Search

Introduction: Protecting and promoting health of employees through the implementation of measures to correct risk factors in the workplace is an important mechanism for achieving the strategic goal of increasing healthy life expectancy. Aim: To develop and pilot a package of tools for planning and implementing workplace well-being programs. Methods: In 2019, the federal project "Strengthening Public Health" was launched, within the framework of which model corporate programs were developed and published, including measures aimed at correcting smoking, poor nutrition, insufficient physical activity, psycho-emotional overstrain and excessive alcohol consumption. A set of tools has been developed to facilitate the development and implementation of workplace well-being programs, maximally focused on the needs of a particular enterprise. The set of tools include a questionnaire for the employer and a questionnaire for employees. Results: The set of tools has been tested by mailing to the chief freelance specialists in medical prevention of 28 regions of the Russian Federation, who responsible for the implementation of workplace well-being programs in the regions. Five hundred and eighty-eight completed questionnaires were received (among them 35 from employers, and 553 from employees). The analysis of the piloting results allowed us to make a number of adjustments to the questionnaires and confirm the importance of studying workers' presentiment in planning workplace well-being programs. The improved questionnaires are available online at https://atriya.gnicpm.ru/ . Conclusion: We developed the set of instruments which must be useful for implementation of the workplace well-being programs. Surveys of employers contribute to obtaining a snapshot of the attitudes and priorities of employers in the region to plan targeted measures to stimulate the implementation of workplace well-being programs at the regional level. Questionnaires for employees can be used for an indepth assessment of the priorities on the concrete workplace and development of a targeted program to the needs of a particular enterprise.

Background: The prevalence of obesity in Russia has increased sharply since the mid-1990s. Interestingly, the prevalence of obesity in Japan is lower than in many Western countries. Japan has implemented different types of weight control programs using a smart device to monitor patients remotely. New health promotion methods from Japan are now being used in Russia. The Russian-Japanese “Tackle Obesity and Metabolic Syndrome Outcome by Diet, Activities and Checking Body Weight Intervention” (RJ-TOMODACHI) study aims to evaluate a preventive intervention using Japanese health monitoring technology in reducing excess body weight, compared with standard care, in Russia. Methods and Results: The trial is a single-center, 3-armed, parallel group randomized controlled trial conducted among overweight/obese adults. It has been designed to compare the effectiveness of 2 newly developed interventions against standard care for 6 months. Participants in the low- and high-intensity intervention groups will have 3 and 6 consultations over the study period, respectively. In all, 260 adults were screened at baseline; 65 did not participate in the trial for various reasons. The remaining 195 people were randomized into 3 groups (high-intensity intervention, n=73, low-intensity, n=73; standard care group, n=49). Conclusions: The trial protocol has been designed so that the methodology can be adapted for use in Russia.

Russia belongs to countries with a high prevalence of arterial hypertension (AH), which is the main cause of premature death in the Russian population. The level of blood pressure (BP) is controlled in less than a third of patients, which may be due to poor adherence to medical recommendations and irregular medication. The manuscript provides a review of studies evaluating the effectiveness of measures to improve adherence to antihypertensive therapy (AHT).Aim. To prepare a systematic review of Russian studies to assess the effectiveness of measures to increase adherence to AHT, to determine/describe the main directions of the intervention and the methodological level.Material and methods. The search for full-text articles on adherence to AHT published in Russian in the period from 2000 to 2019 was carried out in the main Russian and international electronic databases eLIBRARY.ru, Embase, Russian Medicine, MEDLINE. Of the 563 publications found, 20 were included in the review.Results. In 14 studies, adherence was assessed using the 4-item Morisky Medication Adherence Scale (MMAS-4), other studies used bespoke questionnaires or pill counts. Two studies examined factors associated with adherence. The observation period was up 6 weeks to 12 months, the number of participants is 30-2435 people. A higher adherence was noted in women, people over 50 years old, with higher education, working, with concomitant diabetes mellitus and a history of myocardial infarction. Patient education was effective interventions to improve adherence (in particular, in studies, improvement on the MMAS-4 from 1.8 to 3.9 points, p=0.0002 or from 2.80 to 3.79 points, pConclusion. The most effective ways to improve adherence are patient education and the use of drugs fixed combinations. In most studies, subjective methods of adherence assessing were used.

The prevalence of hypertension in the Russian Federation (RF) has been growing in recent years, which causes significant socio-economic burden. Aim . To evaluate economic burden of hypertension in the RF in 2016 including direct costs and economic losses caused by decreased labor efficiency. Material and methods . The calculation included the prevalence of hypertension in the RF and the relative risk of hypertension for cardiovascular diseases (CVD) (including stroke and coronary heart disease), chronic obstructive pulmonary disease (COPD), type 2 diabetes mellitus (DM2), cancer of the trachea, bronchi and lungs, breast and prostate. The calculation included Russian statistics on noncommunicable diseases (NCD) for 2016. Statistical analysis – calculations were performed by Microsoft Excel 10.0 Results . Population attributable risk (PAR) of hypertension in mortality from all CVDs was 34%, in morbidity – 30%, including PAR in mortality from coronary heart disease and stroke 38% and 60%, respectively; the same in morbidity – 28% and 14%, respectively. For DM2 PAR in mortality was 1%, in morbidity – 18%. For COPD PAR in morbidity was ≈24%. PARs in morbidity and mortality for lung, bronchi and trachea cancer were ≈12%, for prostate cancer ≈3%, and for breast cancer 6%. Direct medical costs associated with the analyzed NCDs exceeded 84 billion rubles, direct non-medical costs – over 1.5 billion rubles. In the structure of economic burden, the main part was associated with gross domestic product (GDP) losses due to premature mortality due to hypertension. Conclusion . The total economic burden associated with hypertension in 2016 amounted to 869936 million rubles that corresponded to 1% of Russian GDP.

