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Aim. To evaluate the contribution of arterial hypertension (AH), high lowdensity lipoprotein cholesterol (LDL-C) level and their combination to the development of (myocardial infarction) MI and stroke.Material and methods. The analysis is based on data from 1 and 2 observations of ESSE-RF study (Epidemiology of cardiovascular diseases in various regions of the Russian Federation)". A multi-s tage cluster random sample was used, formed according to the territorial principle on the basis of medical and preventive institutions (health facilities). Socio-demographic data (gender, age, education, wealth), smoking status and medical history were determined. Blood pressure (BP) was measured twice, on the right arm, in a sitting position with an automatic blood pressure monitor. Blood samples and its derivatives (serum and plasma) were stored at a temperature of -70ºC. LDL-C value was also included into analysis (LDl- C ≥3 mmol/l). Prospective monitoring of new cases was carried out in the initial sample without patients with coronary artery disease, MI, and stroke. The median follow-up time is 7.5 years. The sample size was 19 794. 356 non-fatal cases were identified, including 222 cases of MI and 174 cases of stroke.Results. The average age was 44.7 years, in men — 43.2, and in women — 45.3. The prevalence of isolated forms of hypertension, high LDL-C level and its combination were 12.7%, 30.3% and 32%, respectively. It was revealed that the age was the lowest in healthy and those with an increased LDL-C, whereas those with hypertension and combined conditions were older. The risk of nonfatal cases of MI and stroke in the Cox models, was adjusted for gender, age and region. There was a significantly higher risk of new cases of nonfatal CVD in individuals with isolated hypertension compared with those with isolated LDL-C.Conclusion. The frequency of isolated AH and isolated LDL-C were 13% and 30%, respectively. The combined condition was detected in 30%. The presence of AH, isolated LDL-C and their combinations in the sample doubled the risk of new CVD events.

Aim. To study the risk of type 2 diabetes (T2D) using the Finnish Diabetes Risk Score (FINDRISC) and its contribution to all-cause mortality and cardiovascular events in the Russian population aged ­25-64 years.Material and methods. Data from cross-sectional studies ESSE-RF and ESSE-RF2 are included. The random sample was formed using the Kish method. Response was ~80%. The modular questionnaire in­cluded socio-demographic variables, medical history, and main risk factors for noncommunicable diseases. Blood was collected from the antecubital vein on an empty stomach. Biochemical parameters were determined in the clinical diagnostic laboratory of the National Medical Research Center for Therapy and Preventive Medicine. The presence of T2D was determined by questionnaire and/or fasting plasma glucose level ≥7,0 mmol/L. Obesity was defined as a body mass index of ≥30,0 kg/m2; abdominal obesity was defined as a waist circumference of ≥102 cm in men and ≥88 cm in women. FINDRISC risk was graduated as follow: low (20). Persons with diabetes and pregnant women were excluded. The final sample included 26418 people (10268 men and 16150 women). From 14 regions, ESSE-RF and ESSE-RF2 formed a prospective follow-up cohort (n=22812), median follow-up — 7,5 years). Statistical processing was performed using the open-source statistical programming language and environ­ment R (version 4.1).Results. A fifth of people aged 25-64 years are at ≥ moderate risk of T2D. The rate of FINDRISC ≥15 was 10,1% (women 12,4% vs men 6,4%, p

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 assess the prevalence of type 2 diabetes (T2D) and prediabetes in the Russian population aged 25-64 years, as well as the association of prediabetes with risk factors (RFs) of noncommunicable disease. To study the contribution of carbohydrate metabolism disorders to mortality and the occurrence of cardiovascular events.Material and methods. We included data from cross-sectional studies ESSE-RF and ESSE-RF2. The final sample included 26418 people (10268 men and 16150 women) who signed informed consent. A modular questionnaire was used. Biochemical parameters were determined in the National Medical Research Center for Therapy and Preventive Medicine with an Abbott Architect c8000 autoanalyzer using diagnostic kits from Abbott Diagnostics (USA). Impaired fasting glycemia (IFG) was defined as a fasting plasma glucose concentration of 6,1-6,99 mmol/L. The presence of T2D was determined by interview and/or fasting plasma glucose ≥7,0 mmol/L. Obesity was defined as a body mass index of ≥30,0 kg/m2. Abdominal obesity was defined as a waist circumference of ≥102 cm in men and ≥88 cm in women. A prospective observation cohort was formed from 14 regions of ESSE-RF and ESSE-RF2 (n=22812). The vital status of each examined person was clarified once every 2 years. Information on fatal and non-fatal events was collected. Statistical processing was performed using the open-source statistical programming language and R environment (version 4.1). Associations were assessed using logistic regression. Kaplan-Meier curves were used to estimate survival. Associations with endpoints were assessed using Cox proportional hazards models.Results. In the Russian population aged 25-64 years, the prevalence of T2D and prediabetes, assessed by IFG, was 6,9% (men — 7,1%, women — 6,7%) and 6,2% (men — 7,7, women — 5,0% (p

According to the Federal State Statistics Service of Russia, from 1970 to 2019, cardiovascular diseases remain one of the main causes of death in Russia. To date, the relationship between cardiovascular mortality and deprivation in Russia remains insufficiently studied.Aim. To identify the relationship between regional deprivation and cardiovascular mortality among the adult population of Russia.Material and methods. The Russian deprivation index was used to measure the deprivation level. The index indicators were obtained from official Rosstat statistics and the All-Russian Population Census for 2010. Cardiovascular mortality by age (five-year groups) and sex in the constituent entities of Russia from 2006 to 2012 was obtained from the Russian database on fertility and mortality of the Center for Demographic Research of the Russian Economic School.Results. The fully adjusted model showed a reduction in mortality (Mortality Rate Ratio (MRR), 0,93; 95% confidence interval: 0,91-0,94) in regions with the greatest overall deprivation compared to the least deprived regions. There is a decrease in mortality in the most socially deprived regions compared to the least deprived ones. The fully adjusted model showed a trend toward increased mortality across levels of economic deprivation (from less deprived (Q2) to more deprived (Q3 and Q4) compared to least deprived regions (Q1)). Our study showed an increase in mortality in the most environmentally deprived regions — MRR, 1,02; 95% confidence interval: 1,00-1,04.Conclusion. The study established a link between general, social, economic and environmental deprivation and cardiovascular mortality.

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 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.

