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Association of Alcohol Consumption to Mortality in Middle-Aged U.S. and Russian Men and Women

PURPOSE The purpose of this paper is to assess the relationships of alcohol consumption to total and cardiovascular disease mortality in U.S. and Russian men and women after adjustment for several covariates. A secondary objective is to determine how this relationship varies by country and gender. METHODS Men aged 40-59 and women aged 40-69 screened in Russia and the U.S. between 1972 and 1982 were followed for mortality for 13 years as part of the Lipid Research Clinics Prevalence and Follow-up Studies. Alcohol consumption was based on a 7-day recall of drinks of beer, wine, mixed drinks, and liquors. Drinkers of alcohol were classified into four levels based on amount consumed during the recall period. RESULTS Age-adjusted mortality rates were higher for non-drinkers than lower level drinkers in both genders and countries, and there was an indication that mortality rates for high level drinkers, especially in men, approached those of non-drinkers. When mortality rates were adjusted for other risk factors they remained higher for non-drinkers in U.S. men and women, but in Russia, with one exception, there was no difference in mortality rates between drinkers and non-drinkers. Relative risks for cardiovascular disease mortality rates were similar to those of total mortality. CONCLUSIONS Beneficial association of alcohol consumption and mortality may be limited depending upon the prevalence of other risk factors in the studied population.

Association of high-density-lipoprotein cholesterol with mortality and other risk factors for major chronic noncommunicable diseases in samples of US and Russian men

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.

Blood pressure and heart rate response during exercise in men and women in the USA and Russia lipid research clinics prevalence study

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.

Correlates of systolic and diastolic blood pressure in men 40 to 59 years of age sampled from United States of America and Union of Soviet Socialist Republics lipid research clinics populations

The correlates of blood pressure (BP) were investigated in 2 samples using common protocols, one from a Union of Soviet Socialist Republics study in 2 locations and one from a United States of America study in 9 locations. Age, heart rate, Quetelet index, high density lipoprotein cholesterol, natural logarithm of triglycerides and fasting glucose were positively related to systolic BP in both samples. In diastolic BP, alcohol consumption, heart rate, Quetelet index and natural logarithm of triglycerides were positively associated, and number of cigarettes smoked was negatively related in both samples.

Serum Nitrate and Nitrite are Associated with the Prevalence of Various Chronic Diseases Except Cancer.

BACKGROUND Nitric oxide and its metabolites, nitrate and nitrite, are important regulators linked to various diseases. We studied the association of fasting serum concentrations of nitrate and nitrite, combined as NOx, without special diet, with the prevalence of various chronic diseases. METHODS Fasting concentrations of NOx were assayed in a cohort of 1087 patients recruited to Stress Aging and Health in Russia study that represents male and female population in Moscow, Russia, over 55 years of age. Chronic diseases were recorded based on anamnesis and additional assays were run to characterize immune status and lipid and carbohydrate metabolism. Odds ratios were calculated to associate NOx concentrations with prevalence of chronic diseases in pooled deciles below or above borderline. RESULTS NOx over 44.7 µM were associated with increased prevalence of various chronic diseases such as diabetes type II, hyperthyroidism, coronary heart disease, gout and thrombosis/stroke. NOx 65.3 µM and above were associated with lowered prevalence of osteoporosis. NOx levels of 74.6 µM and above were associated with significantly higher number of patients who abstain from consumption of alcoholic beverages. NOx were not associated with cancer. CONCLUSIONS Thus, fasting concentrations of NOx in serum can be an important diagnostic parameter characteristic for specific chronic diseases.