Aim: to study the impact of anti-smoking measures within the Federal Law N 15-FL on the number of hospitalization of patients with acute cardiovascular conditions in the Samara and Arkhangelsk Regions and the Chuvash Republic. Methods: Monthly hospitalization rates for acute myocardial infarction and unstable angina were analyzed usinginterrupted time series by means of the STATA 15.0 software package, which includes the ITS module in three regions of the Russian Federation from 01.01.2012 to 31.12.2017, and by gender (men and women) and age (0-59 years and 60 years and older). Results. Reduction in hospital incidence after each stage of the anti-tobacco policy was obwerved in two of the three regions. In the Samara Region we observed a reductionby 16.3 % in 2013 and by 18.4 % in 2014 for unstable angina and by 10.6 % in 2013 and by 10.5 % in 2014 for acute myocardial infarction, respectively. In the Arkhangelsk Region the number of hospitalizations decreased by 14.3 % in 2013 and by 14.4 % in 2014 for unstable angina, and by 7.5 % in 2013 and by 7.7 % in 2014 for acute myocardial infarction. No significant decrease was observed in the Chuvash Republic. Gender stratification revealed a decrease in the hospital incidence of acute myocardial infarction and unstable angina in women in the Samara and Arkhangelsk Regions, and in men - only in the Samara region. The percentage of reduction in unstable angina was higher than in the acute myocardial infarction. An analysis of age groups in the Samara Region showed a decrease in the number of hospitalizations for acute myocardial infarction and unstable angina in both age groups, and in the Arkhangelsk Region only in people over 60 years of age. Conclusions: anti-tobacco legislation introduced in Russia in 2013 and 2014 is likely to have contributed to a decrease in the number of hospitalizations for acute cardiovascular diseases, but the effect varied across genders and age-groups.

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 (pConclusion. 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.

Aim. To evaluate the structure of multimorbidity, outcomes and the potential effect of dapagliflozin in patients with a combination of cardiovascular disease (CVD) and type 2 diabetes in Russian clinical practice.Material and methods. The data of 10 registries with the inclusion of 22957 people, including 4370 with type 2 diabetes in 6 regions of the Russian Federation, were analyzed. Scenarios for reducing mortality from all and cardiovascular causes and hospitalizations for CVD were simulated among groups of patients with diabetes combined with myocardial infarction (MI) and diabetes combined with heart failure with reduced ejection fraction (HFrEF) based on data from the Federal Registry of diabetes, the RECVASA and REGION registries, relative risks associated with analyzed adverse events from the DECLARE study.Results. When analyzing the data of all 22957 patients with CVD included in the registries, it was found that the proportion of patients with comorbid diabetes was on average 19.0%. Of the various diagnoses of CVD, the combination with diabetes was most often recorded in patients that had MI – 2.0%, stroke – 22.5% and heart failure – 24.0%. In the RECVASA registry (Ryazan) for 4 years of follow-up of 699 patients with a combination of CVD and diabetes mortality from all causes was 20.9%, and from cardiovascular causes – 15.6%. The simulated number of potentially prevented cardiovascular deaths with dapagliflozin taking in patients with diabetes combined with MI for 4 years in Russia will be 39124, and 37440 cardiovascular hospitalizations. The number of potentially preventable deaths from all causes among patients with diabetes combined with HFrEF will be 4543, cardiovascular deaths in 1995, and the number of prevented cardiovascular hospitalizations will be 7072.Conclusion. According to data from the registries of CVD patients in 6 regions of the Russian Federation, it was revealed that in real clinical practice the proportion of people with comorbid diabetes averaged 19% both at the outpatient and hospital stages. These subgroups of multimorbid patients have both the highest risk of developing fatal and non-fatal cardiovascular complications, and the largest number of indications for prescribing drugs that affect the prognosis due to effects on both CVD and diabetes.

Aim. To study the prevalence of familial hypercholesterolemia (FH), the characteristics of the clinical features and treatment of the disease in selected regions of the Russian Federation, this article describes the design and initial characteristics of patients included in the study.Material and methods. The study participants were selected among those included in the study “Epidemiology of cardiovascular risk factors and diseases in the regions of the Russian Federation” (ESSE-RF) in different regions of the Russian Federation. The study included individuals with lowdensity lipoprotein cholesterol (LDL-C) levels >4.9 mmol/l or LDL-C levels >1.8 mmol/l, but ≤4.9 mmol/l during statin therapy, according to the data obtained in the ESSE-RF study. These persons are invited for examination and questioning by experts in the field of FH diagnostics. On the basis of the survey data and provided medical documentation, the following information is collected: age, sex, smoking status, presence of hypertension, history of coronary artery disease, stroke, atherosclerosis of cerebral and peripheral arteries, LDL-C level, type, volume and duration of lipid-lowering therapy throughout life, presence and dates of secondary causes of hyperlipidemia, information about the family history of development of early cardiovascular diseases and atherosclerotic diseases, increased levels of LDL-C in relatives of the 1st and 2nd degree of kinship. All patients are examined for the presence of tendon xanthomas (Achilles, metacarpal, elbow, knee tendons) and Corneal arcus. During the visit, blood is taken for subsequent biobanking, measurement of current blood lipid levels, elimination of secondary forms of hypercholesterolemia (for subsequent determination of liver enzymes, thyroid stimulating hormone) and genetic testing. The diagnosis of FH is based on Dutch Lipid Clinical Network Criteria (DLCN). Besides, all participants in the study are tested for compliance with the diagnosis of FH according to Simon Broome criteria. All patients with a definite or probable diagnosis of FH according to DLCN or Simon Broome criteria are subjected to ultrasound examination of carotid, femoral arteries and heart and molecular genetic testing for LDLR, APOB and PCSK9 gene variants.Results. Out of 16 360 participants of the ESSE-RF study in 10 regions, 1787 people (10,9%) met the criteria for inclusion in this study. Among them, men accounted for 35.4%, of which 1150 (7%) patients had a LDL-C level >4.9 mmol/l and 637 (3,9%) had a LDL-C level from 1,81 mmol/l to 4.9 mmol/l during lipid-lowering therapy. When compared to the original cohorts of participants from the 10 regions as compared to 3 previously surveyed regions and selected sub-groups within these cohorts we observed significant differences in several parameters such as age, total cholesterol level, triglycerides, LDL-C, the frequency of cardiovascular diseases, that may indicate regional differences in FH prevalence.Conclusion. The analysis of clinical data of the participants of the ESSE-RF study shows that more than 10% of individuals require an additional examination to verify the FH diagnosis, and regional differences in the FH prevalence are possible.

