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Health literacy (HL), including related vaccination, is an important health determinant. For the working population, it helps to maintain and improve their ability to work. Despite the clear benefits of vaccination, vaccine confidence has recently declined worldwide, which may lead to decreased vaccination coverage and a renewal of infectious diseases. Based on this, increasing the level of public health, including vaccination issues, is one of the preventive medicine tasks. Staff groups seem to be an effective place for implementing measures to improve the health and vaccination prevention of the working population.Aim. To assess the level of public health, including vaccination issues, among the working Russian population using digital technologies.Material and methods. The study was conducted online and included employees filling out a questionnaire on their own. The results were posted on the Atria digital platform, which is a tool for assessing and implementing corporate programs to improve employee health. HL was assessed using the updated 2019 Health Literacy Survey Questionnaire (HLS19-Q) adapted into Russian and validated. The study lasted 18 months (from December 2022 to May 2024).Results. A total of 58357 employees took part in the study on the Atria digital platform to assess the public health level, of which 47044 (80,6%) were women. In general, workers had a predominantly excellent HL (n=39637, 67,9%), while in women it was 69,4% (n=32644). The insufficient HL varied slightly among workers of different age groups. The fewest workers with an excellent HL were recorded in the age group of 40-49 years (65,4%, n=11857), and the most among workers >60 years old (74,2%, n=3573). The study found that 43,3% of men and 56,2% of women are vaccinated against influenza annually. Among those workers who are vaccinated against influenza annually, the highest HL rate was recorded among workers >60 years of age (63,4%, n=4188), and the lowest among workers

Aim. To evaluate the usage of antihypertensive drugs (AHDs) and their combinations in participants aged 35 to74 years with arterial hypertension (AH) in the population-based study ESSE-RF3.Material and methods. Representative samples of the population aged 35 to 74 years from 15 regions of Russia (n=28731) with a response rate over 70% were examined in the ESSE-RF3 study. Therapy received by 9944 participants with AH (with systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg, or when the subject was taking AHDs) was analyzed. Information about AHDs intake (brand name of the drug) was recorded by questionnaire and coded according to International Nonproprietary Names by classes. Statistical analysis was performed using the open-source R 4.1 environment. Comparison of discrete indicators between groups was performed using Fisher’s exact test. The significance level for all tested hypotheses was taken as.05. The study was approved by the Ethics Committee of FGBI “NMRC TPM” of the Ministry of Health of the Russian Federation, each participant signed an informed consent.Results. Among the patients receiving therapy for AH, angiotensin-converting enzyme inhibitors (ACEIs) were used by 38.8% of participants, angiotensin receptor blockers (ARBs) — 31.6%, betablockers (BBs) — 29.0%, сalcium channel blockers (CCBs) — 21.5%, diuretics — 18.6%, 1.1% — outdated AHDs; 8.6% — other groups of drugs. Monotherapy was used by 53.1% of patients, 33.1% of participants received two, and 13.9% received three AHDs. Among participants taking two or more AHDs (including single-pill combinations (SPC)), males most often received the combination of BB+ ACEI and females — BB+ARBs. SPC AHDs were used by 10.3% of those receiving therapy (males: 9.8%, females: 10.6%). Among SPCs, the top three combinations were CCBs + ACEIs (28%), diuretics + ACEIs (27.5%), and diuretics + ARBs (24.4%).Conclusion. The population study ESSE-RF3, based on the survey of a representative sample of the Russian population aged 35-74 years, showed that more than a half of participants with AH receiving therapy were used the monotherapy, only every tenth of those treated received SPC. The problem of insufficient patients’ literacy was indicated — about 1% of patients received outdated AGPs. In addition, 8.6% of patients used non-AHDs for the treatment of AH. For improving the control of AH treatment, it is necessary to increase the adherence of patients to the prescribed therapy and more strict adherence of doctors to the published guidelines for AH treatment.

Aim. To describe the methods used to assess the implementation of new national tobacco and nicotine control policies in the regions of the Russian Federation (EPOHA-RF 2).Material and methods. An online survey sample was designed to include a minimum of 1000 respondents in each region, including current smokers and/or users of electronic nicotine delivery systems (ENDS) and former smokers and/or users of ENDS who quit within the past 3 years (800:200 ratio). Participants were aged 15 and older and resided in 12 regions of the Russian Federation. The sample was collected using the river sampling method and was quota-based by sex, age, and settlement type using 2022 Rosstat data. Weighting coefficients were calibrated against control indicators from nationally representative Rosstat surveys. Data were collected in 2023 using a questionnaire programmed on an online platform for self-completion by respondents. The questionnaire included 74 measurable parameters aligned with the anti-tobacco law.Results. The total sample size across the 12 regions was 12662 individuals as follows: Moscow (n=1094), St. Petersburg (n=1041), Chuvash Republic (n=1046), Krasnodar Territory (n=1047), Primorsky Territory (n=1062), Arkhangelsk Region (n=1042), Astrakhan Region (n=1077), Belgorod Region (n=1048), Novosibirsk Region (n=1030), Orenburg Region (n=1042), Samara Region (n=1071), and Tyumen Region (n=1062). The distribution of respondents within each region corresponded to the age, sex, and settlement type distribution of smokers/ENDS users reported by Rosstat. The data collected from the survey underwent a weighting procedure. A database was created in MS Excel format based on the respondents' answers.Conclusion. The structure and data collection methods used to assess the implementation of national tobacco control policies in 12 Russian Federation regions provide results that are highly representative of the opinions of current and former smoker/ENDS users across all age and sex groups in urban and rural areas regarding the implementation of tobacco and nicotine control policies in the Russian Federation.

This narrative review was prepared by a working group based on actual data at the international and Russian level. The review examines data on the frequency of added sugar consumption in Russia, as well as the changes in prevalence of non-communicable diseases, including obesity and type 2 diabetes, caused by excessive consumption of foods high in simple carbohydrates.

Aim. To make a cost-effectiveness analysis of increasing the prescription rate of combination therapy with beta-blockers (BBs), angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs/ARBs), statins and oral anticoagulants (OACs) in patients with coronary artery disease (CAD) in combination with atrial fibrillation (AF) and heart failure (HF).Material and methods. Based on the analysis of 6 medical registers, the proportion of patients with CAD in combination with AF and HF among all patients with CAD, and the prescription rate of BBs, ACEIs/ ARBs, OACs and statins, was assessed. Mortality and hospitalization rates were also determined in patients receiving only part of therapy or without it. In multivariate statistical models, the reduction in the risk of adverse events was calculated when all 4 drug groups were prescribed. Costs were calculated based on government procurement data and current compulsory health insurance rates. The obtained estimates were used to build a Markov model.Results. According to the modeling results, the number of patients with CAD in combination with AF and HF in the Russian Federation is 1,16-1,27 million people. When prescribing from 0 to 3 drug groups out of 4 required, the mortality rate was 115, and the hospitalization rate was 246 per 1000 patient-years. In the group of patients receiving all 4 groups of drugs, there was significant hazard ratio for death and hospitalization was 0,434 and 0,765, respectively. When modeling the prescription of drugs from all 4 groups in 1000 patients currently receiving only 0-3 groups of drugs, there was a reduction in the expected number of deaths by 52,3% (153 lives saved) and an expected number of hospitalizations by 16,0% (99 prevented hospitalizations) over 3 years. Additional costs per 1 life saved amounted to 515,3 RUB thousand.Conclusion. Patients with a combination of CAD, HF and AF are one of the groups with the highest risk of death and hospitalization for CVD. Modeling has shown that increasing coverage of this group of patients with appropriate therapy, including BBs, ACEIs/ARBs, statins and OACs, is a clinically and economically feasible solution.