The prevalence of familial hypercholesterolemia in the West Siberian region of the Russian Federation: A substudy of the ESSE-RF

Background The prevalence of familial hypercholesterolemia (FH) in Russia has not previously been evaluated. The aim of our study was to investigate the prevalence of FH in the population of the West Siberian region of Russia, and then estimate the frequency of coronary artery disease (CAD) and treatment with cholesterol-lowering medication in FH patients. Methods The sample of our study consisted of participants from the population-based cohort of The Epidemiology of Cardiovascular Risk Factors and Diseases in Regions of the Russian Federation Study (ESSE-RF), conducted in the Tyumen and Kemerovo regions (1,630 and 1,622 people, respectively, aged 25–64). All participants who had LDL-cholesterol higher than 4.9 mmol/l and who had LDL-cholesterol less than or equal to 4.9 mmol/l but had statin therapy were examined and interviewed by experts in FH. Results The prevalence of patients with definite FH was 0.24% (one in 407) (95% confidence interval [CI]: 0.06%–0.42%), with probable FH was 0.68% (one in 148) (95% CI: 0.38%–0.98%), and with definite or probable FH combined was 0.92% (one in 108) (95% CI: 0.58%–1.26%). 40% (95% CI: 20.8%–59.2%) of patients with definite or probable FH had CAD. However, only 23% (95% CI: 6.3%–39.7%) of patients with definite or probable FH were on statins. The odds ratios for CAD and myocardial infarction (MI), adjusted for age, gender, region, smoking, hypertension, and diabetes mellitus, were 3.71 (95% CI: 1.58–8.72) (p = 0.003) and 4.06 (95% CI: 0.89–18.55) (р = 0.070) respectively for individuals with definite or probable FH relative to those who were unlikely to have FH. Conclusions The prevalence of FH in Russia may be significantly higher than previously estimated. There is underdiagnosis and undertreatment of FH in Russia.

Serum nitrite and nitrate levels, NOx, can predict cardiovascular mortality in the elderly in a 3‐year follow‐up study

Nitric oxide (NO) is an important functional regulator that contributes to progression of various cardiovascular diseases. We studied associations between nitric oxide metabolites, nitrite and nitrate (NOx), and cardiovascular mortality in a prospective 3-year follow-up cohort study in 1,869 elderly patients aged over 55 years. The Cox proportional hazard regression model was adjusted for multiple factors including sex, age, risk corresponding to preexisting cardiovascular conditions, and serum inflammatory markers (C-reactive protein, interleukin-6, fibrinogen, and leucocytes count). During the follow-up period, there were a total of 348 deaths including 216 deaths unrelated to cardiovascular events and 132 cardiovascular deaths. Cox regression adjusted for factors related to cardiovascular disease risks and inflammatory markers showed a significant association between high levels of serum nitric oxide metabolites, NOx, and increased cardiovascular mortality (hazard ratio 2.21; 95% confidence interval 1.13-4.31) but there was no association with non-cardiovascular mortality. Analysis of adjusted hazard ratios demonstrates that association of serum nitric oxide metabolites with cardiovascular mortality was independent of levels of inflammatory markers. Thus, elevated concentrations of serum nitric oxide metabolites are a predictor of cardiovascular mortality and may be used as an integral marker of cardiovascular death.

HEART RATE LEVELS IN THE POPULATIONS OF THE RUSSIAN FEDERATION AND THE UNITED STATES OF AMERICA DURING THE THIRTY-YEAR PERSPECTIVE

Heart rate (HR) acceleration is one of the risk factors of the number of prevalent chronic non-communicable diseases. Aim . To evaluate changes in mean levels of HR in the Russian Federation (RF) and the United States of America (USA) in different age and sex groups from 1975 to 2014. Material and methods . HR levels in men and women of different age groups were evaluated in the populations of the RF and the USA in 1975-1982 and in 2007-2014 by the secondary analysis of cross-sectional trials data. A total number of cases was 48974. Results . In 80th years of XX century Russian men and women of all age groups had lower HR as compared to the USA, the distinctions were statistically significant in all age groups except for men aged 25-34 years (p<0.0001). During the next 3 decades HR significantly decreased in all groups of the USA population, while the RF population demonstrated variety of HR levels trends in different groups, absolute distinctions in mean values were relatively small and did not exceed 2 beats per minute. At the present time HR levels are less in the RF as compared to the USA in women aged 25-55 years and in men aged 25-34 years; in 55-64-year old men HR is somewhat higher in the RF than in the USA, other groups revealed statistically insignificant distinctions. Conclusion . The USA evidently loosed out to the RF in mean levels of HR in all age groups 35 years earlier. During the next 3 decades situation has been worsened as applied to the RF and distinctions with the USA have been largely smoothed over.