Intensive investigation of cardiovascular disease (CVD) risk factors (RFs), both traditional (smoking, dyslipidemia, diabetes, etc.) and non-traditional, which are a component of the so-called exposome, as well as their non-drug and drug correction provide wide prospects for effective cardiovascular prevention. Prevention becomes the dominant trend in cardiology and in medicine in general. The aim of the article was to describe cardiovascular prevention in young, middle, elderly and senile age. Due to the multifaceted nature of cardiovascular RFs, an integrated biopsychosocial approach, individual and population-based prevention, cumulative risk assessment of all CVDs, intersectoral collaboration and the involvement of decision-makers, are key to the success and effectiveness of prevention measures. It is important to note that, on the one hand, preventive measures should be started as early as possible due to cumulative effect of RFs, on the other hand, most of the preventive interventions for CVD are extremely relevant at all life stages.

Introduction 24-hour movement behaviours (physical activity, sedentary behaviour and sleep) during the early years are associated with health and developmental outcomes, prompting the WHO to develop Global guidelines for physical activity, sedentary behaviour and sleep for children under 5 years of age. Prevalence data on 24-hour movement behaviours is lacking, particularly in low-income and middle-income countries (LMICs). This paper describes the development of the SUNRISE International Study of Movement Behaviours in the Early Years protocol, designed to address this gap. Methods and analysis SUNRISE is the first international cross-sectional study that aims to determine the proportion of 3- and 4-year-old children who meet the WHO Global guidelines. The study will assess if proportions differ by gender, urban/rural location and/or socioeconomic status. Executive function, motor skills and adiposity will be assessed and potential correlates of 24-hour movement behaviours examined. Pilot research from 24 countries (14 LMICs) informed the study design and protocol. Data are collected locally by research staff from partnering institutions who are trained throughout the research process. Piloting of all measures to determine protocol acceptability and feasibility was interrupted by COVID-19 but is nearing completion. At the time of publication 41 countries are participating in the SUNRISE study. Ethics and dissemination The SUNRISE protocol has received ethics approved from the University of Wollongong, Australia, and in each country by the applicable ethics committees. Approval is also sought from any relevant government departments or organisations. The results will inform global efforts to prevent childhood obesity and ensure young children reach their health and developmental potential. Findings on the correlates of movement behaviours can guide future interventions to improve the movement behaviours in culturally specific ways. Study findings will be disseminated via publications, conference presentations and may contribute to the development of local guidelines and public health interventions. Funding Agencies|American Council on Exercise, USA; Beijing Health System High Level Talents Training Project, China [2015-3-88]; Biomedical Research Foundation, Dhaka, Bangladesh [BRF-19-01]; Canadian Institutes of Health Research Frederick Banting and Charles Best Canada Graduate Scholarship (CGS-M)Canadian Institutes of Health Research (CIHR); Canadian Institutes of Health Research Planning and Dissemination GrantCanadian Institutes of Health Research (CIHR) [155265]; Civilian Research Development Foundation (CRDF) Global [OISE-20-66864-1]; Department of National Planning and Monitoring, PNG Government [02704]; Early Start, University of Wollongong, Australia; Faculty of Health Sciences at the University of the Witwatersrand, Johannesburg, South Africa; Fogarty International Center (FIC) of the National Institutes of Health [D43 TW010137]; Geran Universiti Penyelidikan (GUP), Universiti Kebangsaan Malaysia [GUP-2018-142]; Global Challenges Program, University of Wollongong, Australia [888/006/497]; Harry Crossley Foundation, South Africa; National Institute of Education-Ministry of Education, Singapore [OER 04/19 TWP]; Pham Ngoc Thach University of Medicine, Vietnam [1319/QD-TDHYKPNT]; Sasakawa Sports Research Grant, Sasakawa Sports Foundation, Japan [190A2-004]; Stella de Silva Research grant from Sri Lanka College of Paediatricians, Sri Lanka; The DST-NRF Centre for Excellence in Human Development at the University of Witwatersrand, Johannesburg, South Africa; International Society of Behavioral Nutrition and Physical Activity, Pioneers Program (ISBNPA-2021); The University Research Coordination Office of the De La Salle University, Philippines [29 IR S 3TAY192021]; Universidad de La Frontera Research Directorate, Chile [DI20-0093, DFP19-0012, DI20-1002]; WHO European Office for Prevention and Control of Noncommunicable Diseases

Introduction The Russian Federation reported one of the largest number of COVID-19 infections. Major restrictions (social distancing, travel bans, event cancellation, changes to work practices) were introduced on the 28th March 2020 with the level of restrictions varied depending on the epidemiology of the virus from region to region. Purpose is to estimate the impact of COVID-19 on sleep among adults in Russia. Methods The NMRC TPM conducted a national online-survey ‘Study of the impact of restrictions on physical activity of the population in self-isolation due to COVID-19'. Data were collected during the period of tightest restriction through the country between 26 April 2020 and 6 June 2020. A link on the online survey was distributed through the regional center of public health. Sleep quality was assessed by comparing the period before the COVID-19 and the last 7 days. Results In spring 2020, 2432 completed questionnaires from 62 regions of Russia were received. There was a predominance of female respondents (86.6%), the average age was 33.6±14.9 years and 38.2±13.1 years for men and women, respectively. The majority of completed questionnaires were received from the Republic of Tatarstan (n = 804), Irkutsk (n = 474), Sakhalin (n = 225) and Tver regions (n = 152). Compare pre-COVID to during COVID there was a significant decline in the number of days per week participants reported not getting enough sleep (3.21±2.44 to 2.86±2.57; p < 0.001) and participants also reported an increase in the number of days per week they had trouble falling asleep (1.70±2.24 to 2.13±2.48; P < 0.001). The number of days participants waking up earlier than wanted before and during the pandemic has not changed (2,6 Đ, 2,59 (p < 0,5)). Conclusions Effective health promotion strategies directed at adopting or maintain positive health related behaviors such as targeted social media messaging and balanced media reporting, should be used to maintain healthy sleep during these unprecedented times. Key messages Changes in sleep quality during COVID-19 identified as a result of the online-survey ‘Study of the impact of restrictions on physical activity of the population in self-isolation due to COVID-19'. Effective health promotion strategies directed at adopting or maintain positive health related behaviors should be used to maintain healthy sleep during COVID-19 pandemic.

Despite treatment advances, the prognosis of patients with both primary and secondary pulmonary hypertension (PH) remains unfavorable. The increased activity of the sympathetic nervous system is one of the universal mechanisms involved in the PH pathogenesis. Pulmonary artery denervation is a novel minimally invasive pathogenetic method of PH treatment. The denervation procedure is mainly implemented by using radiofrequency ablation of the pulmonary trunk, where most sympathetic nerve fibers are located. In this article we present an overview and analysis of the present state, results of various experimental and clinical studies, as well as clinical experience. The results of studies demonstrated the safety of endovascular surgery and its beneficial effect on both hemodynamic and clinical parameters.

