[The epidemiological situation as a factor determining the strategy for reducing mortality in the Russian Federation].

Chronic non - communicable diseases, mainly cardiovascular diseases, are the leading cause of death worldwide, including in the Russian Federation (RF). The article analyzes the negative and positive trends of the most relevant risk factors for cardiovascular diseases for the period from 2013 to 2017, and also provides a strategy for reducing mortality in the Russian Federation for the period up to 2024 based on data from an epidemiological analysis.

[Empirical dietary patterns and their influence on health in epidemiological studies].

The last two or three decades in the epidemiology of nutrition empirical approaches to assessing the diet of the population are increasingly being used. However, in Russian studies, these approaches are used extremely rarely, which may be due to insufficient knowledge of the essence, methodological aspects and the field of application of posterior dietary patterns. In this regard, the aim of this review was to highlight the essence, methods and main results of using empirical approaches to assessing the diet of the population. Results. This review discusses the main methodological features of multivariate analysis methods - factor analysis (principal component analysis) and cluster analysis. The main trends of dietary patterns characteristic of the epidemiology of nutrition, and various in different countries and regions are shown. The results of studies of the impact of dietary patterns on some indicators of health status (cardiovascular and oncological diseases, diseases of the musculoskeletal system, diabetes mellitus, metabolic syndrome and its components, mortality) are considered. A brief description of the few Russian studies that used the principal component method in identifying empirical dietary patterns of population is given. In general, this review indicates that the use of multidimensional statistics to highlight population dietary patterns as part of an empirical assessment is nowadays one of the most important components of nutrition epidemiology in different countries. An empirical assessment allows us to consider the diets of the population from a factual point of view and significantly supplements the scientific knowledge obtained using other epidemiological approaches. Currently, considerable experience in the development of methodological approaches to dietary patterns, as well as in the analysis of their associations with various indicators of health status has been accumulated. Conclusion. All this testifies to the high relevance of the considered epidemiological approaches and the need for their testing in Russian conditions, which, perhaps, will give new knowledge about the dietary patterns formation and its impact on the health status of Russians.

[Empirical dietary patterns in the Russian population and the risk factors of chronic non-infectious diseases (Research ECVD-RF)].

Currently, in the epidemiology of nutrition, methodological approaches to the empirical assessment of the diets of the population and their relationship to health indicators are actively using. In Russia, these approaches have been used in a number of cohort and regional studies, however, such studies are not available for the entire Russian population. Aim. Identification of empirical dietary patterns in the Russian population and analysis of their associations with risk factors for chronic non-communicable diseases. Material and methods. The work was carried out as part of a multicenter epidemiological study "Epidemiology of cardiovascular diseases in the regions of the Russian Federation" (ECVD-RF) in 2013-2014. The final sample size was 19 520 people aged 25- 64 years. Arterial hypertension, general and abdominal obesity, hypercholesterolemia, hypertriglyceridemia, low HDL, high LDL, and hyperglycemia were observed as risk factors for chronic non-infectious diseases. The data on the frequency of consumption of 13 food groups, which were grouped into 10 groups by combining dairy products into one were collected by interviewing. The identification of dietary patterns and assessment of their sustainability was performed using factor analysis (principal component analysis). In accordance with the individual commitment of the participants to the selected dietary patterns the sample was grouped into quartiles for each of the patterns. In order to ensure associations between patterns commitment and risk factors, a logistic regression analysis was used adjusted for the socio-demographic characteristics of the participants. Results and discussion. Four stable dietary patterns with a total specific gravity of the explained variance of 55.9% were identified and conventionally designated as "Reasonable" (milk, sweets and confectionery, fresh fruits and vegetables, cereals and pasta), "Salt" (sausages, pickles and pickled products), "Meat" (meat, fish and seafood, poultry meat) and "Mixed" (beans, pickles and pickled products, fish and seafood). The set of products of the "Reasonable" patterns mainly corresponds to the "Healthy" or "Balanced" patterns in foreign studies, the combination of the "Salt" and "Meat" patterns - the "Western Salt". Adherence to a "Reasonable" pattern was associated with a decrease in the likelihood of risk factors for chronic non-communicable diseases, and to a "Salt" and "Meat" patterns, on the contrary, with an increase. The associations obtained generally correspond to the results of similar foreign studies. A "Mixed" dietary pattern was associated with a few risk factors, which did not allow an unambiguous assessment of the pattern in terms of its impact on health. Conclusion. The study identified empirical dietary patterns of the Russian population and characterized them in terms of associations with the state of health of risk factors for chronic non-communicable diseases.

[Sleep disorders and stroke: data of the esse-rf study]. / Narusheniia sna i insul't: dannye issledovaniia ÉSSE-RF.

