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There is a strong inverse association between educational attainment and coronary heart disease (CHD) mortality in men in the USSR Lipid Research Clinics (LRC) Study. Less educated men were characterized by higher mean blood pressure, high density lipoprotein cholesterol (HDL-C), cigarettes smoked and by lower mean low density lipoprotein cholesterol (LDL-C) and body mass index (BMI). With respect to nutritional variables, less educated men were characterized by higher mean energy per kg body weight and alcohol intake and by lower mean intake of fat, saturated, mono- and polyunsaturated fatty acids, cholesterol, sucrose, and other sugars. The Keys score closely predicted the differences in plasma cholesterol among the educational groups in the randomly selected sample. In men without CHD at entry, the age and clinic-adjusted relative risk for CHD mortality was 2.4 for the least educated compared with the most educated group; on adjusting for systolic blood pressure, HDL-C, LDL-C, BMI, alcohol intake and number of cigarettes, the relative risk was reduced to 1.9. These data indicate that only 22% of the twofold excess of CHD mortal ity associated with low education was statistically attributable to the major risk factors. The failure to explain more of the education-CHD mortality gradient in the USSR LRC cohort was similar to observations from cohort studies in Great Britain and the US. Other correlates of low education must be explored to explain the association. [ABSTRACT FROM PUBLISHER]

Aim: To study prevalence of arterial hypertension (AH) in relation to gender, age, profession, risk factors (RF), RF combination; efficacy of active long-term multifactor prevention among the employees of industrial enterprises in some regions of Russia., Material and Methods: 14000 males and 20969 females from industrial enterprises of Cheboksary, Pskov, St-Petersburg were examined. 8974 males and 14515 females worked at enterprises of active intervention (EAI) while 1848 males and 1643 females were employed at comparison enterprises., Results: Correction of RF conducted at six EAI reduced a mean level of systolic blood pressure (SBP) and diastolic blood pressure (DBP), frequency and intensity of smoking, overweight and cases of RF combination, improved ECG parameters, wellbeing of hypertensive patients, increased number of examinees free of risk factors, decreased number of days of temporary disability. Among EAI employees overall mortality, ishemic heart disease mortality and cerebrovascular disorders fell., Conclusion: Five- and 10-year active multifactor office prophylaxis resulted in reduction of the rate and intensity of RF, number of temporary disability days by 48%. Arterial hypertention, combination of RF in healthy and hypertensive subjects at the start of the trial significantly promoted high all-causes and cardiovascular mortality at all enterprises studied. Active multifactor prophylaxis reduced those mortalities significantly.

Aim: To study prevalence of ischemic heart disease (IHD) and its various clinical forms depending on sex, age, profession including risk factors (RF) and their combination and efficiency of long-term multifactorial active prevention programs at enterprises in several regions of the Russian Federation., Material and Methods: 14,000 male and 20,969 female volunteers were observed in organized groups in three Russian cities (Cheboksary, Pskov, St-Petersburg). 8984 males and 14,515 females entered seven groups of outpatient follow-up and active long-term multifactorial prevention during 5-10 years., Results: Risk factor correction produced a significant decrease in mean systolic and diastolic blood pressure, frequency and intensity of smoking, overweight, improved ECG parameters, increased number of the examinees free of risk factors; state of IHD patients improved. Overall mortality, IHD and stroke mortality, number of temporary disability days were significantly less in the prevention group., Conclusion: Active multifactorial "in office" prevention for 5 to 10 years reduced RF prevalence and intensity, quantity of days at sick-leave fell by 48.5%. The presence of IHD and risk factors in both groups increased overall mortality rates and cardiovascular (IHD and stroke) mortality rates at the beginning of the study. The multifactorial prevention of IHD and risk factors resulted in a significant reduction of overall mortality rates as well as cardiovascular mortality rates in groups of active prevention.