Aim. To assess the dynamics of blood pressure (BP) and determine the predictors of the hypotensive effect after carotid artery stenting (CAS).Material and methods. The analysis included 99 patients who underwent CAS in a period of March 2014 and May 2016. Inclusion criteria: (1) the presence of 50% symptomatic or 70% asymptomatic stenosis of the carotid artery (according to NASCET criteria), (2) follow-up for at least 1 year, (3) measurement and recording of BP at four points: 24 hours before surgery, 1 hour, 24 hours and 12 months after surgery. Results. According to office measurement of BP, the average systolic/diastolic pressure was 117,11/60,75, 119,73/60,75, 134,75/70,48 mm Hg after 1 hour, one day and 12 months after the intervention, respectively. In comparison with the average numbers of BP before the intervention, 148,13/89,52 mm Hg there was a significantly significant decrease in BP levels after CAS (pConclusion. The obtained results indicated the need for more thorough conservative postoperative management, especially for patients with a dissociated circle of Willis. It is also necessary to achieve the target blood pressure values by individualized correction of antihypertensive therapy.

Objective: To evaluate the prevalence and geographic distribution of overweight and obesity in Russian adults aged 25–64 years as well as the association between chronic risk factors and obesity. Methods: Data were obtained from the survey “Epidemiology of Cardiovascular Diseases and Its Risk Factors in Some Regions of the Russian Federation” (ESSE-RF). This is a large cross-sectional multicenter population-based study that included interviews and medical examination (anthropometry, blood pressure [BP] measurement, and laboratory analysis) applied in 2012–2014. Results: The sample included 20,190 adults (response rate 79.4%) aged 25–64 years. Approximately one third of participants (30.3%) had obesity and another third (34.3%) were classified as overweight. BMI increased with age in both sexes. The prevalence of obesity between regions ranged from 24.4 to 35.5%. Overweight and obesity levels decreased with higher education (men only). Overall obesity rates were higher in rural than urban populations, but rates of overweight were similar in rural and urban populations. Participants with obesity were more likely to have BP > 160/100 mm Hg (odds ratio > 2.0) and also > 140/90 mm Hg, raised blood glucose, and high triglycerides. Conclusion: The prevalence of overweight and obesity in Russian adults aged 25–64 years is not evenly distributed geographically, but it is comparable to that of other European countries. Individuals with obesity were also more likely to have indicators of poor cardiovascular and metabolic health.

Background The aim of this study was to evaluate the impact of COVID-19 on the levels of physical activity (PA) and sleep and to examine specific COVID-19 factors that may be associated with changes in PA and sleep among adults in Russia. Methods Cross-sectional data were collected during the period of tightest restrictions between 26 April 2020 and 6 June 2020. Eligible participants included all Russian adults aged 18 years and over. Participants reported their sleep patterns and problems, frequency and duration of walking, moderate- and vigorous-intensity PA, and muscle strengthening activities before COVID-19 and during the past 7 days. Access to an outdoor green space and fitness centres, use of online resources, adherence to self-isolation recommendations and other preventive measures from Ministry of Health were self-reported. Results The sample included 2432 participants from 62 regions, 83% of who were female. There was a significant decline in the number of days per week participants reported not getting enough sleep (3.21 ± 2.44 to 2.86 ± 2.57; P P P P Conclusion Compared with before COVID-19, PA and sleep hygiene were adversely affected during COVID-19. Awareness of factors associated with these declines will assit policymakers in developing strategies to mitigate the negative lifestyle behaviours that have manifested during the COVID-19 confinement.

Background The insufficient consumption of fruit and vegetable (F&V) is important contributors to main non-communicable diseases (NCDs). Russia lags behind many countries in the world in per capita consumption of F&V. A growing number of countries have implemented subsidies to address the growing burden of dietary-related diseases. The purpose of the study is to assess the potential social and economic impact on mortality and morbidity due to main NCDs of policy to subsidies F&V in Russia. Methods Using a population model of dietary-related diseases and health care costs, we simulated the effect of 10% subsidy on F&V, over the 15 years of the Russian population. We estimated cardiovascular diseases (CVD), diabetes and cancers cases prevented, health-related costs, and incremental cost-effectiveness ratios. Baseline prevalence of the risk factor was derived from the Russian epidemiology survey. Results Subsidies aimed at reducing the price of F&V by 10% can lead to an increase in the consumption of F&V by about 14%, and thereby prevent 37 064 deaths, the projected economic effect due to the prevented deaths will amount to 10.7 billion rubles over 15 years. The number of prevented cases of CVD will be 28 881, type 2 diabetes - 580 cases, cancer - 4025 cases. When calculating the economic effect for the analyzed period, the prevented medical costs for CVD will amount to 147.9 million rubles, for cancer - 86.6 million rubles, for type 2 diabetes - 3 million rubles. The implementation of this measure in the Russian population will allow to “save” 221.6 million rubles related to the payment of disability benefits from the main NCDs and 1.2 billion rubles due to the prevented loss of GDP from disability over 15 years. Thus, the cumulative forecasted effect of this measure in the Russia over 15 years will amount to 11.2 billion rubles. Conclusions The modelling illustrates the potentially large social and economic benefits of subsidies on F&V for improving population health. Key messages The insufficient consumption of fruit and vegetable (F&V) is important contributors to main non-communicable diseases (NCDs). The modelling illustrates the potentially large social and economic benefits of subsidies on F&V for improving population health.