High salt intake is a risk factor for the development of hypertension, most cardiovascular diseases and their complications.Aim. To study the characteristics of high salt intake in Russian and Moscow populations according to epidemiological studies.Material and methods. Data from representative samples of adult population aged 25-64 years (n=21922, 8372 men and 13550 women) from Russian 13 regions and persons aged >18 years (n=4063, 1662 men and 2401 women) from Moscow were used. A combination of 2 out of 3 items was taken as excess salt intake: daily consumption of meat and sausage products and pickles and/or adding salt to the finished dish. The results are presented as frequencies and odds ratios (OR).Results. The prevalence of high salt intake in the Russian population was 49,3% (53% among men and 47% among women); in the Moscow sample — 49,6% (60,3% for men and 41,9% for women). The habit of adding salt to a finished dish is widespread in the Russian Federation — 40,5% (47% among men and 34,7% among women); among Muscovites it is less pronounced — 25,8% (31,6% among men and 21,7% among women). Positive associations of high salt intake were noted with male sex (OR=1,1), education level (OR=1,5 and OR=1,3 for primary and secondary education, respectively), smoking (OR=1,74), alcohol consumption (OR=1,3, OR=1,4 and OR=1,5 — for moderate, high and very high alcohol consumption, respectively), rural place of residence (OR=1,34), anxiety (OR=1,27), depression (OR=1,36) and abdominal obesity (OR=1,1), and negative — with thyroid disease (OR=0,9), previous cerebral stroke (OR=0,8) and type 2 diabetes (OR=0,87). The prevalence of high salt intake in the all-Russian sample is not associated with income level and age, but was noted among Muscovites.Conclusion. In the Russian population, a high prevalence of high salt intake was revealed, which is more pronounced among smokers, alcohol drinkers, those with primary and secondary education levels, rural residents, as well as those with anxiety and depression.

Aim. To study the associations of elevated brain natriuretic peptide (BNP) and heart failure (HF) and their contribution to the survival of the middle-aged population.Material and methods. The analysis included blood pressure levels and heart rate, anthropometric parameters and biochemical tests. BNP was determined on an Architect i2000sr analyzer (Abbot Diagnostics, USA). HF was diagnosed according to criteria close to the EPOCH-CHF study criteria: cardiovascular disease (CVD), weakness, shortness of breath. Survival analysis was performed for 5037 people from the ESSE-RF2 sample (Ryazan and Omsk regions, the Republic of Karelia, Krasnodar Territory). The analysis used a composite endpoint (n=143) of CVD death plus non-fatal myocardial infarction or cerebrovascular accident. The follow-up time was, on average, 3,82 [3,65-3,86] years.Results. The prevalence of HF in the ESSE-RF2 sample aged 35-64 years was 7,9% according to our criteria, while a third of the participants were men (35,9%). The average age of the population was 45 [34; 55] years, which is significantly lower than the age of patients: 56 [50; 61] years. Almost 100% of patients with HF in our sample at this age were etiologically associated with hypertension (HTN) (94,1%), which is more than 2 times higher than in the population. A third of HF is due to coronary artery disease, which is 4 times higher than in the population. Similarly, the prevalence of cerebrovascular accident and diabetes exceeds their prevalence in the population. The detection rate of elevated BNP (>35 pg/ml) was 11,9% in the population, and 24,5% in the HF sample. An independent significant contribution of BNP >100 pg/ml was revealed, which can be characterized as the most powerful marker associated with HF. The relative risk was 3,21 [1,75-5,39]. Kaplan-Meier curves show higher survival of participants without HF and elevated BNP levels (>35 pg/ml) compared to other groups. There were no significant differences between the curves with HF and elevated BNP, while patients with HF in combination with an elevated BNP had a significantly lower survival rate. Analysis using Cox models indicates that patients with only HF or only with elevated BNP die ~2 times more often than those who do not have these signs. An increase in BNP along with HF has a cumulative effect: individuals with both high BNP and HF die 5 times more often than those who do not have these disorders at all, and ~2 times more often than those who have only one sign.Conclusion. The obtained results indicate that an elevated level of BNP is a prognostically unfavorable factor at the population level. Although blood BNP levels are recommended to be measured in individuals with suspected CVD, we believe sufficient randomized controlled trials are needed to evaluate the potential use of BNP in individuals with risk factors. This can improve the diagnosis and, accordingly, the treatment and prognosis of HF.

Aim. To perform a population analysis of Non-High Density Lipoprotein Cholesterol level (non-HDL-c) in Russian population and to evaluate its association with cardiovascular events.Material and Methods. The material consisted of results obtained from 11 regions of the ESSE-RF1 Study and from 4 regions of the ESSE-RF2 Study. Study protocols were identical. The studies were performed in 2012-2014 and 2017, respectively. Endpoints were assessed in 19041 people aged 35-64 years. The median follow-up was 6.5 years in ESSE RF (1) and 3.8 years in ESSE RF(2). Analysis was performed for three lipid variables: total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and non-HDLC in two samples: the general population sample and the same sample without individuals with coronary heart disease (CHD), myocardial infarction (MI) and/or stroke history and not taking statins (the population sample of "without a history of cardiovascular diseases [CVD]". The analysis of nonlinear associations was performed using the generalized additive Cox model. The combined cardiovascular endpoint was represented by cardiovascular death and nonfatal MI and stroke. Traditional and laboratory FRs, socio-demographic parameters were analyzed. The significance level for all tested hypotheses was set to be 0.05.Results. The prevalence of elevated non-HDL-C level (>3.7 mmol/l) was found to be 74.6%. No gender differences were found: there was 74.6% for men and 74.5% for women. Both mean values and prevalence of elevated non-HDL-C were increased with age in women, and its level was slightly decreased in men after 55 years old. Almost all analyzed RFs were significantly associated with elevated non-HDL-C in these two population samples. In both samples elevated total CH and elevated LDL-C were associated with all-cause mortality after correction for all RFs. On the contrary, the non-HDL-C was associated with CVD combined end pints. It has been shown that the risk of these end points increases uniformly with increase in levels of non HDL cholesterol, no nonlinear associations were found.Conclusion. The results of a population-based analysis of non-HDL-C performed in the Russian population for the first time confirmed that elevated non-HDL-C levels contribute significantly to determining the risk of cardiovascular events in the medium term. It can be assumed that the new risk scales (SCORE2 and SCORE OP) proposed by the European Society of Cardiology and the European Society of Preventive Cardiology, which include non-HDL C instead of TC, will allow adequate assessment of 10-year cardiovascular risk for Russians. However, continued monitoring of endpoints in order to obtain stable associations is required.

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

The methodological rationale contains a description of epidemiological research methods, provides an analysis of the key concepts of epidemiology (population, sample, risk factor (RF)), in the context of prevention priorities, as well as describes each of the main RFs for noncommunicable diseases (NCDs), including cardiovascular diseases. Emphasis is placed on behavioral and mediated biological RFs, such as smoking and alcohol consumption, poor nutrition (low consumption of vegetables and fruits), physical inactivity, high blood pressure, dyslipidemia and obesity, hyperglycemia and diabetes. The methodological rationale was created with the aim of popularizing epidemiological studies, expanding the scope of its use by clinicians, primary care physicians, specialists from medical prevention centers, providers of preventive measures, as well as decision makers in the healthcare system. The sphere of the implementation of epidemiological data covers both the planning of preventive programs for the modification of risk factors in the population, and monitoring the effectiveness of preventive measures. These materials will also be useful in the development of a population, regional and municipal strategy for the prevention of NCDs and related RFs in Russia.