Aim: To study contribution of alcohol consumption (AC) to mortality of coronary heart disease (CHD), cerebral stroke (CS), cardiovascular diseases (CVD), overall mortality (OM) in a random population of working males., Material and Methods: The results are available of a 21.5 year cohort study of mortality in a random population of 7,815 male citizens of Moscow and St-Petersburg aged 40-59 years., Results: The attributive risk of AC for mortality of CHD, CS, CVD and OM was 16.6, 14.8, 7.7 and 11.9%, respectively. The lowest relative risk to die of CHD, CVD and OM among the cohort studied was observed in males taking alcohol 168.0 ml per week maximum., Conclusion: It is necessary to approach differentially to assessment of AC effects on development of many diseases and further investigations are needed to reveal fine mechanisms of action of different alcohol drinks on human organism.

Aim: To study prevalence of cardiovascular disease risk factors (CRF) in relation to sex, age, occupation as well as efficiency of active long-term multifactorial prophylaxis in the groups of active intervention (AI) and observation., Material and Methods: The comparison group consisted of 1848 male and 1643 female volunteers. 8326 males and 13,116 females entered the group of active intervention and observation., Results: Risk factors correction led to lowering of mean systolic and diastolic arterial pressure, smoking intensity, overweight, to improvement of wellbeing of cardiovascular patients. The number of examinees with several risk factors decreased while those free of risk factors increased. There was also a reduction in the number of days of temporary disability. In AI group total mortality, coronary heart disease and cerebral event mortality fell manifold., Conclusion: Five- and ten-year active multifactorial "in-office" prophylaxis decreased frequency and intensity of risk factors. Lowering of cardiovascular disease incidence was associated with a 44.4% decrease in the number of days on sick-leave. The presence of cardiovascular diseases, combination of risk factors in healthy subjects and in cardiovascular patients in the beginning of the study significantly increased total mortality, cardiovascular mortality in comparison and active intervention groups. Active multifactor prophylaxis in persons with risk factors and cardiovascular diseases, especially in combination with risk factors, in the beginning of the study reduced total mortality and mortality of cardiovascular disease in active intervention.

The paper contains data on prevalence of low, normal, excessive body mass and obesity among urban male populations aged 20-54 years in different regions. Relative risk of death associated with body mass was estimated on the basis of a twenty years prospective study of sample populations in Moskva and St-Peterburg and level of attributed risk was used for assessment of contribution of body mass to cardiovascular mortality and mortality from other chronic diseases. Levels of main risk factors, smoking intensity and alcohol consumption were studied in deciles of body mass index distribution.

Aim: Evaluation of cardiovascular diseases (CVD) prevalence and their dynamics after active prevention program., Materials and Methods: 1382 male and 155 female volunteers were included into the group of active prevention in their office. 1024 males and 776 females with natural history were compared as a control group. 5-year follow-up was performed in 543 males and 569 females in comparison with 97 males and 119 females. 10-year follow-up covered 82 males and 191 females from the active prevention group and 178 males and 118 females from the referent group., Results: The risk factor correction has resulted in a significant decrease in both systolic and diastolic BP mean levels, prevalence of ECG abnormalities, smoking habits, overweight and combination of the risk factors, general mortality rate, CHD and stroke mortality, number of days of temporary disability., Conclusion: The primary and secondary "in office" prevention for 5 to 10 years diminishes the prevalence of the risk factors. The temporary and primary disability rates were connected with the presence of CVD. CVD, in line with other risk factors, significantly increased cardiovascular and general mortality rates.

Aim: To study the prevalence of ischemic heart disease (IHD) and its various clinical forms depending on both sexes, age, profession, risk factors and efficiency of active prevention programs., Material and Methods: 1848 males and 1643 females were inspected as a control group. 8326 males and 13,116 females volunteers were included into the groups of active prevention and observation., Results: Risk factor correction produced a significant decrease in both systolic and diastolic BP mean levels, prevalence of ECG abnormalities together with smoking habits occurrence, overweight and their combination. The general mortality rate, IHD and stroke mortality were significantly less in the group of prevention as well as the number of days of temporary disability., Conclusion: Primary and secondary "in office" prevention for 5 to 10 years diminished the prevalence of risk factors and events of IHD. The presence of IHD, risk factors increased general mortality rates and cardiovascular mortality rates in both groups. The multifactorial prevention of IHD contributed to a decline in general mortality rates and cardiovascular mortality rate.