Background Cardiovascular disease (CVD) mortality is substantially higher in Russia than in neighbouring Norway. We aimed to compare blood pressure- and lipid-lowering medication use and proportion meeting treatment targets between general population samples in the two countries in those with CVD and diabetes. Methods The study population was adults aged 40–69 years reporting a diagnosis of myocardial infarction (MI), stroke and/or diabetes participating in cross-sectional population-based studies in Russia (Know Your Heart (KYH) 2015–18 N = 626) and Norway (The Tromsø Study 2015–16 (Tromsø 7) N = 1353). Reported medications were coded according to the 2016 WHO Anatomical Therapeutic Chemical Classification system. Treatment targets were defined using the Joint European Societies guidelines for CVD prevention in clinical practice (2016). Results Age- and sex-standardized prevalence of use of lipid-lowering medications was higher in Tromsø 7 for all three conditions with a disproportionately large difference in those reporting MI (+ 48% (95% CI 39, 57%)). Proportion meeting treatment targets for LDL cholesterol was poor in both studies (age- and sex-standardized prevalence of control KYH vs Tromsø 7: MI 5.1% vs 10.1%; stroke 11.6% vs 5.8%; diabetes 24.9% vs 23.3%). Use of antihypertensive medication was higher in KYH for stroke (+ 40% (95% CI 30, 50%)) and diabetes (+ 27% (95% CI 19, 34%)) groups but approximately equal for the MI group (− 1% (95% CI -1, 1%)). Proportion meeting blood pressure targets was lower in KYH vs Tromsø 7 (MI 51.8% vs 76.3%; stroke 49.5% vs 69.6%; diabetes 51.9% vs 63.9%). Conclusions We identified different patterns of medication use in people with CVD and diabetes. However despite higher use of lipid-lowering medication in the Norwegian study treatment to target for total cholesterol was poor in both Russian and Norwegian studies. In contrast we found higher levels of use of antihypertensive medications in the Russian study but also that less participants met treatment targets for blood pressure. Further work should investigate what factors are responsible for this seeming paradox and how management of modifiable risk factors for secondary prevention could be improved.

Objective To study the prevalence of cardiovascular (CV) risk factors (RFs) in the rural population of the Chui region of Kyrgyzstan (Central Asia). Methods The sample was representative of the population in terms of age and sex and included at least 10% of the population aged 18-65 y. Of the 1,672 people included in the cohort, 1.330 people responded to the invitation (79.5% of the total sample population). All study participants were interviewed using standardized questionnaires and examined by a cardiologist. Blood pressure (BP), weight, height, waist circumference (WC), fasting serum glucose, and fasting lipid level were measured. Results The prevalence of major CV RFs in the examined sample was as follows: arterial hypertension 34.1%, obesity 25.7%, and abdominal obesity 52.3%; the factors were significantly more prevalent in women (68.2%) and increased with age. The frequency of lipid metabolism disorders was 88.4% in the examined subjects, and an increased level of low-density cholesterol (70.5%) was common. Hypodynamia was detected in 15.6% of the subjects, diabetes mellitus in 3.76%, and a family history of cardiovascular disease was present in 34.8% of the examined subjects. The frequency of smoking was 24.6% and was significantly higher in men (46.9%). Conclusion Abdominal obesity, followed by hypercholesterolemia and arterial hypertension were the most common RFs among the rural population of the Chui region of Kyrgyzstan. Smoking was the most common RF among men. The prevalence of traditional CV RFs, except smoking, increased with age.

ObjectiveRussia has one of the highest cardiovascular mortality rates. Modernisation of the Russian health system has been accompanied by a substantial increase in uptake of percutaneous coronary intervention (PCI), which substantially reduces the risk of mortality in patients with acute ST-elevation myocardial infarction (STEMI). This paper aims to describe contemporary Hospital treatment of acute STEMI among patients in a range of hospitals in the Russian Federation.MethodsThis study used data from a prospective observational cohort of 1128 suspected patients with myocardial infarction recruited in both PCI and non-PCI hospitals across 13 regions and multiple levels of the health system in Russia. The primary objective was to examine the use of reperfusion strategies in patients with STEMI.ResultsAmong patients reaching PCI centres within 12 hours of symptom onset, the vast majority received angiography and PCI, regardless of age, sex and comorbidity, in line with current European Society of Cardiology guidelines.ConclusionPatients reaching Russian hospitals are very likely to receive appropriate treatment, although performance varies. The best hospitals can serve as beacons of good practice as PCI facilities continue to expand across Russia where geography allows.

BackgroundThe Russian Federation has very high cardiovascular disease (CVD) mortality rates compared with countries of similar economic development. This cross-sectional study compares the characteristics of CVD-free participants with and without recent primary care contact to ascertain their CVD risk and health status.MethodsA total of 2774 participants aged 40–69 years with no self-reported CVD history were selected from a population-based study conducted in Arkhangelsk and Novosibirsk, Russian Federation, 2015–2018. A range of co-variates related to socio-demographics, health and health behaviours were included. Recent primary care contact was defined as seeing primary care doctor in the past year or having attended a general health check under the 2013 Dispansarisation programme.ResultsThe proportion with no recent primary care contact was 32.3% (95% CI 29.7% to 35.0%) in males, 16.3% (95% CI 14.6% to 18.2%) in females, and 23.1% (95% CI 21.6% to 24.7%) overall. In gender-specific age-adjusted analyses, no recent contact was also associated with low education, smoking, very good to excellent self-rated health, no chest pain, CVD 10-year SCORE risk 5+%, absence of hypertension control, absence of hypertension awareness and absence of care-intensive conditions. Among those with no contact: 37% current smokers, 34% with 5+% 10-year CVD risk, 32% untreated hypertension, 20% non-anginal chest pain, 18% problem drinkers, 14% uncontrolled hypertension and 9% Grade 1–2 angina. The proportion without general health check attendance was 54.6%.ConclusionPrimary care and community interventions would be required to proactively reach sections of 40–69 year olds currently not in contact with primary care services to reduce their CVD risk through diagnosis, treatment, lifestyle recommendations and active follow-up.

Aim. To analyze the associations of health care system resources utilization and temporary disability (TD) with the main risk factors (RF) for cardiovascular diseases (CVD) in working age population based on ESSE-RF study data.Material and methods. The analysis was based on ESSE-RF study data (13 regions of the Russian Federation). Standard epidemiological survey methods and evaluation criteria were used. The analysis included results of a survey of the ESSE-RF study participants about the utilization of health services and TD during last 12 months. Average number of outpatient visits, hospitalizations (including duration of in-hospital treatment and number of cases), ambulance calls and TD (a number of days and cases) per one study participant and associations with RF for CVD were estimated. We conducted a comparative analysis of the utilization of health services and TD in association with cardiovascular RF, also logistic regression analysis was performed to predicting the likelihood of outpatient visits, hospitalizations, ambulance calls and TD.Results. A total of 21,923 individuals in the 25-64 age group were included: men – 8,373 (38%) and women – 13,550 (62%). Number of men who was hospitalized significantly increased in group with tobacco consumption (1,41; p