Aim. To assess the prevalence of non-alcoholic fatty liver disease (NAFLD) using the liver obesity index — FLI (Fatty Liver Index), and to study its associations with socio-demographic indicators and behavioral risk factors for NAFLD.Material and methods. The data from the multicenter ESSE-RF study (Epidemiology of cardiovascular diseases in the regions of the Russian Federation) — samples from the unorganized male and female population aged 25-64 years were used. 5,161 respondents were included, of which 2,275 (44,1%) were men. To assess the prevalence of NAFLD, the liver obesity index FLI was used, calculated according to the formula by Bedogni G, et al. (2006). A high FLI index ≥60 was considered a predictor of liver steatosis.Results. High FLI ≥60 was detected in 38,5% of men and 26,6% of women. Multivariate analysis of associations of high FLI index in men and women showed a strong relationship with age: men — odds ratio (OR) 5,01, 95% confidence interval (CI): 3,82-6,59 (p

Aim. To study the prevalence of myocardial infarction (MI) in the population of Russian regions and its contribution to cardiovascular events.Material and methods. The analysis material was representative samples of the population aged 35-64 years from 11 Russian regions, examined within the multicenter study “Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation”. The response rate was about 80%. The study used a community-based systematic stratified multiply random sample. During the study, information on prior MI was obtained using a standard questionnaire. Anthropometry and measurement of blood pressure (BP) and heart rate (HR) with an automatic BP monitor were performed. Resting electrocardiography (ECG) was performed, followed by Minnesota coding. Major and minor QQS waves and STT segments were considered as ischemic ECG abnormalities. Biochemical parameters were determined using an Arkhitect 000 Clinical Chemistry Analyzer. The median prospective follow-up was 6,21 [5,25; 6,75] years. A composite endpoint (CE) was analyzed, including cardiovascular death and non-fatal MI. During the follow-up period, 363 all-cause deaths were detected, of which 134 were from cardiovascular diseases, while 196 — CEs. Statistical analysis was carried out in R 3.6.1 environment.Results. The MI prevalence among the Russian population was 2,9%; 5,2% for men and 1,5% for women, increasing with age. Men with prior MI were more likely to take statins and beta-blockers than women as follows: 39,0% vs 25,6% and 29,3% vs 27,1%, respectively. MI newly diagnosed within the follow-up period was associated with the following risk factors (RFs): smoking, increased BP, HR, triglycerides and glucose. For individuals with prior MI, a significant relationship was found only with smoking. Multiple comparison of the contribution of RFs, ECG abnormalities, and prior MI showed that the inclusion of ischemic ECG abnormalities in the analysis significantly increases the risk of cardiovascular events in individuals without prior MI compared with individuals without both MI and ECG changes. A high CE risk was noted in patients with prior MI: relative risk (RR), 4,73 (2,92-7,65); the addition of ischemic ECG abnormalities increased the RR to 5,75 (3,76-8,8).Conclusion. The RR of CEs in patients with prior MI without or with ischemic ECG changes is 4,73 and 5,75 times higher than in patients without MI and ECG abnormalities. The risk factors identified in this case cannot explain such an increase in CEs. It is obvious that people with prior MI need rehabilitation. The presence of RFs in patients with newly diagnosed MI indicates insufficient primary prevention, which suggests that strengthening preventive measures to eliminate conventional risk factors in patients with newly diagnosed MI will help reduce the risk of recurrent MI or cardiovascular mortality.

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 relationship of blood pressure (BP) and heart rate (HR) in a sample of men and women 25-64 years old and their predictive value for the development of fatal and non-fatal cardiovascular diseases (CVD) and mortality from all causes.Material and methods. Prospective observation was for cohorts of the population aged 25-64 years from 11 regions of the Russian Federation. 18,251 people were included in the analysis. Each participant gave written informed consent. All surveyed persons were interviewed with a standard questionnaire. BP was measured on the right hand with an automatic tonometer. BP and HR were measured twice with an interval of 2-3 min with the calculation of the average value. The patients were divided into 4 groups: the first group with BP80; the third group – BP≥140/90 mm Hg and HR≤80; the fourth group – BP≥140/90 mm Hg and HR>80 beats/min. Risk factors and cardiovascular history were analyzed as well. Deaths over 6 years of follow-up occurred in 393 people (141 – from CVD). Statistical analysis was performed using the open source R3.6.1 system.Results. A HR>80 beats/min was found in 26.3% of people with BP≥140/90 mm Hg, regardless of medication. Analysis of the associations between HR and BP showed that for every increase in HR by 10 beats/min, systolic BP increases by 3 mm Hg. (p80 beats/min and BP≥140/90 mm Hg had the shortest life expectancy (p80 beats/min in people with BP≥140 mm Hg amounted to 26.34%. Every 10 beats/min significantly increases the risk of mortality by 22%. Increased HR with elevated BP leads to increased adverse outcomes.

Aim. To study the influence of social determinants on the frequency of glomerular filtration rate (GFR) categories of various levels, as well as associations with a number of cardiovascular diseases (CVD) and cardiovascular risk factors among the population of four Russian regions included in the ESSE-RF-2.Material and methods. The study was performed as part of a multicenter epidemiological study “Epidemiology of cardiovascular diseases in the regions of the Russian Federation. The second study (ESSE-RF-2)”. In total, 6681 people 25-64 years old from 4 regions of Russian Federation were included in the analysis. The CKD-EPI formula was used to calculate GFR by blood creatinine level. Groups with normal GFR (≥90 ml/min/1.73 m²), with an initial decrease in GFR (

Aim. To study the contribution of hypertension (HTN) to survival and mortality in the Russian population.Material and methods. This prospective observational cohort included representative samples from 11 Russian regions (men and women aged 25-64 years, n=18251) examined in 2012-2014 as part of the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF) study. The examination included a questionnaire (12 modules), anthropometric and blood pressure (BP) measurements, as well as biochemical blood tests. HTN was considered aa a systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg, or when a subject receives antihypertensives. Treatment efficacy was considered as the proportion of persons (%) who achieved target BP among those taking antihypertensives. Depending on HTN status, all participants were divided into 4 groups: 1) those without HTN;2) those with HTN, taking antihypertensive agents and having systolic BP ≤140 mm H. and diastolic BP ≤90 mm Hg (effective therapy);3) those with HTN, taking medications, but not achieving target BP (ineffective therapy); 4) those with HTN, not taking antihypertensives. The life status of participants was updated every 2 years. Kaplan-Meier survival curves, as well as univariate and multivariate Cox proportional hazards models were created.Results. The presence of HTN significantly reduced survival (p