Aim. Management of hypertension, a major cause of mortality worldwide, is difficult, with adherence a common problem. The present study aimed to estimate the long-term clinical outcomes associated with different treatment pathways in people with hypertension in Russia.Material and methods. Outcomes were projected over 10 years using a microsimulation model. Four treatment pathways (current treatment practices (CTP), single drug with dosage titration then sequential addition of other agents [start low and go slow, SLGS], free choice combination with multiple pills (FCC) and combination therapy in a single pill (SPC)) were evaluated based on the Global Burden of Disease 2017 dataset. Clinical outcomes were simulated for 1,000,000 individuals for each pathway.Results. Long-term projections associated SPC therapy with reductions in mortality (4.9%), disability-adjusted life years (DALYs, 5.2%), and incidence of complications (including chronic kidney disease, stroke and ischemic heart disease, 9.2%) versus CTP, with greater reductions in all outcomes versus SLGS and FCC. SPC was projected to save 1,193 DALYs compared with CTP over 10 years. Adherence was identified as a key driver in the analysis.Conclusion. Based on 10-year projections, combination therapies (including SPC and FCC) appear likely to reduce the burden of hypertension compared with conventional treatment options in Russia.

Создание руководства поддержано Советом по терапевтическим наукам отделения клинической медицины Российской академии наук.

Aim. To study the gender and age characteristics of dyslipidemia in the population of the Nizhny Novgorod region.Material and methods. A total of 2501 people aged 35-74 among the population of the Nizhny Novgorod region were examined, selected by stratified multi-stage random sampling. The study was performed as part of the third epidemiological study ESSE-RF3. All respondents underwent an anthropometric survey, a questionnaire to identify chronic non-communicable diseases and related risk factors. The following laboratory tests were performed: total cholesterol (TC), low-density lipoproteins (LDL-C), high-density lipoproteins (HDL-C), triglycerides (TG). Among the entire cohort of patients at the time of blood sampling, 276 people (11,0%) were receiving lipid-lowering drugs. They were excluded from further analysis. Hypercholesterolemia (HCL) was recorded with a total cholesterol ≥5,0 mmol/l, an increased level of LDL-C — with a level ≥3,0 mmol/l, hypertriglyceridemia (HTG) — with a TG ≥1,7 mmol/l, a reduced level of HDL-C — with a level in males ≤1,0 mmol/l, in women ≤1,2 mmol/l.Results. The prevalence of HCL was 65,1%. In the young cohort (40-44 years), men were significantly more likely to have hypercholesterolemia, but in the middle (50-54 years) and older (60 years or more) age groups, this lipid metabolism disorder was observed with greater frequency among females. In addition, 68,9% of the respondents had elevated LDL-C levels. When studying the prevalence of this type of dyslipidemia in different age groups among men and women, a similar trend can be noted with similar TC values, but significant gender differences in the prevalence of elevated LDL-C levels l were revealed only in the 60-64 and 65-69 years groups. The prevalence of HTG among the adult population of the Nizhny Novgorod region was 42,6%. Among the 35-49 years and 55-59 years age groups, the prevalence of elevated TG levels was significantly more common among men. The incidence of decreased HDL-C levels was 13,3%. This type of dyslipidemia was significantly more often detected among men only in the youngest subgroup (35-39 years).Conclusion. Among the population of the Nizhny Novgorod region, hypercholesterolemia occurred in 65,1% of respondents, an increased level of LDL-C — in 68,9%, a HTG — in 42,6%, a reduced level of HDL-C — in 13,3%. The data obtained determine a high cardiovascular risk and require the development of prevention and treatment measures for lipid metabolism disorders.

Aim. To analyze the indicators of hospitalization and outpatient visits of patients aged 18 years and older with hypertension (HЕТ) in federal districts (FD) and subjects of the Russian Federation from the perspective of the World Health Organization concept of ambulatory care sensitive conditions.Material and methods. The analysis included data from the annual forms of federal statistics (forms № 12 and № 14), on the number of hospitalizations and the outpatient visits of patients aged 18 years and older diagnosed of HTN (ICD10: I10-I12) in 2022. Results. We analyzed the data of the federal statistics (forms № 12 and № 14) of the FDs and subjects of the Russian Federation in 2022. It was found that the Siberian FD has one of the highest rates of adult outpatient visits with HЕТ aged 18 years and older, where, at the same time, one of the lowest rates of hospitalizations is recorded. In FDs with adult outpatient visits higher than the Russian average, there were higher adult hospitalization than the Russian average (Ural, Central and Volga FDs). In FDs with adult outpatient visits lower than the Russian average, there were higher adult hospitalization than the Russian average (South, North Caucasus and Far East FDs). In the Northwestern FD, adult outpatient visits and adult hospitalization were lower than the Russian average. When analyzing the HTN ratio among the adult population aged 18 years and older, the highest indicator was recorded in the North Caucasus FD, while the heterogeneity of the indicator within the FD was one of the highest among the other FDs. The lowest HTN ratio indicator among the adult population aged 18 years and older was recorded in the Ural FD, while the heterogeneity of the indicator within the FD was the lowest among the other FDs. There was a high variability of the ratio both for all subjects of the Russian Federation and FDs. The ratio values ranged from 1,2 in the Nizhny Novgorod region to 12,26 in the Republic of Dagestan.Conclusion. Accounting for diseases that can be treated on an outpatient basis can help to assess the quality of care to the adult population in primary health care facilities. However, before including this indicator as a quality criterion, a deeper understanding of the reasons influencing its change is required.

Cardiovascular diseases are the leading cause of death worldwide. It is possible to influence the development of these diseases by influencing their main pathogenetic link — dyslipidemia.Aim: to evaluate, using the example of alirocumab, the potential effect of drugs affecting the activity of PCSK9 on the achievement of goals for the prevention of the development of cardiovascular diseases and cardiovascular complications in patients of working age who had an acute myocardial infarction (MI) less than a year ago, with uncontrolled dyslipidemia.Materials and methods. The target group was created based on the Russian clinical guidelines; its number was calculated using Russian registry data. Based on the published results of the clinical trial of alirocumab ODYSSEY OUTCOMES in a group of patients with LDL cholesterol levels of more than 2.6 mmol/l (100 mg/dl), a model was built to estimate the number of fatal and non-fatal outcomes in the target group with standard therapy and with alirocumab.Results. The effect of alirocumab administration was modeled in patients of working age who had a myocardial infarction less than 12 months ago with an LDL cholesterol level of more than 5.0 mmol/l, the number of this group in the Russian Federation was estimated to be 3,029 people. It has been shown that with therapy in this group, mortality can be reduced by 29%, and the number of non-fatal cardiovascular events — by 22%, i. e. alirocumab therapy in this group for 2 years can prevent 29 deaths and 185 non-fatal events, with an increase in the duration of therapy to 5 years, the number of lives saved will be 117 and 401 non-fatal cardiovascular events will be prevented.Conclusion. Modeling has shown that alirocumab therapy in patients with recent myocardial infarction and LDL cholesterol levels above 5.0 mmol/L will significantly reduce mortality in this group and prevent the development of serious nonfatal cardiovascular complications, which will also reduce the burden on specialized hospitals, as well as prevent patients from becoming disabled. At the same time, decision making requires a balanced consideration of all ethical, clinical and economic aspects, including the assessment of costs and potential effects from the position of the of a willingness to pay and the formation of the budget of the health system.