Aim: To evaluate trends in arterial hypertension (AH) and other risk factors and their changes after active prevention program., Material and Methods: 1382 male and 1555 female volunteers were included into the group of active prevention at the workplace vs 1024 male and 776 female controls. 5-year follow-up covered 543 males and 569 females from the prevention group against 97 male and 119 female controls. 10-year follow-up covered 82 males and 191 females, 178 males and 118 females, respectively., Results: Risk factor correction produced a significant decrease in both systolic and diastolic BP levels, prevalence of ECG deteriorations, smoking habits occurrence, overweight. Overall mortality rate, CHD and stroke mortality were significantly less frequent in the prevention group. This group had also less days of temporary disability., Conclusion: The primary and secondary "in office" prevention for 5 to 10 years diminishes prevalence of risk factors. The temporary disability rate depends on the presence of arterial hypertension. The latter together with the other main risk facts significantly influences cardiovascular and general mortality rates.

Examination of blood pressure (BP) and heart rate (HR) measurements at rest and during exercise in samples of USA and Russian middle-aged men and women show significant differences between countries for both genders. Russian men had higher resting systolic blood pressure (SBP) than USA men but lower SBP at both stages of exercise. Russian women had significantly higher resting SBP than USA women at rest and also during exercise. Russian men and women had significantly lower HR at rest and during exercise than USA men and women. Differences between countries were also noted for mean body weight, height, lipid levels, percentages of smokers and several other variables, and it was postulated that differences in these factors might be responsible in part for differences in SBP and HR during exercise. After adjustment for these variables, differences in SBP during exercise between USA and Russian men remained, but differences between USA and Russian women disappeared. For both genders, differences in HR during exercise remained after adjustment. Mortality analyses in USA and Russian men indicated that stage 2 SBP response during exercise was generally not a significant mortality risk factor after adjustment for age, BMI, TC, smoking and resting SBP. In a similar model, stage 2 HR response during exercise was also a non-significant risk factor in mortality.

Previous reports from the Russian Lipid Research Clinics (LRC) study showed no association between the level of high-density-lipoprotein (HDL) cholesterol and mortality from coronary heart disease (CHD), while US LRC data indicated a strong negative association between HDL cholesterol and CHD mortality. This report investigated the association of HDL cholesterol and mortality in these same population samples with follow-up extended to 12 years. The association between HDL cholesterol and mortality remained inverse and significant in the US sample. In the Russian sample, high levels of HDL cholesterol were associated with higher risk of all-cause and cancer mortality, although adjustment for known risk factors reduced the strength of the association. The association between HDL cholesterol and CHD mortality was negative in the Russian sample, although the strength of the association was less than that for the US sample. Extended follow-up reduced the difference in the association between HDL cholesterol and mortality between the two countries; however, important differences remained. Further research will be required to clearly determine the cause for their differences.

Relevance of IHD risk factors and hormone concentrations (insulin, estradiol, testosterone, prolactin, LH, FSH, TTH and hydrocortisone) to IHD incidence was studied in 1200 men. Multivariate statistical analysis demonstrated that only a small number of hormonal indices are associated with main lipid and nonlipid risk factors. The relationships exist between systolic arterial pressure (SAP) and hydrocortisone, between TTH and total cholesterol, SAP and age, estradiol, testosterone and age. Significant independent associations were found between IHD prevalence and age (R = 0.140, 3 = 0.000), SAP (R = 0.130, P.0.001), HDLP cholesterol (R = -0.082, P = 0.007), height (R = -0.078, P = 0.010), insulin (R = 0.067, P = 0.035), standard deviation of estradiol from median value (R = 0.083, P = 0.017). The findings confirm a great role of high SAP in the development of IHD, a significant and independent association of high insulin levels with IHD prevalence, the presence of nonlinear relation of estradiol concentration to IHD occurrence in males.