Aim. To study the associations of subclinical and clinical anxiety and depression, assesed by the Hospital Anxiety and Depression Scale (HADS), ≥8 points and ≥11 points, respectively, with all-cause mortality and cardiovascular mortality, as well as with the total number of nonfatal cardiovascular events (CVEs) in Russia.Material and methods. The study included male and female population aged 25-64 years from the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF) study who signed an informed consent. The study included 16941 people (men, 6811 (40,2%)). To assess the anxiety and depression, HADS scale was used. The statistical analysis included individuals with subclinical/clinical (HADS ≥8) and clinical (HADS ≥11) anxiety and depression (HADS-A and HADS-D). The median of prospective follow-up was 5,5 years (from 2012 to 2019). The composite endpoint (CE) (cardiovascular death and nonfatal CVE occurred in 268 (4,2%) men and 203 (2,1%) women, while all-cause — in 220 (3,2%) men and 152 (1,5%) women.Results. The results obtained showed that the survival rate of men and women with varying degrees of anxiety (HADS-A ≥8 and ≥11) was associated with all-cause mortality and CE in women. However, this relationship has not been confirmed in multivariate models. In the multivariate Cox proportional hazards model 1 (M1), a significant association of depression with all-cause mortality in women was revealed — HADS-D ≥8: relative risk (RR), 2,22; 95% confidence interval (CI): 1,56-3,15 and ≥11: RR, 2,43; 95% CI: 1,65-3,59 (p

Aim. To study the associations of increased spatial QRS-T angle (sQRS-Ta ≥90°) with cardiovascular risk factors (RFs).Material and methods. We analyzed 1411 electrocardiography (ECG) records of men and women aged 25-64 years from a random regional sample of the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF) study. Relationships of sQRS-Ta with the following RFs were assessed: hypertension (HTN), systolic blood pressure (SBP) ≥140 mm Hg, diastolic BP (DBP) ≥90 mm Hg, pulse pressure (PP) ≥60 mm Hg; glucose ≥7,0 mmol/l, hypercholesterolemia; hypertriglyceridemia; high-density lipoprotein cholesterol (HDL-C) ≤1,0/1,2 mmol/l in men/women, low-density lipoprotein cholesterol (LDL-C) >3,0 mmol/l; C-reactive protein (CRP) >1 mg/L; overweight, obesity and abdominal obesity; heart rate (HR) >80 bpm; age >52 years.Results. Weak but significant correlations of sQRS-Ta with age (in women), SBP, DBP, PP, body mass index, waist circumference, lipids, glucose, CRP were revealed. Univariate logistic regression demonstrated significant associations of increased sQRS-Ta with HTN, elevated SBP and PP, overweight, obesity and abdominal obesity, hypercholesterolemia, elevated LDL-C and CRP, hyperglycemia, age >52 years and heart rate >80 bpm. There were no associations of increased sQRS-Ta with male sex, elevated DBP, smoking, hypertriglyceridemia, and low HDL-C levels. The sQRS-Ta associations characteristic of women was similar with associations found among the entire sample. Men with increased sQRS-Ta had no associations with any of analyzed RFs. In multivariate models, increased sQRS-Ta was associated with the following combination of RFs: age >52 years, heart rate >80 bpm, HTN, increased PP, overwaight, and male sex. According to direct stepwise selection among all subjects and in women, the main contribution to sQRS-Ta was made by SBP, age, HDL-C and heart rate.Conclusion. Despite the significance of stepwise regression model (p=0,0001), the low coefficient of determination R2 may indicate other not yet identified determinants with relevant associations with sQRS-Ta.

Aim. To assess regional living conditions with cardiovascular outcomes based on prospective stage of the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF) study.Material and methods. We used data from a 3- and 5-year prospective stage of the ESSE-RF study (2012-2013). For initial screening, 16210 people aged 25-64 were included. To characterize the regions of residence, 5 regional indices (RIs) were used. The following endpoints were considered: cardiovascular death, myocardial infarction, stroke, composite endpoint (cardiovascular death + myocardial infarction + stroke). To assess the correlations, generalized estimating equations with nested data structure (individuals in the regions) were used. The studied associations were adjusted for a wide range of potential effect modifiers.Results. There are multiple direct associations of RIs with the likelihood of all endpoints. The exception was the reverse association of Industrial RI with cardiovascular death. The most stable associations regarded Mixed RI, Industrial RI and Socio-geographical RI, with a high RI significance in endpoint development, compared with well-known individual cardiovascular risk factors. Separate associations were noted for Economic RI and Demographic RI.Conclusion. The results indicate a significant contribution of a number of regional living conditions to individual risk of fatal and non-fatal cardiovascular outcomes.

The presence of a disease, the prognosis of which can be improved by dietary modification, motivates a patient to change their eating habits.Aim. To study the associations of dietary patterns and alcohol consumption with cardiovascular diseases (CVDs), diabetes, myocardial infarction (MI), and stroke in the adult population.Material and methods. The analysis was carried out using data from representative samples of population from 13 Russian regions aged 2564 years (n=19520; men, 7329; women, 12191). The response rate was ~80%. Dietary characteristics were assessed by frequency method.Results. In the diet of people with CVDs, the daily intake of vegetables/ fruits increases by 84% in men and by 19% in women, while the use of animal fats in cooking decreases by 28% and 20%m respectively (p

The alcohol consumption is associated with dietary patterns. Aim. To study the associations of alcohol consumption and dietary patterns in the adult population. Material and methods. The analysis was carried out using representative samples of male and female population aged 25-64 years (n=19437; men, 7306; women, 12131 women) from 13 Russian regions.The response rate was 80%. We assessed nutrition by the frequency of consuming basic food groups. The low alcohol intake (LI) category includes women and men who consume

Experimental and clinical data indicate a significant contribution of lipoprotein(a) (Lp[a]) to the atherogenesis. However, the pathophysiological mechanisms of this relationship are not fully understood.Aim. To investigate the distribution of Lp(a) in the population of the regions participating in the Study “Epidemiology of Cardiovascular Diseases in the Regions of the Russian Federation” (ESSE-RF) and to evaluate its associations with cardiovascular risk factors.Material and methods. Representative samples of the male and female population of 7 regions of the Russian Federation, aged from 25 to 64 years, enrolled in the multi-center cross-sectional epidemiological study were analyzed. A total of 10332 people were examined, of whom 3732 were men (36.0%) and 6600 were women (64.0%), the average age was equal in both sexes.Results. The mean value of Lp(a) reached 22.4 mg/dl (standard deviation 21.3 mg/dl) and significantly differed from the median (11.1 mg/dl; interquartile range from 3.9 to 20.2 mg/dl), forming the right-skewed distribution in both male and female population. Lp(a) levels were statistically significantly correlated with the level of low-density lipoproteins cholesterol (LDL-C), ароВ/аpoAI and total cholesterol. Notably, the odds ratios were growing by quintiles, and increased along with increasing lipid values (p

