displayed GGT values close to that of the background population.

Factors behind the increase in cardiovascular mortality in Russia: apolipoprotein AI and B distribution in the Arkhangelsk study 2000.

BACKGROUND: Cardiovascular mortality is markedly higher in Russia than in Western Europe and the US. Little is known about indicators of atherosclerotic risk in the Russian population. To our knowledge, this is the first study of apolipoprotein (apo) AI and B in Russia based on the WHO-IFCC standard. METHODS: We measured apo AI and B by immunoturbidimetric assay in 3694 men and women from Arkhangelsk, Russia, in 1999-2000. RESULTS: The age-related distribution of apo B was similar to that in other countries, whereas the apo AI profile was different. For men > or = 20 years, apo AI was considerably higher than in studies from other countries. Women had also relatively high apo AI concentrations, although the difference was not as pronounced as in men. The apo AI concentration was positively associated with age and lifestyle variables such as alcohol consumption and physical activity, and negatively associated with body mass index and self-reported myocardial infarction. gamma-Glutamyltransferase was positively associated with apo AI in both sexes. CONCLUSIONS: The apparently favorable apolipoprotein profiles contrast with official death statistics indicating high cardiovascular mortality in Russia. High apo AI might indicate excessive alcohol consumption.