HEART RATE AND ITS ASSOCIATION WITH THE MAIN RISK FACTORS IN THE POPULATION OF MEN AND WOMEN OF WORKING AGE

Aim. To study the association of heart rate (HR) with the health parameters obtained in the ESSE-RF study. Material and methods . The data of the multicenter epidemiological study of ESSE-RF were used in the work. 8,343 men and 13,531 women aged 25-64 years were examined. The response to the survey was about 80%. The analysis is performed depending on the elevated heart rate. Education, place of residence, region, lipid profile, levels of C-reactive protein (CRP) and glucose, history of diabetes, anxiety and depression, elevated blood pressure were analyzed as factors possibly associated with increased heart rate. Epidemiological diagnosis of ischemic heart disease (IHD) was established using the Rose questionnaire, an electrocardiogram analysis, followed by the Minnesota code coding. Results. Almost every fifth inhabitant had a pulse rate of more than 80 beats/min. No significant difference was found between the sexes. The increase in heart rate in men, starting in the age group 25-34 years to 45-54, and in women only up to 35-44 years with subsequent reduction in men and women was found. The prevalence of increased heart rate varies from region to region. The highest heart rate in men is recorded in Orenburg (33.1%), Ossetia (Alania) and Volgograd (29.7% and 27.6%, respectively), in women – in Vladivostok (37.4%), and the lowest heart rate in both gender groups – in Samara (9.4% for men and 8.1% for women). Increase in heart rate in men with secondary education [odds ratio (OR) 1.24; 95% confidence interval (CI) 1.10-1.40], smokers and quitters (OR 1.90, 95% CI 1.63-2.27), who did not drink alcohol during the last year (OR 1.18, 95% CI 1.021.37), living in rural areas (OR 1.22, 95% CI 1.04-1.42), who are obese (OR 1.27, 95% CI, 1.101.45), having elevated blood pressure (OR 2.24, 95% CI 1.88-2.67), elevated levels of triglycerides, glucose and CRP was found after correction for age, region and all indicators included in the analysis (multidimensional model). The heart rate >80 beats/min was found significantly less often in people with history of myocardial infarction. A different model was found in women, it included, like in men, living in the village, elevated levels of blood pressure, triglycerides, glucose and CRP, but not education, smoking and alcohol consumption, obesity. Anxiety, low level of high-density lipoproteins and history of diabetes mellitus were also in the model in women. С onclusion . Significant associations between increased heart rate and metabolic risk factors, inflammation and residence in the village are found.

Chronic Respiratory Diseases in the Regions of Northern Russia: Epidemiological Distinctions in the Results of a National Population Study

The aim of the study is to investigate the epidemiological situation regarding chronic respiratory diseases in populations that inhabit different climatic–geographical regions of Russia, and to develop targeted programs for prevention of these diseases. Methods: (1) a comparative analysis of the standardized mortality data in Russia and other selected regions of the Russian North using the European standard for respiratory diseases, in a population aged 25–64; and (2) data from a randomized cross-sectional epidemiological study, with subjects from three different climatic-geographical regions of Russia. Results: (1) the respiratory disease-related mortality rates in the majority of Russian Northern regions were much higher compared to the national average. Although death rates from chronic lower respiratory diseases were higher among the Northern regions and in the whole of Russia relative to the countries of European Union (EU), the cause of death in the populations of the Northern regions tend to be lower respiratory infections and pneumonia; and (2) despite the absence of any significant differences in the prevalence of smoking, the prevalence of chronic respiratory diseases (COPD) is significantly higher in Far North Yakutsk compared to the other two regions in this study—Chelyabinsk and Vologda. The status of hyperborean had the highest chance of a significant contribution to COPD and cardiorespiratory pathology among all other risk factors. The results revealed a need for effective targeted strategies for primary and secondary prevention of chronic respiratory diseases for the populations of the Northern regions of Russia. Conclusions: The revealed regional distinctions regarding the prevalence of, and mortality from, chronic respiratory diseases should be taken into consideration when designing integrated programs for chronic non-communicable disease prevention in these regions.