Aim. To study the problem of obesity at the national level.Material and methods. The ESSE-RF3 study examined a representative sample of the population of 15 Russian regions aged 35-74 years with a response >70% (n=28731). Modular design questionnaire was used. The study received approval from the Independent Ethics Committee of the National Medical Research Center for Therapy and Preventive Medicine. Signed informed consent was obtained from each participant. Body mass (BM) was measured once with an accuracy of 100 g. The height was measured with an accuracy of 0,5 cm once in a standing position without shoes. Waist circumference was measured with a standard measuring tape with an accuracy of 0,5 cm. There were following BM categories: insufficient (BM index (BMI) 40). Abdominal obesity (AO) was assessed using the following criteria: waist circumference ≥102 cm and ≥88 cm for men and women, respectively. The changes of obesity were studied with the inclusion of materials from the ESSE-RF (2012-14) and ESSE-RF2 (2017) studies, carried out using the same methodology with ESSE-RF3 in the same age range of 35-64 years. Statistical analysis was carried out using the open-source R 3.6.1 environment. Analysis of associations between factors and a binary variable was carried out using the logistic regression method. The significance level for all tested hypotheses was 0,05.Results. Mean BMI values is 28,2±4,6 kg/m2 among men and 28,9±5,9 kg/m2 among women. The prevalence of overweight is 44,0 and 33,7%, obesity — 30,0 and 39,5%, AO — 30,9 and 55,1% among men and women, respectively. In addition, 30,3% have a combination of obesity and AO; obesity and/or AO — 49,1%. Obesity statistics did not significantly change, but in each section the rates are higher among women. The closest associations were found between obesity and hypertension (men: odds ratio (OR) (95% confidence interval) 2,88 (2,66-3,12), women: OR 3,03 (2,81-3,27) (p

Aim. To analyze the prevalence of anxiety and depression in Russians using the Hospital Anxiety and Depression Scale (HADS) during the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF) study. To study the associations of increased levels of anxiety and depression (HADS-A/ HADS-D ≥8+) with demographic and socio-economic characteristics according to the ESSE-RF3 study.Material and methods. In the ESSE-RF3 study, a representative sample of the population of 15 Russian regions aged 35-74 years was examined with a response >70%. After removing respondents with missing data from the analysis, the final sample was 28716 people. The level of anxiety/depression was assessed by the sum of points

Aim. To analyze the prevalence of smoking according to the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation-3 (ESSE-RF3) study, and compare these data with the previous two stages.Material and methods. Data from following three cross sections of the ESSE-RF study were used: 2013-2014, 2017, 2020-2022. At the first stage, the prevalence and probability of smoking was assessed according to ESSE-RF3 data in 2020-2022 (n=28628, 35-74 years). At the second stage, an analysis was carried out over time using data from all three ESSE-RF sections (n=43804, 35-64 years).Results. In the overall ESSE-RF3 sample, the prevalence of smoking was 17,0% (men — 27,7%, women — 7,6%). Smoking probability varies significantly by sex, age, education level and income. Over time, the standardized prevalence of smoking increases from 25,0% in 20132014 to 26,2% in 2017, and then decreases to 21,5% in 2020-2022. Women are characterized by the same direction of trends, while men had consistent decrease in prevalence from 41,3 to 37,0 and 34,3%, respectively. The probability of smoking in 2017, relative to 20132014, decreases only in some socio-demographic categories of the population. In 2020-2022, a decrease in the probability of smoking is typical for both the general sample and all subgroups of the population.Conclusion. The results obtained characterize the current situation and time trends of the last decade and contain important information on smoking epidemiology in Russia.

At the present time, there is a growing trend of vegetarian diets, even in countries with a traditional Nordic diet.Aim. To study the prevalence and characteristics of vegetarian diets in the Russian population at the present stage.Material and methods. The analysis included data from representative samples of the adult population 25-74 years old, examined within three sections of the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF) study in 20132014, 2017 and 2020-2022. A total of 57351 participants (24862 men and 32489 women) were analyzed. Nutrition assessment was carried out using the frequency method. Restrictive diets include semi-vegetarian, vegetarian and vegan diets. Data are presented as frequencies and odds ratios (OR) with 95% confidence intervals (CI).Results. The prevalence of restrictive diets in the Russian population according to three sections of the ESSE-RF study was 3,1%. There is an increase in the prevalence of these diets from 2,7% in 2013, to 3,6% in 2017 and 3,3% in 2020-2022. Men are less likely than women to exclude red meat from their diet (OR 0,55 [0,49-0,61], p

Aim. To study the proportion of coronavirus disease 2019 (COVID-19) survivors and hospitalization cases of the Russian population for the period 2020-2022, depending on socio-demographic characteristics.Material and methods. The work was performed on random samples of the population aged 35-74 years from 15 regions participating in the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation-3 (ESSE-RF3) study. The examination was carried out from February 2020 to March-April 2022 (n=28718, 47% men).Results. According to a survey of sample participants, the proportion of respondents who had COVID-19 by the spring of 2022 among all surveyed was 26,0%. Among 45-54-year-old respondents, this parameter was maximum (28,0%), while among those aged 65-74-year-old — minimal (22,3%). The following categories of people were more likely to have COVID-19: women (27,9 vs 23,9% of men, p

Aim. To establish reference values of handgrip test for a middle-aged and elderly population (35-74 years), as well as study the association of health characteristics and muscle strength.Material and methods. For the analysis, we used data from the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation-3 (ESSE-RF3) study, conducted in 2020-2022. The sample was selected similarly to the previous ESSE-RF stages. The sample included 27689 men and women aged 35-74 years from 14 Russian regions. Of the individual variables, the characteristics with the highest evidence level of influence on muscle strength were taken as covariates. Muscle strength was assessed by a handgrip test using a MEGEON 34090 device with an accuracy of 0,1 kg. Three measurements were taken for each arm in a standing position, and the maximum value was used in the analysis. Normative sex-specific handgrip test values were established regardless of age: a participant's handgrip value was considered reduced if it was 2 standard deviations below the average value of participants at the age with the best/highest scores.Results. The average handgrip test values for the entire male sample were 43,4±11,1 kg, while for the female sample — 27,6±6,1 kg. In men under 53 years of age, muscle strength decreases at a rate of 0,12 kg/year, then the decline accelerates to 0,48 kg/year. In women under 45,5 years of age, a slight and insignificant increase in muscle strength was detected by 0,02 kg/year, and after 45,5 years, handgrip value falls at a rate of 0,2 kg/year. Therefore, both men and women lose 1,3% of muscle strength per year to year and the decline rate do not differ. The peak age can be considered 35 years old, since at this age, the average muscle strength in men and women is 47,6±11,5 and 29,2±5,7 kg, respectively, and the calculated norm (M–2SD) for men was 47,6–2´11,5≈24 kg using rounding down, and for women it was 29,2– 2´5,7≈17 kg. With age, as expected, the proportion of people of both sexes with a metabolic syndrome level below the threshold increases, reaching 7,5% after 65 years. Multivariate regression analysis showed that, taking into account adjustments for covariates, for every 10 years, muscle strength decreases by an average of 3,1 kg in men and by 1,7 kg in women. Negative associations of metabolic syndrome with inflammation markers (fibrinogen and C-reactive protein) and noncommunicable diseases are also significant, but only men have significantly lower rates of metabolic syndrome in the presence of anxiety and depression, low income and urban residence.Conclusion. The use of handgrip test in any age range during medical examinations or preventive examinations of the adult population and informing primary care specialists about the results obtained can help improve the general health of the population.