BackgroundArterial hypertension (HT) is common in the Russian adult population, with half of affected individuals inadequately controlled. Low adherence to medication seems likely to be a factor. We report a scoping review of studies on adherence to antihypertensive therapy (AHT) in Russia to determine the extent of research undertaken, the frequency of adherence among adults diagnosed with HT, methodologies used in the studies, and their ability to describe determinants of adherence.MethodsA scoping review of published studies that have assessed adherence to AHT in Russian HT patients searched the main Russian and international electronic databases eLIBRARY.ru, Russian Medicine, Embase, MEDLINE for full-text reports published in the Russian language between 2000 and 2017. The last search was on November 28, 2017. Among 520 reports identified, 31 were included in the review.ResultsEighteen studies assessed adherence using the 4-item Morisky Medication Adherence Scale (MMAS-4); others used bespoke questionnaires or pill counts. 25 studies assessed levels of adherence, 11 examined its determinants, and 18 examined intervention strategies. The proportion of “adherent” patients varied from 11 to 44% using the MMAS-4, from 23 to 74% when using bespoke questionnaires, and from 5 to 43% when using pill counts. Adherence was associated with sociodemographic factors, access to free drugs provided through the Medicine Assistance Scheme (MAS), use of home blood pressure (BP) monitoring, anxiety, and comorbidity. There was no evidence that adherence was associated with income or physical activity. Evidence of an association between MAS, grade of HT, or experience of hypertensive crisis was inconclusive. Various methods to improve adherence were studied including patient education (improved from 1.8 to 3.9 points,p = 0.0002 or 2.80 to 3.79 points,p p ConclusionsThe main determinants of adherence to AHT are sociodemographic characteristics, the severity of HT, and presence of comorbidity. Patient education and use of fixed-dose combinations of drugs were identified as most important for improving adherence. Most studies assessing adherence use self-reported methods so there is a need for greater use of objective methods.Trial registrationThis scoping review has not been registered.

Background Russia has one of the highest mortality rates from cardiovascular disease (CVD) in the world. For patients with acute myocardial infarction (AMI), longer pre-hospital delays are associated with increased complications and mortality. The aim of this study is to use multivariate analyses to identify risk factors for prolonged pre-hospital delay and its components (patient decision time delay and transport time delay) in the Russian Federation for AMI patients. Methods A total of 1128 hospitalised patients with suspected AMI were recruited in a prospective observational study with a representative sample of suspected AMI patients from 16 hospitals in 13 regions of Russia, of theses 6 cases were excluded as they had an MI while already hospitalised, 243 cases were excluded due to missing date/time data. Data were collected from both patient questionnaires and clinical records. Pre-hospital delays analysed include total pre-hospital delay ≥2 hrs, patient decision time (≥ 1 hr) and transport time (≥1). Logistic regression models were used to identify patient (sociodemographic, socioeconomic, previous medical history), symptom and admission related predictors of increased delays. Results The median total pre-hospital delay was 4.83 hrs (IQR 2.64–10.82), decision time 1.25 hrs (IQR 0.38–4.5), and transport time 2.03 hrs (IQR 1.23–4.5). No age differences were found across total, decision or transport related delay. The odds of admission within 2 hours from symptom onset (total prehospital delay) significantly decreased with poorer wealth status, indirect route to hospital and symptom onset between 12–6am. Additionally, taking aspirin was associated with lower odds of arriving within 2 hrs. Whilst symptom presentation and co-morbidity was not significantly associated with total delay, patients who thought their symptoms were due to a problem with their heart were more likely to reach the hospital within 2 hours (OR1.65, 95% CI 1.03–2.62). Odds of transport delay >1 hr were significantly greater for patients travelling indirectly but significantly lower for male patients. Symptom onset overnight was associated with increased transport time. Odds of decision time >1 hr were significantly greater among patients that did not attribute their symptoms to a heart problem and patients with symptoms stating overnight (12–6am). Sociodemographic, socioeconomic and comorbid status were not significantly associated with decision time. Conclusion Pre-hospital delay in the Russian Federation is protracted, particularly when patients travel indirectly to their definitive health facility. Symptom characteristics (time of onset and attribution to heart) are important for all components of pre-hospital delay in the Russian Federation. The is initial evidence that male patients experience reduced transport times, but further analyses are required to understand why. Tractable areas for improvement exist; reducing patient decision time and increasing use of EMS.

Aim. To study of the prevalence of the metabolic syndrome and its components among residents of the Kyrgyz Republic.Methods. This study was conducted within the framework of the international «INTEREPID» project, in which, in addition to Kyrgyzstan, the Russian Federation and Kazakhstan participated. Study type is cross-sectional epidemiological study. A cohort was formed randomly, consisting of 1672 people, representative of sex and age structure of the population. In addition to completing the questionnaire, we performed the following examinations: estimation of height, body weight and waist size, measurement of blood pressure and heart rate, electrocardiogram, as well as the determination of a number of biochemical parameters: sugar and creatinine levels in blood and lipid profile (low density lipoproteins, high density lipoproteins and triglycerides levels).Results.Among the residents of the Kyrgyz Republic the prevalence of metabolic syndrome was 30.9% with predominance of its occurrence among women (33.3% vs. 27.7% in men, pConclusion. Among the residents of the Kyrgyz Republic the high prevalence of the metabolic syndrome was registered with certain gender and ethnic features of its components occurrence.

Aim. To estimate economic efficiency of a complex of resource-saving activities for cardiovascular diseases prevention at a workplace. Material and methods. The complex of activities including preventive examination and preventive intervention with their efficacy monitoring was performed in 523 people of a technical research institute staff. Preventive examination included evaluation procedures for cardiovascular diseases and their risk factors (89,5% of respondents). Preventive intervention based on risk factors modification was performed in intervention group. Control group included staff not participating in preventive consultation. Costs associated with cardiovascular diseases and risk factors (medical care consumption and temporary disability) and cost- efficiency analysis was performed. Results. High prevalence of arterial hypertension, metabolic and psychoemotional risk factors at workplace was found in preventive examination. Significant reduction in blood pressure (BP) and total cholesterol (TC) plasma level as well as a tendency to cardiovascular risk (CVR) decrease was reached due to preventive intervention. Costs associated with cardiovascular diseases and their risk factors in intervention group were lower than these in control group (168 584 and 489 500 rbl per 100 people yearly, respectively). Cost- efficiency analysis shown that costs of BP, TC plasma level and CVR reduction were moderate in intervention group. Costs were not efficient in control group. Conclusion. Implementation of cardiovascular diseases prevention at workplace is economically efficient both for society and for employer.