AIM: To assess the association between stroke and self-reported sleep disorders in the epidemiological studies of cardiovascular diseases in various regions of Russia (ESSE-RF). MATERIAL AND METHODS: A questionnaire survey included unorganized male and female population, aged 25 to 64 years, from 13 regions of the Russian Federation. In the analysis, answers to the question related to history of stroke: 'Did the doctor ever tell you that you had / had the following diseases?' (the 'Diseases' module) were included. The authors also evaluated answers about sleep duration, insomnia complaints, and sleepiness (the 'Sleep assessment' module). RESULTS AND CONCLUSION: Of 20 357 respondents, 422 (2%) confirmed the history of stroke. Both short and long sleep duration were not associated with stroke. Complaints of sleep disorders (snoring, sleep apnea, difficulty falling and maintaining sleep, as well as their combinations) were more frequently correlated with stroke. After adjustment for gender, age, body mass index, office blood pressure, the regression analysis showed that odds ratio was not significant for all complaints, except the combination of sleep apnea with frequent daytime sleepiness (1.7 (95% CI 1.04-2.8) (p=0.034). Therefore, symptoms of sleep-disordered breathing and insomnia are more common in respondents with the history of stroke. The combination of sleep apnea and frequent sleepiness complaints may indicate more severe sleep disorders in post-stroke patients.

[Epidemiology of Arterial Hypertension in Russian Federation - Importance of Choice of Criteria of Diagnosis].

PURPOSE: Assessment of prevalence of arterial hypertension (AH), need for prescription of antihypertensive therapy (AHT), and efficacy of AHT in Russian population in accordance with novel guideline of the American College of Cardiology/American Heart Association ("American recommendations") on diagnosis and treatment of AH (2017). MATERIALS AND METHODS: Epidemiological study ESSE-RF (ЭССЕ-РФ) was carried out in 12 regions of Russian Federation (RF) with different climatic-geographic characteristics. Number of examined residents of RF aged 25-65 years was 20 652. The sample was stratified by  gender and age. Examination included anthropometry, laboratory tests, blood pressure (BP) measurement with the OMRON tonometer. The SCORE scale was used for evaluation of risk of development of cardiovascular diseases (CVD). In  American recommendations AH was defined as  follows: 1-st degree  - systolic BP (SBP) 130-139  and/or diastolic BP (DBP) 80-89 mm Hg, 2-nd degree - BP ≥140/90 mm Hg and/or presence of AHT. In recommendations of the European Society of Cardiology (2013, 2018) ("European recommendations") AH was defined as BP ≥140/90 mm Hg and/or presence of AHT. RESULTS: We analyzed data of examination of  20 607  participants - 7806 men (37.9%) and 12 801  women (62.1%). According to  European recommendations AH was diagnosed in 10 347  persons (50.2%)  - 3987 men (51.1%) men and 6 360 women (49.7%). According to American recommendations AH was registered in 14 853 persons (72.1%) - 6 059 men (77.6%) and 8 794 women (68.7%). AHT received 6324 persons (61.1% of those with AH); according to American recommendations, the onset of AHT was indicated to additional 620 persons with 1-st degree AH because of high CVD risk. Among all participants with AH (on and without AHT) strengthening of AHT for achievement of target BP level was required in 77.8 and 92.6% of patients according to European and American recommendations, respectively. CONCLUSION: Application of novel criteria of AH diagnosis from 2017 ACC/AHA guideline to Russian population would increase prevalence of AH up to 72.1%. Onset of AHT would be indicated in 13.8% of patients with 1-st degree AH, while in 93% of patients receiving AHT its strengthening would be required.

[Cardiovascular mortality in the Russian Federation and possible mechanisms of its changes]. / Smertnost' ot serdechno-sosudistykh zabolevanii v Rossiiskoi Federatsii i vozmozhnye mekhanizmy ee izmeneniia.

The article presents data on the mortality trends in Russia during the last decade in comparison with other countries in Europe. It is shown that in spite the decline in death rates, Russia remains among the countries with the highest mortality rates from CVD. The specifics of mortality that distinguish Russia from other countries are described: a large variability between regions in mortality levels, differences between sexes, dependence on geographical location and socio-economic development of the regions, and late referral to a doctor in life-threatening conditions. The article emphasizes the role of risk factors and accessibility and quality of medical care to the population, as the two main components of the mechanism for changing mortality from CVD.

[Social-demographic aspects of insomnia in the Russian population according to ESSE-RF study]. / Sotsial'no-demograficheskie aspekty insomnii v rossiiskoi populiatsii po dannym issledovaniia ÉSSE-RF.