Aim. To assess the associations of social and behavioral risk factors with cognitive impairment in the Russian population aged 55-74 years.Material and methods. This study was conducted as part of the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation-3 (ESSE-RF3) study. A total of 13736 participants living in 14 Russian regions were examined. Cognition was assessed using the Mini-Mental State Examination (MMSE) score as follows: cognitive impairment was recorded in the total score

Aim. To assess adherence to a healthy lifestyle depending on the individual and socio-economic characteristics of the Russian population (according to the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation-3 (ESSE-RF3) study), followed by a comparative analysis with ESSE-RF2 (2017).Material and methods. The analysis was carried out based on research data from ESSE-RF2 in 2017 and ESSE-RF3 in 2020-2022. The healthy lifestyle adherence index included following parameters: no smoking; sufficient consumption of vegetables and fruits; physical activity; no excessive salt intake and alcohol abuse. Three following categories of adherence to a healthy lifestyle were analyzed: high, satisfactory, low. From individual variables, individual socio-economic characteristics with the highest evidence level of influence on healthy lifestyle were taken.Results. In the ESSE-RF3 sample, 47,2% of respondents had low adherence to a healthy lifestyle, 37,2% — satisfactory, and 15,6% — high. Women are more committed to healthy behavior compared to the male population — 19,6 vs 11,1% (p

Aim. To analyze alcohol consumption according to the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation-3 (ESSE-RF3) study and compare these data with the previous two ESSE-RF sections.Material and methods. Data from following cross-sectional sections of the ESSE-RF study were used: 2013-2014, 2017, 2020-2022. At the first stage, alcohol consumption was assessed according to ESSE-RF3 data in 2020-2022, conducted during the coronavirus disease 2019 (COVID-19) pandemic (n=28685, 35-74 years). At the second stage, a comparison of all three sections of the ESSE-RF study was carried out (n=42043, 35-64 years). Alcohol consumption was divided into those not drinking alcohol, those drinking alcohol little or moderately (

Aim. To study the epidemiological characteristics and changes of hypertension (HTN), as well as factors associated with HTN in the Russian population aged 35-74 years.Material and methods. The Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation-3 (ESSE-RF3) study examined a representative sample of the population aged 35-74 years of 15 Russian regions with a response >70% (n=28611). Modular design questionnaire was used. Blood pressure (BP) was measured twice after a 5-minute rest in a sitting position on the right arm with an Omron blood pressure monitor. There were following criteria for hypertension: systolic blood pressure (SBP) ≥140 mm Hg and/or diastolic blood pressure (DBP) ≥90 mm Hg, and/or antihypertensive therapy. The effectiveness of treatment was considered the proportion (%) of people who achieved target blood pressure values among those being treated, while the control was considered the proportion (%) of patients with a BP

Aim. To study levels and types of physical activity, as well as its individual socio-demographic and seasonal determinants in the Russian population according to the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF) study.Material and methods. Data from the ESSE-RF2 (2017) and ESSERF3 (2020-2022) was used. The sample included 28731 men and women aged 35-74 from 15 regions. The level of physical activity was assessed using the Global physical activity questionnaire (GPAQ). The following socio-economic and demographic characteristics were taken as covariates: sex, age, place of residence (urban and rural), level of education, marital status, work characteristics, income level, season of the year. Statistical analysis was performed using SPSS version 22 (IBM Corp. USA).Results. The study showed that 27,4% of the sample have insufficient physical activity. Among the low physical activity category, there are more women than men (28,12 vs 26,7%, p

Aim. To study the prevalence of dyslipidemias and their association with various risk factors in the Russian population of men and women aged 35-74 years in 2020-2022.Material and methods. This work was carried out as part of the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation-3 (ESSE-RF3) study. The sample included 28731 men and women aged 35-74 years living in 15 Russian regions. Hypercholesterolemia (HC) was diagnosed with total cholesterol (TC) ≥5,0 mmol/l, while elevated low-density lipoprotein cholesterol (LDL-C) was considered ≥3,0 mmol/l, hypertriglyceridemia — with triglyceride levels ≥1,7 mmol/l, reduced high-density lipoprotein cholesterol (HDL-C)

Aim. To assess the prevalence of psychological stress (PS) using the Perceived Stress Scale-10 (PSS-10) in various Russian regions and to analyze PS associations with socio-demographic characteristics and behavioral risk factors and some non-communicable diseases (NCDs).Material and methods. We studied representative samples of the population aged 35-74 years in the Russian regions, examined as part of the Epidemiology of Cardiovascular Diseases in Regions of Russian Federation-3 (ESSE-RF3) study. The subjects were interviewed using a questionnaire containing a section on the psychological stress — PSS-10. For men, PS levels are ranked as follows: "Low" — 0-11, "Medium" — 12-17, "High" — 18-40. For women, PS levels are ranked as follows: "Low" — 0-13, "Medium" — 14-19, "High" — 20-40. Statistical analysis was carried out using the open-source R 3.6.1 environment.Results. The average PS level was 12,0±7,3 (men: 10,7±7,0; women: 13,1±7,4). Every fifth person (20,3%) in the Russian population has a high PS level, with higher PS rates among women compared to men (high PS level — 21,6 vs 18,9%, respectively). A high PS level was associated with the income level (average or low), no marriage, unemployment, low level of physical activity, depression, anxiety, NCDs (type 2 diabetes, myocardial infarction, stroke), additionally for women — hypertension.Conclusion. The Russian population is characterized by a high PS prevalence, while PS rates are higher among women, which must be taken into account when predicting the NCD risks.