Educational status affects the nature of nutrition.Aim. To study the differences in the nutrition pattern of the adult population of the Russian Federation, depending on the educational qualification.Material and methods. The analysis includes the results of a survey of representative samples of male and female population aged 25-64 years (19,520 people, of which 7,329 men and 12,191 women) from 13 regions of the Russian Federation. The nature of the diet was evaluated by the frequency of consumption of the main groups of products and individual eating habits (supplementation, the use of animal fats in cooking).Results. Men of high literacy have higher consumption of raw vegetables and fruits — by 20%, dairy products — by 14%, including cheese — by 15%. There is also a lower consumption of meat and sausage products — by 17%, pickles — by 12% and poultry — by 11%. Less commonly, there is an adding more salt habit — by 18% and the use of animal fats in cooking — by 10%, more often — the consumption of low-fat and non-fat dairy products — by 22%, as well as raw sugar in an amount not exceeding 5% of the daily calorie content — by 21% The level of consumption of red meat, cereals and pasta, legumes, sweets, cottage cheese, sour cream and cream showed no significant differences with men of a different educational status. Women of high educational status more often include vegetables and fruits in their daily diet — by 14%, dairy products — by 18%, including cheese — by 15%. Less often they consume butter — by 12%, as well as foods with a high salt content: meat and sausage products — by 22% and pickles, marinades — by 15%. Russians with “above average” education are less likely to add more salt — by 14% and use animal fats in cooking — by 14%, more often they choose low-fat and nonfat dairy products — by 21%. In the level of consumption of red meat, cereals and pasta, legumes, sour cream and cream, there were no differences.Conclusion. People with a high literacy in the Russian population regardless of gender differences have a more protective diet compared to people with a low educational status.ESSE-RF study participants and article co-authors: Moscow: Zhernakova Yu. V., Boytsov S. A., St. Petersburg: Rotar O. P., Vladivostok: Kulakova N. V., Nevzorova V. A., Vladikavkaz: Astakhova Z. T., Vologda: Shabunova A. A., Volgograd: Nedogoda S. V., Voronezh: Chernykh T. M., Ivanovo: Belova O. A., Kemerovo: Artamonova G. V., Indukaeva E. V., Krasnoyarsk: Grinshtein Yu. I., Petrova M. M., Orenburg: Libis R. A., Samara: Duplyakov D. V., Tomsk: Trubacheva I. A., Kaveshnikov V. S., Serebryakova V. N., Tyumen: Efanov A. Yu., Medvedeva I. V., Shalaev S. V.

The higher prevalence of alimentary-dependent risk factors for chronic non-communicable diseases in the Russian Federation among rural residents suggests that there are differences in the diets of city and village residents.Aim. To examine the diet differences of city and village adults.Material and methods. The analysis included representative samples from male and female population aged 25-64 years (n=21923, of which 8383 and 13550 are men and women, respectively) from 13 regions of the Russian Federation. The diet features were assessed by the frequency of consumption of themain food groups and individual eating habits: salting, the use of animal fats in cooking.Results. Rural men 18% more often than urban daily consumed meat sausages, 13% — salting and marinades and less often included in the diet meat (23%), fresh vegetables and fruits (28%), “milk, kefir, yogurt” (12%), sour cream (17%), quark (23%) and cheese (14%). Rural women less often consumed meat (19%), dairy products (18%), including cottage cheese (25%) and cheese (26%), but more often — salting (34%) and beans (10%). Rural women more often salt already prepared food — the odds ratio (OR) =1,32; 95% confidence interval (CI) 1,03-1,70 (X2=4,81, p=0,0282). Excess sugar intake among rural men was more common — OR=1,23; 95% CI 1,10-1,37 (X2=13,06, p>0,0001). The women of the village more often added butter to the dishes (sandwich, porridge, mashed potatoes, etc.) than the urban ones — OR=1,14; 95% CI 1,03-1,25 (X2=6,90, p=0,0086), in contrast to men, for whom the consumption of butter did not differ. In general, excess consumption of salt and sugar in the diet of village men was more common than among city men — OR=1,26; 95% CI 1,13-1,42 (X2=15,95, p>0,0001), in contrast to women, among whom no such differences were found (X2=3,02, p=0,0821). The diet, characterized by excessive consumption of salt, sugar and insufficient consumption of vegetables and fruits, was more often present among rural men — OR=1,30; 95% CI 1,12-1,53 (X2=10,92, p=0,0009). In urban and rural women, differences in the frequency of such diet were not found.Conclusion. The urban dietary pattern is characterized by higher consumption of meat, dairy products, vegetables and fruits, while in the rural model, the consumption of beans, salting, sugar and butter is higher.Participants of the ESSE-RF study: Moscow: Zhernakova Yu. V., Boytsov S. A., Saint-Petersburg: RotarO. P., Vladivostok: Kulakova N. V., Nevzorova V. A., Vladikavkaz: Astakhova Z. T., Vologda: Shabunova A. A., Volgograd: Nedogoda S. V., Voronezh: Chernykh T. M., Ivanovo: Belova O. A., Kemerovo: Artamonova G.V., IndukayevaE. V., Krasnoyarsk: Grinshtein Yu. I., Petrova M. M., Orenburg: Libis R. A., Samara: Duplyakov D. V., Tomsk: Trubacheva I. A., Kaveshnikov V. S., Serebryakova V. N., Tyumen: Efanov A. Yu., Medvedeva I. V., Shalaev S. V.