Background: Death rates from cardiovascular disease in Russia are among the highest in the world. In recent years, the Russian government has invested substantially in the healthcare system, with a particular focus on improving access to advanced technology, especially for acute myocardial infarction (AMI). This protocol describes a study to understand the management of AMI in different Russian regions, investigating the role of patient, clinical, and health system characteristics. Methods: A prospective observational study has recruited a representative sample of AMI patients within 16 hospitals from 13 regions across Russia. Criteria for inclusion are being aged 35-70 years with a confirmed diagnosis of AMI and surviving until the day after admission. Information being collected includes health system contacts and features of clinical management prior to the event and in the 12 months following discharge from hospital. Following initial exploration of the data to generate hypotheses, multivariate analyses will be applied to assess the role of these characteristics in both treatment decisions and any delays in time critical interventions. Between June 2015 and August 2016, 1,122 patients have been recruited at baseline and follow-up to 12 months post-discharge is scheduled to be completed by autumn 2017. The study is unique in examining patient factors, clinical management prior to admission and in hospital in the acute phase and throughout the critical first year of recovery across a diverse range of geographies and facilities. It uses standardized instruments to collect data from patients and health care providers and includes regions that are diverse in terms of geography and development of cardiology capacity. However, given the limited health services research capacity in the Russian Federation, it was not possible to obtain a sample that was truly nationally representative.

Source at https://doi.org/10.20996/1819-6446-2018-14-4-474-487. Aim: To describe the characteristics of the patient with MI who is admitted to a hospital and to characterize the main diagnostic and treatment interventions in clinic. Material and methods: This study is observational and the part of big international project. It includes a representative sample of patients with MI admitted to 16 clinics in 13 regions of Russian Federation (Arkhangelsk region, Belgorod region, Bryansk region, Tver region, Saratov region, Rostov region, Samara region, the Republic of Tatarstan, Perm region, Tyumen region, Khanty-Mansiysk Autonomous district, Kemerovo region, Altai region). Patients were selected at random from among those experiencing a MI that were alive on the next morning after hospitalization. Enrollment took place from June 2015 to August 2016. Results: Of 1,128 patients included in the study, 872 were male (77.3%) and 256 females. 21.4% of patients had a previous MI, 8.3% had undergone PCI, and 2.2% CABG. Turning to cardiovascular risk factors, 46.2% of patients smoked prior to hospitalization, 34.6% were obese and 52.1% had a high cholesterol level. Only 40.0% of patients had no contact with the health care system within 12 months before the MI. Every fourth patient (25.1%) had undergone dispensarisation within 12 months before MI, women significantly often than men (33.5% and 22.6%, p Conclusion: Patient with a MI in Russian clinics is likely to have had a history of cardiovascular disease, and to have regular contact with the health care system within 12 months before the development of cardiovascular event. We demonstrated the high rates of appropriate MI treatment, without significant gender and age difference (except for thrombolysis), however, there is a reserve for increasing the proportion of patients who are undergoing revascularization. Цель: Описать характеристики пациентов,госпитализированных с инфарктом миокарда (ИМ) и охарактеризовать основные диагностические и лечебные мероприятия в клинике. Материал и методы: Это наблюдательное исследование является частью крупного международного проекта. В исследование включена репрезентативная выборка больных с ИМ, поступивших в 16 клиник в 13 регионах Российской Федерации (Архангельская область, Белгородская область, Брянская область, Тверская область, Саратовская область, Ростовская область, Самарская область, Республика Татарстан, Пермский край, Тюменская область, Ханты-Мансийский автономный округ, Кемеровская область, Алтайский край). Пациенты были рандомизированы из числа тех, кто поступил с ИМ, и был жив на следующее утро после госпитализации. Этап включения продолжался с июня 2015 г. по август 2016 г. Результаты: Из 1128 пациентов, включенных в исследование, 872 были мужского пола (77,3%) и 256 – женского. У 21,4% пациентов был ИМ в анамнезе, у 8,3% – чрезкожные коронарные вмешательства (ЧКВ), и у 2,2% – аортокоронарное шунтирование. Что касается сердечно-сосудистых факторов риска, то 46,2% пациентов курили до госпитализации, у 34,6% было ожирение, и у 52,1% – повышенный уровень холестерина. Только 40,0% пациентов не имели контактов с системой здравоохранения в течение 12 мес до ИМ. Каждый четвертый пациент (25,1%) прошел диспансеризацию в течение 12 мес до ИМ. Первичная реваскуляризация выполнена 73,2% пациентов, ЧКВ была первичной попыткой реваскуляризации у 49,4% пациентов, а у 46,7% пациентов ЧКВ было со стентированием. Заключение: Пациенты, госпитализируемые в клиники Российской Федерации с ИМ, имеют анамнез сердечно-сосудистых заболеваний и частые контакты с системой здравоохранения в течение 12 мес до развития сердечно-сосудистого события. Продемонстрирована высокая частота применения рекомендованных подходов к лечению ИМ, без существенных различий по полу и возрасту (за исключением тромболизиса), однако есть резерв для увеличения доли лиц, которым выполняется реваскуляризация.