Cardiological screening for hypertension has been carried out in two population samples of males. The ordered samples consisted of workers and employees (a total of 1383 subjects) of two institutions. Of them workers made up 64.3%. A random male population comprised 2481 subjects. Of them 1188 (47.88%) were employees. The incidence of hypertension appeared much higher in the random population. It was specific for age and occupation. Hypertension occurred more frequently among workers than employees in both populations. The occurrence of hypertension was associated with body mass excess and age.

The prevalence of systolic and diastolic arterial hypertension (AH) was studied on a material of random representative samples of male population aged 20-54 years in the cities of Moscow, Saint Petersburg [correction of Sankt-Peterburg], Tallinn, Kiev, Novosibirsk, Alma-Ata, Tashkent and Bishkek. AH was estimated in connection with risk factors (RF) from the standpoint of uni- and multidimensional statistical analysis. It has been established that RF (age, cholesterol and triglycerides concentration, overweight and alcohol use) make more significant contribution into the prevalence of diastolic AH whereas the systolic AH prevalence is largely determined only by age and education. The data obtained are likely to form the basis for the design of a more integral system of prophylaxis of cardiovascular diseases.

Physical development of 2049 Ulan-Ude children aged 14 years was studied. Differences between body size and mass in Buryat and Russian children, girls and boys, were determined. Local standards of children's physical development were set.

The prevalence of risk factors (RF) to develop cardiovascular disorders alone and in combination has been studied in males aged 20-54 differing by occupation and education. They lived in various cities of CIS and Baltic States. It was established that RF alone and in combination are common among the male population. The risk is the highest in the group of males engaged in hard physical labour (p < 0.05) and in low-education subjects. In subjects with higher education RF are the lowest. RF alone and in combination proved higher in Europeans and Siberians compared to males living in the Central Asia.

A comparative study of hypercholesterolemia and lipid distribution in males aged 20-54 randomly selected in one of the districts of Moscow, St. Petersburg, Tallinn, Kiev, Novosibirsk, Tashkent, Alma-Ata and Bishkek has been performed. A comparative interpopulation analysis involved mean values of blood lipid spectrum: total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDLPC), high-density lipoprotein cholesterol (HDLPC). TC, TG, LDLPC in blood were higher in European region and Siberia than in Middle Asia populations. These findings correlated with hypercholesterolemia prevalence. An average of 50% of European population studied need preventive treatment for hypercholesterolemia.

The data obtained from a screening of 1,467 males aged 40-59 years made it possible to characterize the relation of dyslipoproteinemias, primarily hypoalphacholesterolemia, to the incidence of coronary heart disease and risk factors in males, by using factorial and multivariate analyses. The findings suggest that hypoalphacholesterolemia is closely associated with hypertriglyceridemia in its atherogenicity, thus from the clinical point of view low levels of HDL cholesterol should be used as a ground for thorough examination of lipid metabolism, with great emphasis on metabolic disturbances of triglyceride-rich lipoproteins.

The data obtained in the prospective study of females aged 20-69 years in one of the Leningrad districts made in possible to assess the role of basic risk factors of cardiovascular diseases (CCV) as predictors of death. For females, arterial hypertension was not found to be a significant risk factor for CCV mortality. Among lipid fractions, elevated levels of low density lipoprotein (LDL) cholesterol was demonstrated to hold the lead (the risk ratio, 3.6), high levels of triglycerides occupied the second place (the risk ratio, 1.88, and the content of total cholesterol occupied the third place (the risk ratio, 1.7). Low body weight was the major protective factor in females. Following 5 years of the primary survey, the cumulative cancer mortality continued to increase in individuals having low cholesterol levels, which opposes the supposition that low cholesterol concentrations are a marker of an existing tumor process. The CCV mortality-total cholesterol level relationship was demonstrated to be prone to u-dependence, i.e. a deviation from average cholesterol levels towards the both directions is an unfavorable factor and requires that a clinicist be more careful.