Many nutritional studies have noted that men and women form their diets from various food sources, preferring different dishes.Aim. To study the sex differences in the nutritional pattern of the adult population of the Russian Federation according to the epidemiological study.Material and methods. The analysis was performed on representative data from male and female population aged 25-64 years (22,258 people, of whom 8,519 men and 13,698 women) from 13 regions of the Russian Federation. The response was about 80%. The nutritional pattern was estimated by the frequency of food consumption with individual quantitative assessment.Results. The most pronounced differences in men and women diets were observed in the consumption of fresh vegetables and fruits, dairy products, meat, and confectionery products. Women more often than men include in their diet (odds ratio, 95% CI): raw vegetables and fruits 1,45 [1,33-1,59], sweets and pastries 1,22 [1,33-1,59] , dairy products 1,57 [1,39-1,76], in particular, cottage cheese 1,69 [1,60-1,79], milk 1,46 [1,36-1,56] and cheese 1,31 [1,23-1,40]. The number of daily consumption of fruits and vegetables is more significant in the diet of women — 207,6 g/day versus 165,8 g/day for men, p

Aim. To study the relationship of different levels of high-sensitivity C-reactive protein (hs-CRP) with cardiovascular events and assess its contribution to the development of outcomes in Russian regions.Material and methods. The work used the data from the multicenter study ESSE-RF — a representative sample of male and female population aged 25-64 years. All participants signed informed consent. The study included 10421 people (women, 6399 (61,4%)). The cohort was followed up from 2012 to 2019 (median follow-up period, 5,5 years). A hard endpoint (cardiovascular mortality and nonfatal myocardial infarction (MI)) was determined in 187 people, while a soft endpoint (nonfatal MI, stroke, revascularization, heart failure progression and cardiovascular mortality) — in 319 people.Results. The results showed that hs-CRP is significantly associated with the main risk factors (with the exception of low-density lipoproteins). At the same time, it was found that optimal hs-CRP level for predicting the risk of cardiovascular events (CVE) in Russian population is significantly lower than 3 mg/L, but higher than 1 mg/L (1,54/1,89 mg/dL for men and women, respectively). Adding hs-CRP to sex and age significantly improved risk prediction (AUC, 79,7; 95% CI, 77,8-81,7). At the same time, adding a wide list of confounders to hs-CRP, sex and age does not improve the model’s predictive value (AUC, 79,7; 78,2-82,1).Conclusion. This study for the first time showed a significant independent contribution of hs-CRP to CVEs development in the Russian population, and the addition of hs-CRP to sex and age significantly increased the predictive value of model.

Abdominal obesity (AO) is an alimentary-dependent risk factor, the development and prognosis of which is directly specified by eating habits.Aim. To study the associations of dietary patterns and AO among the adult Russian population.Material and methods. The analysis was carried out using representative samples of male and female population aged 25-64 years (n=19297; men, 7342; women, 11,955) from 13 Russian regions. The response was about 80%. Nutrition was assessed based on the prevalence of consumption of the main food groups forming the daily diet. Results are presented as odds ratios and 95% confidence intervals.Results. Men with AO, compared with men without AO, more often consume red meat and vegetables/fruits daily by 12% and 13%, respectively, as well as less often eat cereals and pasta, confectionery, sour cream, and cottage cheese by 17%, 24%, 14%, and 19%, respectively. In women with AO, compared to women without AO, there are more differences in the diet, as they more often daily consume red meat by 28%, fish and seafood by 26%, poultry by 23%, meat and sausages and fruits/vegetables by 14%, milk, kefir, yogurt by 11%, as well as less often — cereals and pasta, sweets, and sour cream by 11%, 14%, and 8%, respectively. In women with AO, the prevalence and amount of drinking beer and dry wines is lower, but they consume spirits more frequently (p=0,0001), but without significant differences in amount. Men with AO have a higher prevalence and amount of drinking dry and fortified wines, as well as strong alcoholic drinks. Men with AO drinks higher amount of beer. In addition, men with AO showed a positive association with alcohol consumption (χ=53,64, p

Aim. To study the associations of dietary patterns with HTN in the adult population.Material and methods. The analysis was carried out on the data of representative samples of male and female population from 13 regions of Russia. The age ranged from 25 to 64 years (n=19,520; men, 7329; women, 12191). The response rate was approximately 80%.Results. Men with blood pressure (BP) >140/90 mm Hg more often consume meat and sausage products (OR, 1,08 [95% CI, 1,02-1,16]; p=0,011), less often — fresh vegetables/fruits (0,94 [0.89-0.96]; p=0,028), dairy products: milk, kefir (0,92 [0,87-0,97]; p=0,0041), sour cream (0,90 [0,84-0,96]; p=0,0021), cottage cheese (0,92 [0,85-0,99]; p=0,034) and sweets (0,91 [0,86-0,96]; p=0,00071). Women with BP >140/90 mm Hg less often consume fresh vegetables/fruits (0,95 [0,90-0,99]; p=0,032), milk, kefir (0,95 [0,91-0,99]; p=0,040), cottage cheese (0,95 [0,90-0,99]; p=0,047), cheese (0,92 [0,88-0,97]; p=0,00083) and sweets (0,89 [0,850,93]; p

Aim. To study the sex characteristics of behavioral risk factors for chronic noncommunicable diseases and to assess the integral indicator of adherence to a healthy lifestyle in Muscovites within the AEGIDA-Moscow study.Material and methods. A random sample from the adult population of Moscow aged ≥ 18 years (n=4063; men, 40,9%) was used. The response rate was 78,1%. The standard survey was conducted using an international questionnaire based on the WHO STEPS Instrument. The following parameters were analyzed: smoking, alcohol consumption, physical activity (PA), consumption of vegetables/fruits and salt. High integral indicator of adherence to a healthy lifestyle was recorded in case of normal PA, sufficient intake of vegetables/fruits, non-smoking, and without excessive intake of salt and alcohol.Results. The smoking prevalence in Moscow was 18,3%. Among men, this indicator was more than 2 times higher than among women (28,0 and 11,4%, respectively, p0,5). The prevalence of insufficient consumption of vegetables/fruits (5 g) consumption of salt (60,3 and 41,9%, respectively) and alcohol (6,7 and 4,4%, respectively), and an unfavorable integral indicator of adherence to a healthy lifestyle (47,1 and 30,7%, respectively) among men was higher than among women.Conclusion. The prevalence of smoking, excessive consumption of alcohol and salt, and insufficient intake of fruits/vegetables among men was significantly higher than among women. The prevalence of low PA in the male and female cohorts did not differ significantly. Almost half (47,1%) of men and a third (30,7%) of women have an unfavorable integral indicator of adherence to a healthy lifestyle.