Source at https://doi.org/10.20996/1819-6446-2018-14-6-804-815. Aim: To evaluate the availability and affordability of medicines used to treat of cardiovascular diseases (CVD) in several regions of the Russian Federation with different climatic, geographic, economic and demographic characteristics. Material and methods: The study was conducted in 6 regional capitals, chosen to differ in geographically, economically, and demographically. In each city, 5 pharmacies providing free medicines to certain categories of citizens (beneficiaries) and 5 private pharmacies serving anyone were selected at random. Medicine availability was assessed in all pharmacies, along with price only in the private pharmacies. Data were obtained for both original drug and appropriate generics. A list of 25 of the most frequently prescribed medicines for cardiovascular diseases was compiled. Results: Some general findings emerged. With the existence of a generic drug, the original drug was not available in the pharmacy supplying beneficiaries. Diuretics, as well as some ACE inhibitors, are not available in a number of pharmacies for beneficiaries. Enalapril in most licensed pharmacies is represented by generics, lisinopril in a number of cities is represented by both the original drug and generics. The presence of sartans was much lower than ACE inhibitors. Bisoprolol was most common beta-blocker. Calcium antagonists: if amlodipine was present in all licensed pharmacies, at list as generic, then nifedipine was not available in many licensed pharmacies. Among antiplatelet agents, aspirin was available in most pharmacies, and clopidogrel was mostly represented by generics. As for statins, only simvastatin could be found in almost all pharmacies. When analyzing the cost of drugs in licensed pharmacies, it was found that drugs containing furosemide are the cheapest among generics – about 17 rubles. The most expensive treatment with generics of rosuvastatin – about 4,374 rubles a month. The most expensive original medicine was also rosuvastatin – about 4,500 rubles for 30 tablets, the cheapest – the original drug of furosemide – about 35 rubles. On average, the cost of CVD treatment with major classes of drugs, including ACE inhibitor, beta-blocker, antiplatelet drug and statin, is 1,921.9 rubles per month. Conclusion: The basic cardiovascular medicines were characterized by a relatively high availability in 6 regions of the Russian Federation included in the analysis both by the criterion of the availability of drugs and by the criterion of the minimum price. Цель: Оценить наличие и доступность лекарственных препаратов для лечения сердечно-сосудистых заболеваний (ССЗ) в нескольких регионах Российской Федерации (РФ) с различными климато-географическими, экономическими и демографическими характеристиками. Материал и методы: Исследование было проведено в 6 административных центрах с различными климато-географическими, экономическими и демографическими характеристиками. Были отобраны 5 льготных аптек, предоставляющих некоторым категориям граждан бесплатные лекарственные препараты, а также 5 лицензируемых аптек, обслуживающих всех граждан, находящихся на территории данного субъекта РФ. При этом стоимость препаратов оценивалась только в лицензируемых аптеках. Были собраны данные об оригинальном препарате и о соответствующих дженериках в той же дозе, независимо от класса препарата или категории аптеки. Предварительно был сформирован список, состоящий из 25 лекарственных препаратов, наиболее часто назначаемых при сердечно-сосудистых заболеваниях. Результаты: Анализ наличия препаратов показал общую закономерность – при существовании препарата-дженерика в льготной аптеке оригинальный препарат отсутствует. Диуретики, также как и некоторые ингибиторы АПФ, отсутствуют в ряде льготных аптек. Эналаприл в большинстве коммерческих аптек представлен дженериками, лизиноприл в ряде городов представлен как оригиналом, так и дженериками. Сартанов в наличии заметно меньше, чем ингибиторов АПФ. Из бета-адреноблокаторов чаще всего встречается бисопролол. Антагонисты кальция: если амлодипин присутствует во всех коммерческих аптеках как минимум в виде дженерика, то нифедипин – лишь в некоторых. Среди антиагрегантов аспирин имеется в наличии в большинстве аптек, а клопидогрел, в основном, представлен дженериками. Что касается статинов, то только симвастатин можно найти практически во всех аптеках. При анализе стоимости препаратов в коммерческих аптеках обнаружено, что среди препаратов-дженериков дешевле всего стоят препараты, содержащие фуросемид – около 17 руб. Дороже всего обойдется лечение препаратами-дженериками розувастатина – около 4374 руб в мес. Самым дорогим оригинальным препаратом также является розувастатин – около 4500 руб за 30 таблеток, самым дешевым – оригинальный препарат фуросемида – около 35 руб. В среднем стоимость лечения CCЗ основными классами препаратов, в том числе, ингибитором АПФ, бета-адреноблокатором, антиагрегантом и статином в мес составляет 1921,9 руб. Заключение: Основные сердечно-сосудистые препараты характеризуются относительно высокой доступностью в 6-ти включенных в анализ регионах РФ как по критерию наличия препаратов, так и по критерию минимальной цены.

Objectives: In the Russian Federation, cardiovascular disease (CVD) is the primary cause of death and premature death; however, to date, there have been no systematic cost-of-illness studies to assess the economic impact of CVD. Methods: The economic burden of CVD was estimated from statistic data on morbidity, mortality, and health care resource use. Health care costs were estimated on the basis of expenditure on primary, outpatient, emergency, and inpatient care, as well as medications. Non–health care costs included economic losses due to morbidity and premature death in the working age. Results: CVD was estimated to cost Russia RUR 836.1 billion (€24,517.8 million) in 2006 and RUR 1076 billion (€24,400.4 million) in 2009. Of the total costs of CVD, 14.5% in 2006 and 21.3% in 2009 were due to health care, with 85.5% and 78.7%, respectively, due to non–health care costs. Conclusions: CVD is a leading public health problem. We first assessed the economic burden of CVD in Russia. Our results can be used for planning investments in prevention programs and measures for improving care for patients with CVD. Regular monitoring of the economic burden of CVD in the future at the federal, regional, and municipal levels will allow assessment of the dynamics of economic burden, as well as the effectiveness of investments in the economy in primary and secondary prevention. Because data are relatively unavailable, there are important limitations to this study, which highlight the need for more accurate CVD-specific information.

Over the past decade, outcomes for patients with acute ST-segment-elevation myocardial infarction (STEMI) have been improving in the developed world - mainly, USA and Europe. This is as a result of an organized revolution in AMI (Acute Myocardial Infarction)-care in general and STEMI-care in

[version 3; referees: 3 approved]. Source at https://doi.org/10.12688/wellcomeopenres.14619.3. 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.

OBJECTIVES: Russia faces a high burden of cardiovascular disease. Prevalence of all cardiovascular risk factors, especially hypertension, is high. Elevated blood pressure is generally poorly controlled and medication usage is suboptimal. With a disease-model simulation, we forecast how various treatment programs aimed at increasing blood pressure control would affect cardiovascular outcomes. In addition, we investigated what additional benefit adding lipid control and smoking cessation to blood pressure control would generate in terms of reduced cardiovascular events. Finally, we estimated the direct health care costs saved by treating fewer cardiovascular events. METHODS: The Archimedes Model, a detailed computer model of human physiology, disease progression, and health care delivery was adapted to the Russian setting. Intervention scenarios of achieving systolic blood pressure control rates (defined as systolic blood pressure

In the past decade, outcomes for patients with acute ST-segment-elevation myocardial infarction (STEMI) have improved in the developed world as a result of an organized revolution in STEMI-care. Concurrently, the Acute Myocardial Infarction (AMI) burden in the developing world is steadily rising.