The distribution of publications posted in the Elibrary for the period from January 1, 2012 to December 31, 2022, in the structure of a cognitive matrix of taxonomic characteristics for the analysis and assessment of primary health care in the Russian Federation made it possible to establish areas of scientific interest and identify gaps in specific areas and indicators characterizing its current and future development.Aim. To distribute scientific publications according to the relevant segments of the cognitive matrix of taxonomic characteristics for the analysis and assessment of primary health care in the Russian Federation.Material and methods. A database of 41824 publications was used, for which a triple review was carried out with the involvement of 9 experts selected according to appropriate criteria for level of education, work experience in the healthcare system, and academic credentials. At the first two stages, publications not related to primary health care, as well as duplicate publications, were excluded. At the final stage of reviewing, a selective analysis of publications was carried out, assessing the correctness of their distribution into the corresponding taxa of the cognitive matrix, followed by adjustment (if necessary).Results. A cognitive matrix of taxonomic characteristics has been generated for the analysis and assessment of primary health care in the Russian Federation, containing 30339 publications distributed across relevant domains, subdomains and primary health care indicators. The matrix is also presented in a heat map format, allowing an assessment of the most studied taxa of primary health care, as well as highlighting those areas in primary health care in which more research should be carried out to provide a basis and methodology for making informed decisions on its development.Conclusion. Systematized and ordered publications can serve as a basis for a wide range of users in the preparation of systematic reviews and other publications on specific domains, subdomains, primary health care indicators and universal health coverage principles. This study has shown the high efficiency of the cognitive matrix of taxonomic characteristics as a unified tool for aggregation or decomposition of features characterizing the development of primary health care in the Russian Federation.

Aim. To analyze hospitalizations and outpatient visits to primary health care facilities of patients aged 18 years and older with chronic coronary artery disease (CAD) by federal districts and the constituent entities of the Russian Federation from the perspective of the World Health Organization concept for diseases treating mainly on an outpatient basis.Material and methods. We used data from Federal Statistical Monitoring for 2022 on the number of diseases, hospitalizations and the number of outpatient visits of patients aged 18 years and older with an established diagnosis of CAD (ICD 10:I25).Results. In the Central, Southern and Northwestern Federal Districts, the hospitalizations and outpatient visits of the adult population with chronic CAD were higher, and in the North Caucasus, Far Eastern and Ural Federal Districts — below the Russian average level. In the Volga Federal District, the outpatient visits with chronic CAD were higher than the Russian average, and the hospitalizations were below the Russian average. In the Siberian Federal District, the outpatient visits were lower, and the hospitalizations were higher than the Russian average level. When analyzing the ratio of hospitalization rate to the number of outpatient visits of the adult population with an established chronic CAD in the primary health care unit, characterizing the availability, quality and efficiency of outpatient care, the highest indicator was recorded in the Siberian Federal District, while its heterogeneity within the federal district was the highest in comparison with other federal districts. Its lowest was recorded in the Southern Federal District, while heterogeneity within the federal district was the lowest in comparison with other federal districts. The values of this parameter varied from 3,67 in the Kurgan Oblast to 38,33 in the Republic of Tuva.Conclusion. Accounting for diseases treating primarily on an outpatient basis can become one of the tools for assessing the quality of adult primary health care. However, before including this indicator in the criteria for assessing the quality of medical services, a deeper understanding of the reasons influencing its change is required.

Aim. To analyze availability and affordability of alcoholic beverages in Russian cities.Material and methods. We assessed the actual state of urban infrastructure in the Arkhangelsk, Tver and Sverdlovsk regions. Data were collected in three districts of Arkhangelsk, three districts of Tver, three districts of Yekaterinburg and Revda, where participants of the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation-3 (ESSE-RF3) study (2021) lived. The study objects were elements of the city infrastructure where alcoholic beverages were sold. To assess the infrastructure, special software was developed to collect and analyze the necessary data using Open Street Maps. Data were collected from January to March 2022.Results. In total, 1180 alcohol-selling outlets were identified in the study areas: in Arkhangelsk — 450, in Yekaterinburg and Revda — 444, and in Tver — 286. Mainly alcoholic beverages in Sverdlovsk and Tver regions can be purchased in the alcohol section of a grocery store (n=260, 58,6% and n=185, 41,4%, respectively), and in the Arkhangelsk region — in a specialized liquor stores (n=263, 58,4%). The median number of alcohol stores located within a radius of 1000 m from the place of residence of the ESSE-RF3 participant was 33, and within a radius of 400 meters — 8. In Arkhangelsk, the alcohol was sold in a grocery store located in the same building as the college branch. In the Sverdlovsk region, the nearest alcohol store was located at a distance of 50 m from the kindergarten, in the Tver region — 44 m from the college. A 0,5 liter bottle of vodka was sold below the price floor in 55,1% of specialized liquor stores in the Sverdlovsk region and in 66,8% of such liquor stores in the Tver region.Conclusion. As a result of the study, availability and affordability of alcoholic beverages in Arkhangelsk, Tver, Yekaterinburg and Revda was assessed. The findings reflect the high availability of alcohol and indicate the need for interventions at both the national and local government levels. The used method of collecting and analyzing data demonstrated sufficient research effectiveness and can be recommended for wider use.

Aim. To study the relationship of the density and proximity of tobacco products (TPs) and electronic nicotine delivery systems (ENDS) with increased levels of depression, anxiety and stress among the population in 3 constituent entities of the Russian Federation.Material and methods. The work used data from the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation-3 (ESSE-RF3) study in 3 Russian regions (Arkhangelsk, Sverdlovsk and Tver regions) among the population aged 35-64 years (n=1674), who signed a consent to participate in the study. We analyzed data on the status of smoking and consumption of ENDS, passive smoking, attempts to quit smoking, as well as the presence of depression, anxiety (Hospital Anxiety and Depression Scale (HADS) score ≥8) and stress (Perceived Stress Scale (PSS) >21). Elements of urban infrastructure (data collection: January-March 2022) selling TPs and ENDS were assessed using aт OpenStreetMap-based program. Associations were established using logistic regression analysis.Results. With a twofold increase in the distance of TP and ENDS outlets from the place of residence, the depression probability was reduced by 13% (odds ratio (OR) 0,87; 95% confidence interval (CI): 0,79-0,96) and by 12% (OR 0,88; 95% CI: 0,78-0,99), respectively. With increase in distance from of TP outlets, the anxiety decreased probability by 12% (OR 0,88; 95% CI: 0,81-0,97). With an increase in the number of TP outlets within a radius of 1000 m from the place of residence, there were an increase in the probability of depression (OR 1,18; 95% CI: 1,031,36), anxiety (OR 1,12; 95% CI: 1-1,26) and stress (OR 1,24; 95% CI: 1,05-1,46). A greater number of ENDS outlets within a radius of 1000 m and 400 m was associated with a high likelihood of depression (OR 1,17; 95% CI: 1,02-1,34 and OR 1,25; 95% CI: 1,04-1,47, respectively). An increased depression probability was found in those exposed to tobacco smoke at home (OR 1,88; 95% CI: 1,27-2,73) and at work (OR 1,67; 95% CI: 1,14-2,41). An increase in the number of attempts to quit smoking doubles the odds of depression (OR 2,40; 95% CI: 1,35-4,23) and anxiety (OR 2,00; 95% CI: 1,18-3,38).Conclusion. Unfavorable environmental factors, including the proximity and density of TP and ENDS outlets, can increase the probability of depression, anxiety and stress among the population living in these areas.