Aim. To assess the associations of metabolic syndrome (MS) with sociodemographic and behavioral factors in the Russian population aged 25-64 years.Material and methods. As part of the ESSE-RF 2 study, representative samples of the population of four Russian regions (Krasnodar Krai, Omsk and Ryazan Oblasts, Republic of Karelia) were examined: men (n=3011) and women (n=3721) aged 25-64 years. The response rate was approximately 80%. The study was approved by the Independent Ethics Committee of National Medical Research Center for Therapy and Preventive Medicine. All subjects were interviewed using a standard questionnaire. We analyzed the region and type of residence (urban/ rural area), age, educational level, marital and economic status, behavioral habits, and medical history data. Anthropometric measurements were performed. Blood pressure (BP) was measured with an Omron BP monitor. Lipid profile were assessed. MS was diagnosed according to the IDF criteria (2006). Statistical analysis was performed using the R 3.6.1 software package.Results. Abdominal obesity (AO) was found in 49,7% of men and 61,6% of women. Obesity according to body mass index was noted in 31,6% of subjects (men — 28,6% and women — 34%). MS prevalence in the entire sample was 33,0% and increased with age. In the group of subjects 35-44 years old, the prevalence of MS was significantly higher among men, and among those 55-64 years old — among women. We also found that AO in combination with two MS components was observed in 17,2% of participants; AO with three components — in 11,8%, AO with four components — in 4%. The highest prevalence of MS was noted in theRyazan region (men — 42,0%, women — 37,4%), the lowest — in theRepublic ofKarelia (men — 25,8%, women — 29,6%). In men, age-adjusted univariate logistic regression revealed significant associations of MS with former smoking, low physical activity, and alcohol abuse. Elevated BP and lipid profile abnormalities were significantly associated with low income level. AO was significantly associated with marriage. Similarly, the risk of diabetes and elevated blood glucose levels was lower in single men. Among women, the risk of MS was higher in those without higher education, with low income, smoking, and low consumption of vegetables and fruits. Women living in rural areas have a higher risk of AO and high BP. The risk of lipid metabolism disorders was higher among women with secondary education. Most of these associations were confirmed by multivariate analysis.Conclusion. MS was diagnosed in 33% of Russians aged 25-64 years. The proportion of people with MS increases with age, which, due to the life expectancy increase, suggests an increase in the total number of MS people. Risk factors associated with MS in women are smoking, insufficient consumption of vegetables and fruits, no higher education, and low income. In men, MS are associated with excessive alcohol consumption, smoking, and low physical activity. MS prevalence can be reduced by changing the lifestyle and habits, and if necessary, in combination with drug therapy.

Aim. To assess the prevalence of wide QRS complex (≥110 ms) among the population, depending on sex, age, place of residence (urban or rural area), the presence of obesity and cardiovascular disease.Material and methods. The analysis was based on the ESSE-RF study (n=17,364, men — 38%). Twelve-lead resting electrocardiography (ECG) data from the regions participating in the study were analyzed according to the Minnesota code manual. Patients were divided into groups of QRS

Aim. To study the association of blood pressure (BP) and hypertension (HTN) with salt intake estimated by the survey and the urinary Na+ concentration among men and women 25-64 years old, examined within the ESSE-RF and ESSE-RF-2 studies.Material and methods. Representative samples of the Russian population aged 25-64 years were examined. At the first phase in 2012-2014, 21,888 people (men — 38,2%) were included, and at the second phase in 2017 — 6,714 people (men — 44,7%). The response rate was 80%. We used standard questionnaire. Adding more salt and the consumption of salted foods (sausages, deli meats, and pickled foods) in the criteria “daily or almost daily” was considered excess salt intake (ESI). BP measurement was carried out in a sitting position on the right hand. BP was measured twice with an interval of about 2-3 minutes. HTN was diagnosed at a systolic BP (SBP) ≥140 mm Hg and/or diastolic BP ≥90 mm Hg, or in case of antihypertensive therapy. In ESSE-RF-2, an analysis of the morning urine was additionally performed. Na+ was determined using the EX-Ds ion-selective electrolyte analyzer. All participants were stratified by the quintiles of urine sodium level. Data analysis was performed using the software package R 3.6.1. The models of linear and logistic regression were used. The differences were considered at p

Aim. To study the prevalence of hypotension according to several criteria in the Russia and the USA.Material and methods. We used data of Russian population studies performed in 1975-1982 and ESSE-RF study performed in 2012-2014 at the National Medical Research Center for Therapy and Preventive Medicine. A comparison was made with the data of cross-sectional stu - dies of the US population — National Health and Nutrition Examination Survey (NHANES): NHANES II (1976-1980) and Continuous NHANES (2007-2012). We analyzed age, sex, and systolic and diastolic blood pressure. The prevalence of individuals with hypotension was calculated in men and women of five age groups using four different criteria for hypertension.Results. The prevalence of hypotension in studies of different years according to different criteria was as follows: in the Russia — 0,3-9,0% in men and 2-15% in women; in the USA — 5-30% in men and 8-45% in women. In age group >30 years, the prevalence of hypotension in Russia, by most criteria, decreased approximately by 50% in men and did not change in women. In the United States, according to all criteria, the prevalence in men and women has increased 2-3 times.Conclusion. The prevalence of hypotension in the adult population ranges from decimal percentages to 45% and varies many times depending on the selected criterion.

Aim. To assess the relationship of the population’s adherence to a healthy lifestyle (HLS) with socio-demographics and to carry out a comparative analysis of adherence according to ESSE-RF-1 and ESSE-RF-2 studies.Material and methods. This study was conducted as part of a multicenter epidemiological study ESSE-RF-2 in 4 regions of Russia (n=5897). The following components of HLS were considered: non-smoking, adequate consumption of fruits and vegetables, salt intake, regular physical activity, and low alcohol consumption. According to the combination of components, “high”, “adequate” and “low” adherence to HLS were distinguished. The socio-demographics included gender, age, region, residence (urban/rural), marital status, educational status, income. To compare the results with other studies, the data obtained were standardized according to the 1976 European Standard Population age structure.Results. Initial data on adherence to healthy lifestyle were as follows: high adherence — 21,9%, adequate — 34,5%, low — 43,6%. We observed the following prevalence of low adherence components: excessive salt intake (50,5%), insufficient consumption of fruits and vegetables (37,5%), smoking (22,7%), low physical activity (19,6%), excessive alcohol consumption (4,9%). High adherence to HLS was associated with female gender, older age, urban residence, high educational status, absence of family. In addition, the combined effects of socio-demographics on adherence to HLS were revealed. In particular, we analyzed the effect of high educational status with other characteristics (gender, age, residence), which acted both as a protective and negative factor. A comparative analysis of ESSE-RF-1 and ESSE-RF-2 data showed significant differences in the prevalence of adherence to HLS, which may be due to both methodological differences of studies and a true change in adherence to HLS.Conclusion. High adherence to HLS is detected only in every fifth adult of the studied regions. Low adherence to HLS is associated with a number of socio-demographic characteristics of the population and is specified mainly by the high prevalence of unhealthy diet and, to a lesser extent, low physical activity and smoking.