The authors describe the results of a prospective follow-up of a large population of men and women living in a large industrial city. The data obtained show that the death rate of men is higher than in women; primarily men die of coronary heart disease. The differences in the death rate are more demonstrable in persons under 60. In the older age groups, the differences are not so striking. The presence of coronary heart disease identified during screening has an unfavorable effect on the life prognosis of men and exerts a weak effect on the prognosis in women. The signs of a history of myocardial infarction was the only exception. Women with that form die much more frequently than men. Multifactorial analysis of the relationship between the main risk factors and the death rate due to coronary heart disease has demonstrated that systolic arterial pressure, the age and level of total cholesterol produce an influence on the death rate in both sex groups. At the same time, men manifested the U-like character of the relationship between the death rate and the total cholesterol whereas women showed the "liminal" one. In both sex groups, persons with lower diastolic arterial pressure died more frequently from coronary heart disease, provided systolic arterial pressure was the same. Poor risk factors (Kettle index, education, the level of high density lipoproteins of cholesterol) affected the death rate only in men. Tobacco-smoking produced a significant action on the death rate because of cerebrovascular lesions; however, it was related poorly to the death rate due to coronary heart disease. The data obtained allowed deriving criteria for adequate hypotensive therapy.

The authors provide the results of a prospective study carried out for almost 10 years among men who underwent screenings in 1975-1977 at an age of 40-59 years in Moscow and Leningrad (overall 6431 persons) with a purpose of analyzing potential causes of high risk of death from coronary heart disease in a group of subjects with hypocholesterolemia. Based on a mathematical-statistical analysis, variants of the interpretations of the indicated fact are presented.

A study was made of the prevalence of coronary heart disease, risk factors (arterial hypertension, hypercholesterolemia, hypertriglyceridemia, hypo-alpha-cholesterolemia, overweight, tobacco-smoking) and of the relation of coronary heart disease to the risk factors in men aged 20 to 39 years and 40 to 54 years, living in 8 cities of the USSR. The study was carried out on material of random representative samples. It has been established that the prevalence of coronary heart disease and risk factors is bigger among the populations living in the European part of the USSR and Siberia, being lower among the populations of Central Asia. The relationship between coronary heart disease and the risk factors is pronounced to a greater measure in arterial hypertension and overweight and to a less degree in other conditions. Besides, the relation of coronary heart disease to the risk factors is marked to a much greater measure among men belonging to the senior age groups.

The data obtained in a prospective study made it possible, using Markov's analysis, to assess different forms of coronary heart disease (CHD) of long duration and to elaborate an unsophisticated scale for estimating individual risk of death from that disease. The Markov's analysis demonstrated a high enough probability (over 20%) of transformation to a remission for patients with all forms of CHD, with the probability being the least for persons with painless ischemia. The most unfavorable prognosis was assumed for patients who suffered myocardial infarction of had associated angina pectoris of effort and ischemic alterations as shown by the ECG. The highest death rate is predicted for the latter group (about 54% during 20 years). In the group of persons with painless ischemia, the death rate approaches that among patients with a history of myocardial infarction (32 and 39%, respectively). Isolated angina pectoris of effort has the most favorable prognosis.

The study presents the results of follow-up of a male population born between 1916-1935, living in a city district of Leningrad in 1975. The first epidemiological examination, designed to detect ischaemic heart disease (IHD) and its risk factors included 3,907 men. Repeated screening using the same protocol was conducted, at a 7-8 year interval, in 2,160 men. During the first screening, IHD was diagnosed in 461 persons; in 34.5% of them, according to the results of the second screening, IHD had a "stable course"; in 24.3% the second screening did not confirm the presence of IHD and 18.0% died of IHD complications in the meantime. A group of new non-fatal cases of IHD has been identified (13.9%). An analysis of the association between the course of IHD and the presence of risk factors has shown that while, in the group without the three main risk factors, the incidence was 6.0 +/- 2/1000 man-years, the respective figure was 41.2 +/- 7.3 in the group with the three risk factors present.