The experience of managing patients with COVID-19 around the world has shown that, although respiratory symptoms predominate during the manifestation of infection, then many patients can develop serious damage to the cardiovascular system. However, coronary artery disease (CHD) remains the leading cause of death worldwide. The purpose of the review is to clarify the possible pathogenetic links between COVID-19 and acute coronary syndrome (ACS), taking into account which will help to optimize the management of patients with comorbid pathology. Among the body's responses to SARS-CoV-2 infection, which increase the likelihood of developing ACS, the role of systemic inflammation, the quintessence of which is a "cytokine storm" that can destabilize an atherosclerotic plaque is discussed. Coagulopathy, typical for patients with Covid-19, is based on immunothrombosis, caused by a complex interaction between neutrophilic extracellular traps and von Willebrandt factor in conditions of systemic inflammation. The implementation of a modern strategy for managing patients with ACS, focused on the priority of percutaneous interventions (PCI), during a pandemic is experiencing great difficulties due to the formation of time delays before the start of invasive procedures due to the epidemiological situation. Despite this, the current European, American and Russian recommendations for the management of infected patients with ACS confirm the inviolability of the position of PCI as the first choice for treating patients with ACS and the undesirability of replacing invasive treatment with thrombolysis.

Relevance. Patients with diabetes mellitus have an increased risk of developing various infections, including those of the lower respiratory tract. Immunization with anti-pneumococcal vaccines reduces pneumonia-related hospitalizations and deaths.Aim. Evaluate the cost-effectiveness of vaccination against pneumococcal infection in 40and 65-year-old patients with type 2 diabetes mellitus (DM2).Material and methods. The analysis was carried out from the perspective of the healthcare system. The Markov model based on Russian epidemiological data, taking into account the results of foreign studies, was used. Vaccination schedules with 1 dose of 13-valent pneumococcal conjugate vaccine (PCV13) followed by 1 dose of pneumococcal 23-valent polysaccharide vaccine (PPV23) and vaccination with only 1 dose of PCV13 were evaluated. The time horizon of the study is 5 years. Costs and life expectancy were discounted by 3.5% per year.Results. Vaccination of 65-year-old patients with type 2 diabetes is characterized by extremely high cost-effectiveness (the incremental cost effectiveness ratio – ICER – for PCV13+PPV23 vaccination is 189.27 thousand rubles/QALY, and PCV13 vaccination entails a cost reduction of 371.92 rubles per 1 vaccinated). When vaccinating 40-year-old patients, the ICER for PCV13 + PPV23 vaccination is 491.31 thousand rubles/QALY, and for PCV13 – 55.31 thousand rubles/QALY.Conclusion. Vaccination against pneumococcal disease in 40and 65-year-old patients with DM2 reduces the associated morbidity and mortality and is highly cost-effective. Compared to PCV13 vaccination alone, vaccination with PCV13 followed by the introduction of PPV23 provides an increase in the number of prevented cases of the disease and the deaths caused by it, but at the same time requires additional costs.

Aim. To create and train a neural network (NN) of a predictive personalized model of pharmacotherapy choice in patients with heart failure with mildly reduced ejection fraction (HFmrEF) of ischemic origin.Material and methods. The study included 170 people with HFmrEF of ischemic origin, who on the background standard pharmacotherapy, received a beta-blocker (BB) or BB+mineralocorticoid receptor antagonist eplerenone (EP): bisoprolol (BIS); BIS+EP; nebivolol (NEB); NEB+EP. Patients underwent echocardiography and were analyzed for serum aldosterone (AL), tumor necrosis factor-α (TNF-α), matrix metalloproteinase 9 (MMP-9). To create the NN model, the following approximate predictive function of parameters was used: age, AL, TNF-α, MMP-9, sphericity index (SI), type of pharmacotherapy. The result of this function is a parameter vector: AL, TNF-α, MMP-9, SI and quality of life (QOL). The designed NN model is implemented in the Matlab software package for solving machine learning and Data Science problems. The NN model is represented as a connected graph and NN function. Dichotomous analysis was used to compare the effect of treatment types in pairs. For intergroup comparison of therapy, the Wilcoxon W test method. The critical significance (p) was considered

Cardiovascular diseases (CVDs) are the leading threat to the population health in the Russian Federation (RF), ranking first in the mortality structure. Demonstration of the economic impact of CVD is a rationale for investing in prevention and treatment. The economic damage caused by CVD in 2016 in the RF amounted to RUB 2,7 trillion, which is equivalent to 3,2% of gross domestic product (GDP). In the structure of damage by diseases, coronary artery disease occupies a leading position — RUB 1 trillion or 1,3% of GDP, while cerebrovascular diseases, stroke and myocardial infarction — RUB 560, 424 and 213,2 billion, respectively. Evaluation of cardiovascular prevention measures is not an easy task because the effect develops over a significant period of time. At the same time, various processes can affect the effect. The RF analysis showed that the potential economic effect from anti-tobacco and anti-alcohol measures, reducing salt consumption and increasing physical activity will be RUB 8,1 trillion in labor productivity increase over 15 years (equivalent to 7,8% of GDP in 2018), with most of the effect from the prevention of CVD deaths. Analyzing the economic impact of CVDs, preventive and curative measures provide a rationale for investment and is an important step in making informed decisions.

Aim. Research of the association of heart rate variability (HRV) with the level of psychosocial stress (PS) and other indicators of the risk of cardiovascular diseases in a sample of 41-44-year-old men living in Moscow.Material and methods. A total of 299 men aged 41-44 years were examined. The study included a clinical examination and a survey using a standard questionnaire. The categorization of risk factors (RF) for cardiovascular diseases (CVD) was carried out in accordance with generally accepted criteria The psychosocial stress was assessed using the Reeder scale. Depending on the psychosocial stress level, all surveyed men were divided into 3 groups by terciles: group 1 (3,28-4,0 points) – mild stress, group 2 (2,71-3,14) – moderate stress, group 3 (1,28-2,57) – severe stress. The analysis of HRV was performed on the basis of a short recording of an electrocardiogram using the original software package.Results. Nonparametric ANOVA showed that the mean [M (95% CI)] values of the HRV time domain (SDNN, rMSSD and the state of regulatory reserves) were lower in the group of men with high PS compared with the group with low PS [25.3 ms (20.9-29.7) versus 40.5 ms (30.7-50.3), p=0.007; 29.5 ms (24.6-34.3) versus 49.5 ms (36.7-62.3), p=0.030; and 46.7 (44.7-48.6) versus 49.7 (48.1-51.4), p=0.019; respectively]. On the contrary, the mean values [M (95% CI)] of the integral indicators of HRV (SI and IVR) were higher in the group of men with high PS [635.8 c.u. (556.2-715.4) versus 488.9 (423.8-554.1), p=0.005; 1172.6 (1045.1-1300.1) versus 904.7 (790.0-1019.4), p=0.003; respectively]. The results of correlation and multiple regression analysis confirmed that these HRV indicators are statistically significantly associated not only with PS, but also with other indicators (age, waist / hip ratio, diastolic blood pressure). However, their predictive value turned out to be low, and the proportion of the explained variance of HRV indices ranged from 2.5 to 13.1%.Conclusion. The weakening of the autonomous regulation of the heart rate with a decrease in the activity of the parasympathetic link, the activation of the central circuit of regulation with the prevalence of sympathetic influences, a decrease in the functional reserves of the heart rate regulation system are associated with an increase in the level of PS and other indicators of the risk of cardiovascular diseases.