Obesity is one of the main risk factors for type 2 diabetes developing. The question of the advantages and disadvantages of using various anthropometric indices [body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHR), lipid accumulation product index (LAPI), visceral obesity index (VOI)] has been under discussion lately.Aim. To perform an analysis of anthropometric obesity indicators (BMI, WC, WHR, VOI, LAPI) depending on the presence of type 2 diabetes in the adult population of the Russian Federation.Material and methods. The results of the study "Epidemiology of Cardiovascular diseases and their risk factors in the regions of the Russian Federation" (ESSE-RF) performed in 2012-2014 in 13 regions of the Russian Federation are included into the analysis. People aged 25-64 years (n=20878; 8058 men and 12820 women) were examined. The following indicators in people with/without type 2 diabetes were analyzed: age; sex; anthropometric indicators: height, weight, WC; smoking status (“never smoked”, “smoked”, “smokes now”); alcohol consumption, which was ranked for “never in the last year” and “a lot” (≥168 g of ethanol per week for men and ≥84 g of ethanol per week for women); the level of systolic (SBP) and diastolic (DBP) blood pressure; heart rate (HR); levels of glucose, total cholesterol (TC), high density lipoproteins cholesterol (HDL-C), triglycerides (TG); WHR; VOI; LAPI, BMI.Results. Levels of TC and glucose, excessive alcohol consumption, BMI were selected in a multifactor regression model in men after adjusting for age, region of residence and IVO. The same factors (SBP instead of alcohol and BMI instead of WHR were included in the model) were selected in women. VOI showed the greatest degree of association with type 2 diabetes regardless of gender after adjusting for age and region of residence (in men odds ratio 1,085; p=0.0001; in women odds ratio 1,136; p=0.0001). Thus, VOI (predictor of type 2 diabetes in population of working age) was common to both sexes.Conclusion. VOI has statistically significant associations with type 2 diabetes. VOI is the best surrogate marker for measuring the degree of abdominal obesity in the Russian population and can be used to determine the presence of type 2 diabetes in clinical practice. Screening for elevated VOI values in healthy individuals and patients with pre-diabetes can serve as a guide for targeted aggressive preventive interventions.Participants of the ESSE-RF Study: Vladivostok: Kulakova N.V., Nevzorova V.A., Shestakova N.V., Mokshina M.V., Rodionova L.V.; Vladikavkaz: Tolparov G.V.; Vologda: Shabunova A.A., Kalashnikov K.N., Kalachikova O.N., Popov A.V.; Volgograd: Nedogoda S.V., Chumachek E.V., Lediaeva A.A.; Voronezh: Chernyih T.M., Furmenko G.I., Ovsyannikova V.V., Bondarcov L.V.; Ivanovo: Belova O.A., Romanchuk S.V., Nazarova O.A., Shutemova O.A.; Kemerovo: Barbarash O.L., Artamonova G.V., Indukaeva E.V., Mulerova T.A., Maksimov S.A., Skripchemko A.E., Cherkass N.V., Tabakaev M.V., Danilchenko Ia.V.; Krasnoyarsk: Grinshtein Yu.I., Petrova M.M., Danilova L.K., Evsiukov A.A., Shabalin V.V., Ruph R.R., Kosinova A.A., Filonenko I.V., Baykova O.A.; Moscow: Gomyranova N.V., Oganov R.G., Oshepkova E.V.; Orenburg: Libis R.A., Basyrova I.R., Lopina E.A.; Samara: Dupliakov D.V., Gudkova S.A., Cherepanova N.A.; St. Petersburg: Konradi A.O., Baranova E.I.; Tomsk: Trubacheva I.A., Kaveshnikov V.S., Karpov R.S., Serebriakova V.N.; Tyumen: Efanov A. Yu., Medvedeva I.V., Storozhok M.A., Shalaev S.V.

In the work, the results presented, gathered in the multicenter study ESSE-RF, and characterizing factors associated with insufficient control of blood pressure (BP) in arterial hypertension (AH) patients.Aim. Evaluation of the factors associated with insufficient BP control in Russian males and females age 25-64 y. o., with AH, by the ESSE-RF data.Material and methods. Representative selections were assessed of 13 regions of Russia, males (n=5563) and females (n=9737) 25-64 y. o., investigated in 2012-2013 y. Systematic stratified multistage random selection was applied. Response about 80%. All participants were surveyed with a standard questionnaire (demography, anamnesis, wealth). Mean values were calculated (M±m), quintiles and ranges. Methods of analytical statistics were applied: dispersion-co variation, logistic regression, odds ratio.Results. Two groups were revealed, with raised BP, that differ basically. Group one, those with BP higher than 140/90 mm Hg, not taking antihypertensive medication, and group two — those who take medications, but do not reach target BP. Group one consists of men almost 2 times more, with risk factors, but no cardiovascular diseases in anamnesis. Only the heart rate (HR) and alcohol overconsumption significantly positively correlate with the treatment absence in men — OR=1,49 (p

Aim. Evaluation of the prevalence of obesity and association with the risk factors of chronic non-communicable diseases of the inhabitants of selected regions of Russia, by the data from ESSE-RF study.Material and methods. Representative selections investigated, of the inhabitants of 13 regions of Russia, totally 21768 participants, males n=8 304, females n=13 464, age 25-64 y. o., under the circumstances of the study “Epidemiology of cardiovascular diseases (ESSE-RF)”, with response ~80%. Standard questionnaire, consisting 12 modules, was developed based upon adapted international methods. For the risk factors prevalence assessment, the standard epidemiological methods were applied. Body mass (BM) was evaluated in the categories of body mass index (BMI) (Ketle index: BMI — Body mass, kg / height, m2). BM as BMI was evaluated as insufficient (BMI

Smoking influences nutrition type and food-related behavior of the smokers.Aim. To evaluate the specifics of adult population of Russian Federation nutrition type according to smoking status.Material and methods. Analysis was done on the representative selection of nonorganized male and female population, age 25-64 y. o. (n=22258, of those males 8519, females 13698) from 13 regions of Russia. Response about 80%. Nutrition character was assessed by the rates of food items consumption with quantitative assessment in several units. Smoking status was assessed with questionnaire with selection to the groups: non-smokers, past smokers, current smokers.Results. Most prominent differences were found on the intake of fresh vegetables and fruits, of curd, cheese, red meat, sausages, pastry and behavior of adding salt to cooked meals. In comparison with the smokers, non-smokers do more often take curd — by 38%, vegetables and fruits — by 30%, and rarer — red meat, by 25%, and sausages, by 21%; they add salt rarer — by 26%. However, pastry and sweets they eat more commonly, by 19%. With the quittance from smoking, there is increase of curd in the meals by 20%, fresh fruits and vegetables by 19%, and decrease of adding salt behavior by 26%, as by 17% — consumption of sausages and by 11% — high fat dairy (sour cream and cream). Sweets and pastry are consumed only 8% more, that distinguishes the model as healthier and more protective against NCD.Conclusion. Smoking influences negatively food related behavior, shaping the character of nutrition with higher intake of meat and sausages, saltings and adding salt behavior, lower consumption of vegetables and fruits, that should be considered in prevention events.