Determinants of Cardiovascular and All-Cause Mortality in Northwest Russia: A 10-Year Follow-Up Study
Introduction
Cardiovascular and all-cause mortality in Russia are among the greatest in Europe. The age-standardized cardiovascular death rates are greater in all age groups of Russian men and women than the corresponding average estimates for the 27 countries of Western Europe (Eur-A). The difference in working ages is particularly large: cardiovascular death rates in Russia are nine times greater in men and six times greater in women ages 30–44 years and seven times greater in men and women ages 45–59 years than the European average estimates (1). The difference in life expectancy between Russia and other industrialized countries is primarily explained by the increased death rates in these age groups. The total number of deaths exceeded the number of births by almost 1 million in 2000 and by 850,000 in 2005 (2).
There is also a large difference in mortality between men and women in Russia, resulting in gender imbalance with a male-to-female ratio of 0.87 (3), which is among the lowest in the world. The ratio rapidly decreases with age; the male-to-female ratio at 60 years or more was less than 0.5 in 2006 (4), whereas the corresponding ratio for Norway was 0.8 the same year (5). High premature mortality from cardiovascular diseases and external causes among Russian men is the main cause of the large gap in life expectancy between men and women (6). In 2003, life expectancy was 58.6 years for men and 71.8 years for women. Since then, life expectancy in 2009 increased to 62.8 and 74.7 years for men and women, respectively (7), although it is still much lower than in Europe.
Despite high cardiovascular mortality, the authors of population-based studies from Russia have failed to reveal high levels of conventional risk factors, taken either individually 8, 9 or combined as a risk score 10, 11, 12. Instead, hazardous alcohol consumption was suggested as the main determinant of high cardiovascular (13) and all-cause mortality 14, 15 among Russian men. Other risk factors, such as low socioeconomic status 16, 17, unhealthy lifestyle (18), and psychosocial distress, have also been studied in association with cardiovascular mortality (19). It was also suggested that cardiovascular mortality is artificially inflated because of misattribution of alcohol poisonings to cardiovascular deaths (6). However, the authors of another study have not supported this finding (13).
Only two longitudinal studies on factors associated with cardiovascular and all-cause mortality have been performed in Russia. The first included only men ages 40–59 years and was performed during the 1980s in Moscow and St. Petersburg (17). The other included men and women aged 25–64 years, and the authors collected data during the 1990s in Western Siberia. When one takes into account the vast distances and ethnical and cultural heterogeneity, there is still a need for more longitudinal studies in Russia.
The principal aim of this study was to assess the influence of both conventional and novel risk factors (apolipoproteins, C-reactive protein, gamma glutamyl transferase [GGT], serum albumin, and alcohol intake) on cardiovascular and all-cause mortality by gender in a typical Northwestern Russian town.
Section snippets
Methods
This study was approved by the Regional Ethics Committee in Tromsø, Norway, and verbal informed consent was obtained from all participants. A prospective cohort study was conducted in Arkhangelsk, Northwest Russia. Altogether, 1966 men and 1738 women ages 18 years or older who attended one outpatient clinic in 1999–2000 comprised the cohort. The response rate was 98.9%. The participants underwent a medical examination, filled out a 6-page questionnaire, and had blood drawn for laboratory
Results
Baseline characteristics of the cohort by gender are presented in Table 1. Men smoked more and had more hazardous patterns of alcohol consumption. Women scored less than men on the AUDIT and CAGE tests. The proportion of participants that were single and with university education was greater in women. The means of TC levels, glycated hemoglobin levels, and prevalence of obesity (BMI ≥ 30) were greater among women.
Altogether, 242 subjects (147 men and 95 women) died by October 2010 during the
Main Findings
This was the first cohort study from Russia in which a significant dose–response association between hazardous alcohol consumption and the risk of cardiovascular death was found in women. A consumption of at least 80 g of alcohol (250 mL of vodka) monthly was associated with a 5-fold increased risk of cardiovascular death compared with the reference group. Binge drinking (a consumption of ≥5 AU on one occasion) was associated with a 3-fold risk compared with abstainers. A positive answer on one
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