Aim. To assess the significance of troponin I (hs-cTnI) for cardio­vascular risk stratification in a population of Russian working-age men and women of.Material and methods. The data of 13976 men and women aged 25-64 from the ESSE-RF1 and ESSE-RF2 multicenter studies were analyzed. The examination included following points: standard questionnaire, measurements of height, weight, waist circumference, body mass index, blood pressure, pulse rate, biochemical tests. The level of hs-cTnI in blood serum samples stored at -70оC in the Biobank of the National Medical Research Center for Therapy and Preventive Medicine was determined by chemiluminescent immunoassay analysis. Individual cardiovascular risk was calculated using the SCORE scale: values 12 pg/ml; women 10 pg/ml. We analyzed following hard endpoints: cardiovascular death or non-fatal myocardial infarction, and composite endpoint: the same and stroke.Results. The prospective analysis of the relationship between troponin levels and endpoints and composite endpoints showed that in participants without prior CVD, hs-cTnI levels >12 pg/ml in men and >10 pg/ml in women are associated with an increased risk of endpoints and composite endpoints by 3,39 (1,91-6,03) and 2,69 (1,6-4,52) times (p

Состояние здоровья в значительной мере определяет качество жизни человека. Это значимый социально-экономический ресурс и основа национальной безопасности страны.

Russian Society of Cardiology, National Society of Preventive Cardiology

Risk management is a key aspect of the organization and management of biobanks, which is part of the overall quality management system aimed at early detection, analysis and minimization of events, that can lead to negative consequences for the biobank, as well as affect the quality of biosamples and related data. The article presents the biobanking risk classification with the description of each category.Aim. To develop and implement the methodology for identification, analysis, evaluation and development of risk management measures for the biobanking process in the biobank of the National Medical Research Center for Therapy and Preventive Medicine.Material and methods. We present the methodology of the risk management process developed on the basis of the literary data, world experience and experience of the biobank of the National Medical Research Center for Therapy and Preventive Medicine.Results. The biobanking risk management procedure was developed and implemented in the biobank of the National Medical Research Center for Therapy and Preventive Medicine in 2020. The work carried out made it possible to identify, analyze and evaluate a wide range of potential negative events and actions that could lead to biobank damage, both in the form of financial losses and ethical and technical issues related to the biobanking process. A significant reduction in the frequency of emergency events and the high stability of the biobank operation under the influence of various external factors prove the effectiveness of the approach used.Conclusion. The creation and maintenance of a risk management system in the biobank allows, in combination with other measures, to ensure the safety and high quality of the procedures for collecting, processing and long-term storage of biomaterial and related data by creating an environment that rules out or minimizes the impact of various risks.

Aim. To analyze the availability and affordability of alcohol and tobacco outlets using the specialized software developed by the National Medical Research Center for Therapy and Preventive Medicine in the pilot subject of the Russian Federation — the Sverdlovsk Oblast.Material and methods. For the first time, experts from the National Medical Research Center for Therapy and Preventive Medicine conducted a pilot study to assess the actual state of the infrastructure of a separate subject of the Russian Federation (Sverdlovsk Oblast). The study objects were the urban infrastructure elements in which alcohol and tobacco products are sold. In order to assess the infrastructure, special software was developed using Open Street Maps to perform data collection tasks. The infrastructure data collection for the pilot study took place from January to March 2022.Results. The total number of tobacco outlets is 299, most of which are located in supermarkets (82,6%, n=247). The share of individual tobacco outlets accounts for 13,7% (n=41). Out of 357 supermarkets, 247 (69%) have tobacco sales section. The average lowest price of a cigarette pack is 121,6±15,7 RUB (minimum — 30 RUB, maximum — 207 RUB). Twentyseven (10,9%) of 247 supermarkets located

Aim. To present first results of the study on the assessment of municipal infrastructure using specialized software in a pilot subject of the Russian Federation (Sverdlovsk Oblast).Material and methods. The following infrastructure elements of four municipalities of the Sverdlovsk Oblast have been assessed in the period from January to March 2022: sports facilities, grocery stores, fairs/markets with fresh vegetables and fruits, alcoholic drinks in shops and supermarkets, special liquor stores, tobacco outlets, fast food restaurants). The assessment was made with specialized software developed using Open Street Map (OSM) that allows real-time recording of objects for interactive map data visualization.Results. The density of sales outlets for tobacco, alcohol, fresh vegetables and fruits was 2,3, 3,4 and 2,4 per 1 km², respectively; the density of sports facilities, fast food and restaurants — 1,3, 0,9 and 0,5, respectively. The number of sales outlets for tobacco, alcohol, fresh vegetables and fruits per 100 thousand people was 111,6, 167,7 and 116,5, respectively, while the number of sports facilities, fast food and restaurants — 63,5, 44,1, 25,0, respectively.Conclusion. Creation and implementation of integrated system for assessing a unified preventive environment for promoting health and maintaining a healthy lifestyle at the municipal level using a combination of objective (GIS technologies, paraclinical tests) and subjective assessment methods (personal survey), as well as the introduction of interactive maps of municipal infrastructure, will make possible use of evidence to make decisions on the development and implementation of programs for the prevention of cardiovascular diseases and health promotion, as well as their management at the regional/municipal level.

One of the effective approaches to the prevention of noncommunicable diseases and the extension of labor potential is the introduction of workplace wellbeing programs (WWPs). The implementation of WWPs and the formation of health promotion working conditions contribute to improvement of the wellbeing and quality of life of employees, reduce presenteeism, absenteeism and improve the economic performance of the company.Aim. To assess the experience of implementing the WWPs among employers in Russia using the ATRIA electronic platform.Material and methods. Experts from the National Medical Research Center for Therapy and Preventive Medicine have developed a set of tools (a questionnaire for employers and employees) to assist in the development and implementation of WWPs. A link to an ATRIA electronic platform was sent to the chief external specialists in preventive medicine to ensure a wide coverage of the country’s population. The survey was conducted from April 2020 to October 2021.Results. The survey involved 181 employers and 7500 employees (women, 63,2%, n=4735), but not every respondent answered all questions. The companies related to education, science and culture (23,8%, n=43), metallurgy/mining (19,9%, n=36) and chemical/ petrochemical industry (11,6%, n=21). The majority of employers (73%; n=73) consider it necessary to develop and implement WWPs, while the majority of them (66,9%, n=121) were not familiar with such programs. Companies mainly implement health examinations (79,4%, n=100), vaccination (78,6%, n=99), measures aimed at increasing the physical activity (73,8%, n=93). Only 50% of employers evaluate the effectiveness of WWPs: according to a survey of employees — 41,2% (n=47), according to temporary disability rate — 27,2% (n=31), according to staff turnover — 13,2% (n=15). Through the implementation of the WWPs, employers expect to improve employee health (94,4%, n=171), employee satisfaction (81,2%, n=147), morale (77,3%, n=140) and workforce productivity (75,1%, n=136).Conclusion. The prevalence of WWPs in Russia varies depending on the industry, the entities involved in its implementation, the nature of work and the number of employees, which creates health inequalities and justifies the need to develop targeted interventions and measures to implement WWPs.

Aim. To assess the 7-year survival rate and the association of risk factors (RFs) with all-cause and cardiovascular mortality among rural residents in Russia and the Kyrgyz Republic, as well as to analyze ethnic characteristics (according to the Interepid study).Material and methods. This study was carried out within the Interepid international project, which included a cross-sectional epidemiological study of the prevalence of major noncommunicable diseases and their risk factors in 2011- 2012, and a prospective stage among rural residents of two countries (Russia, the Kyrgyz Republic). In 2019, the vital status of respondents was reassessed (7 years after the initial examination), and endpoints were collected, including all-cause and cardiovascular deaths.Results. A significant similarity of rural residents of the analyzed regions in relation to the factors associated with mortality was revealed. Smoking in men, obesity in women, and hypertension in both sexes were associated with an increased death risk. Country differences were found only in relation to low physical activity and dietary habits. Ethnic developments in the population of the Kyrgyz Republic also concerned only the contribution of food habits.Conclusion. The results obtained are important for planning, implementing and evaluating the effectiveness of public health promotion programs. It is also necessary to develop differentiated treatment and prevention measures in the Russian population and among the indigenous inhabitants of the Kyrgyz Republic, including taking into account the prevalence of CVD risk factors and their impact on life prognosis.

Aim. To evaluate a 1-year outpatient management of patients after myocardial infarction (MI) aged

Aim. To establish the correlations of the soluble suppression of tumorigenicity 2 protein (sST2) and N-terminal pro-brain natriuretic peptide (NT-proBNP) with some clinical and paraclinical characteristics of patients with heart failure (HF).Material and methods. The study included 130 patients with HF (men — 54, women — 76, mean age, 64,3±8,3 years) from the regional registry of HF patients in the Voronezh Oblast. All patients underwent echocardiography and general clinical investigations. In addition, the serum levels of sST2 and NT-proBNP were determined and their correlations with other parameters were studied.Results. The blood level of sST2 in HF patients was 339,8 [266;405] pg/ml. In the study sample of patients with HF, sST2 levels correlated with right atrial (r=0,49) and right ventricular (r=0,32) sizes, left ventricular end-diastolic dimension (r=0,34) and volume (r=0,33), left ventricular early diastolic filling rate (r=-0,35), blood calcium level (r=-0,55) and functional class of exertional angina (r=-0,37).Conclusion. The data obtained may indicate a pathogenetic relationship between sST2 and systolic and diastolic dysfunction of the left ventricle and right heart.

Previous studies have shown significant differences in the health status of the population depending on the place of residence. Despite the ongoing preventive measures, there is no improvement in the epidemiological situation in relation to noncommunicable diseases, including due to unfavorable living conditions. This study is a continuation of the following earlier studies: Epidemiology of Cardiovascular Diseases in Regions of Russian Federation (ESSE-RF) and ESSE-RF-2.Aim. To assess the prevalence of cardiovascular diseases, various risk factors (RFs) of these diseases and their association in Russian regions with different economic, climate and geographic characteristics to determine the risk profile of the region and develop approaches to targeted prevention programs specific to the regions.Material and methods. The study selected 30 regions representing each federal district of the Russian Federation. The survey of participants is carried out in three stages as follows: survey using an original modular questionnaire; measurements, including anthropometry, hand grip strength test, blood pressure and heart rate assessment; blood sampling, followed by biobanking and laboratory tests.Conclusion. The results obtained will allow deepening knowledge about the RF profile specific to a particular region, evaluating the effectiveness of preventive programs, and planning new ones taking into account regional and socio-demographic characteristics. This will become the basis for a better understanding of the socio-economic burden of noncommunicable diseases and the economic damage of RFs.

Aim. To study the efficacy and tolerability of Sputnik V vaccination in patients with noncommunicable diseases (NCDs) compared with healthy individuals.Material and methods. The retrospective analysis included data from 800 men and women aged 18 to 90 who were vaccinated from February to May 2021 at the National Medical Research Center for Therapy and Preventive Medicine. Sputnik V (Gam-COVID-Vac, Russia), consisting of two doses, was used as a vaccine. The mean age of the patients was 50,46±13,16 years. Patients were questioned in two stages: before vaccination and after the first dose of vaccination. The following clinical and paraclinical investigations were carried out: saturation assessment, measurement of temperature, blood pressure and heart rate at rest, pharynx examination, auscultation of the heart and respiratory organs. The blood concentration of antibodies (IgM and IgG) was determined after 21 days and 42 days. For analysis, patients were divided into three groups. The first group included healthy individuals (n=238, 29,8%), the second group — patients with one NCD (n=385, 48,1%), and the third group — patients with two or more NCDs (n=177, 22,1%).Results. The sex composition was comparable in all three groups, while the mean age differed. In the first group, the mean age was 43,93±10,80 years, while in the second and third groups — 50,51±12,55 and 59,12±12,37 years, respectively (p

High salt intake is an important risk factor for cardiovascular diseases (CVD), closely related to the level of blood pressure in the population. The purpose of the review: to study population-based interventions for CVD prevention, aimed at reducing salt intake; to assess the potential for their implementation in the Russian Federation. We presented population-based strategies for dietary salt intake reduction used in different countries. The main components of strategies aimed to correct this risk factor in the Russian Federation were identified. The main components of the population-based approach to reducing salt intake are: determining population salt consumption, identifying sources of salt in the diet, monitoring of salt content in products, engaging with the food industry, consumer awareness campaigns, changes in product labeling, tax measures. An integrated approach to the problem is the most successful. Measures which were highly effective have not yet been fully implemented in the Russian Federation. At the moment, taxation of high-salt foods and tax subsidies for healthy food are not applied. Food manufacturers are not sufficiently involved - there are no legislatively introduced measures to reduce salt through food reformulation. Firstly it has to be applied to diet-forming products that are consumed daily, such as bakery and dairy products, and meat products.

Aim. To analyze hospital admission and ambulatory care of the patients with arterial hypertension (AH) in federal districts and regions from the perspective of the WHO concept of diseases, which can be treated in ambulatory settings (ambulatory care sensitive conditions, ACSC).Material and methods. For analysis we used data from annual forms of federal statistical monitoring (12 and 14), which includes data on hospital admissions with hypertension in federal districts and separate regions in 2017. Hypertension included diseases characterized by raised blood pressure, ICD10: I10-I13.Results. We performed the analysis of 12 and 14 forms per districts and regions of the Russian Federation. Regions with increased hospitalization rates and an increased ratio of the hospitalizations to number to outpatients visits were identified. High variability of these indicators was observed both among both between regions and federal districts. The values of the ratio indicator vary from 0.0131 in the Nizhny Novgorod Region to 0.0234 in the Chechen Republic. The average value of the ratio in the federal district varies from 0.032 in the Volga Federal District to 0.119 in the North Caucasus Federal District. In the North Caucasus and Far East Federal District the value of the indicator is significantly higher than in other districts.Conclusion. Assessing diseases which can be treated in ambulatory setting scan be one of the tools for evaluating the quality of medical care in primary care facilities. However, before including ACSC as an indicator of the quality of health care delivery, a deeper understanding of the reasons that can impact its rates is required.

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, p

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.