AIM: To estimate the prevalence of insomnia symptoms and their association with socio-demographic characteristics in the regions participated in the study. MATERIAL AND METHODS: Data from participants of the cohort study Epidemiology of cardiovascular disease in various regions of the Russian Federation (ESSE-RF), aged 25-64 years, from 13 regions of the Russian Federation were analyzed. They were interviewed about sleep complaints: difficulties falling asleep, maintaining sleep, sleepiness and sleeping pill intake (response variants: never, less than once a week, 1-2 times a week, three and more times a week). Responses with complaints occurring at least three times a week were considered as insomnia symptoms. Social and demographics characteristics from survey included: age, gender, education, marital status, job/employment, type of housing. The final analysis included 20 359 respondents. RESULTS: Clinically significant frequent (≥3 times a week) difficulties of falling asleep were reported by 17.2% respondents, difficulties in maintaining sleep by 13.6%; drowsiness by 6.3%, taking sleeping pills by 2.9% respondents. Women reported sleep complaints twice more after comared to men. The occurrence of frequent difficulties to falling asleep and nocturnal awakenings increased with age - from 11.4% and 5.9% to 24.2% and 20.7%. The highest occurrence of insomnia symptoms to such as difficulties in falling asleep and nocturnal awakenings was found in women, older age groups, divorced subjects or living separately, those with primary education, retired or disabled and living in a communal apartment or 'other' type of housing. CONCLUSION: Symptoms of insomnia are widespread among participants of the ESSE-RF study and associated with socio-demographic characteristics. Groups with high risk of insomnia include women, older age groups, divorced or living separately, those with primary education, unemployed pensioners and people with disabilities living in a communal apartment or 'other' type of housing.

The prevalence of abdominal obesity and the association with socioeconomic status in Regions of the Russian Federation, the results of the epidemiological study - ESSE-RF.

AIM: The aim of the study is to determine the prevalence of AO in the population and to assess the association with socioeconomic factors according to the data of the ESSE-RF study (Epidemiology of Cardiovascular diseases in the Regions of the Russian Federation). MATERIALS AND METHODS: The object of the study is a random population sample of men and women aged 25-64 years from 13 regions of the Russian Federation (n=21 817). Abdominal obesity in men was defined as waist circumference (WC) >94 cm, and in women - WC >80 cm. Body mass index (BMI) >30.0 kg/m2 was adopted as the criterion of common obesity. RESULTS: The prevalence of AO in Russia was 55% (61.8% in women and 44% in men), while the percent of people with obesity, defined by BMI was significantly lower (33.4%). The number of examined patients with AO increased with age among both men and women (p<0.0001). A person with AO more often were people with low and very low income and low education levels (p<0.0001). Direct association between employment status and family status and AO in present study did not find, but WC was statistically significantly important criterion among male workers in comparison with those who never worked (p<0.0001), young men and women married, as well as married men of older age groups (p<0.0001).

[Mortality and risk factors for non-communicable diseases in Russia: Specific features, trends, and prognosis]. / Smertnost' i faktory riska neinfektsionnykh zabolevanii v Rossii: osobennosti, dinamika, prognoz.

In the Russian Federation, the increase in all-cause and cardiovascular disease mortality began in the 1960s and lasted almost continuously until 2003. In our country, the characteristics of mortality are its substantially higher rates among men and a large regional variability, which is associated with economic, climatic, and geographic factors. Urbanization coupled with dietary changes and the higher prevalence of hypertension is the most likely initial impetus to the rise in mortality rates. The subsequent increase in mortality can be explained by the higher prevalence of behavioral and biological risk factors, alcoholism, and, since the 1990s, by heavy and protracted socioeconomic upheavals and lifestyle changes. The mortality decline since 2006 has been linked to the strengthening of the health system and to the reduction in the prevalence of smoking among men and hypertension in women. The slowing down of the pace of mortality decline may be due to the increase in the prevalence of hypertension and obesity among men. The modelling data show that by 2025, reductions in smoking prevalence rates by 23% among men and by 12% among women and increases in the efficiency of hypertension treatment by 17.2% in men and by 11.2% in women will reduce cardiovascular mortality rates by 15%.

[Five Year Dynamics of Main Clinical Symptoms in Patients With Ischemic Heart Disease in Russia in Comparison With Other Countries (the CLARIFY Registry)].

The CLARIFY register (The prospeCtive observational LongitudinAl RegIstry oF patients with stable coronary arterY disease) combined data of outpatients with stable coronary artery disease (CAD) from 45 countries including Russia. Purpose of this publication was to analyze dynamics of stable angina during 5 years of follow up in the Russian CLARIFY cohort compared with cohorts of patients from European and non-European countries. MATERIAL AND METHODS: Number of patients recruited in Russia was 2249. RESULTS: During 5 years of observation proportion of angina decreased by 65.5, 39.5 and 37.0% in Russia, European and non-European countries, respectively. Proportion of patients with heart rate (HR) <60 bpm at the beginning of observation was 17.4, 25.4 and 23.4% in Russia, European and non-European countries, respectively. By the end of 5 years there was a significant increase in the proportion of patients with HR <70 bpm in Russia, while in Europe and other countries response to HR reducing therapy was much more modest. Perhaps this was due to improved treatment of patients recruited in Russia, for example, ivabradine at the end of the observation period was prescribed two times more than in the beginning. Patients from Russia had significantly lower all cause mortality compared with patients recruited in European countries (p<0.03); no significant differences were observed between Russian and European cohorts in cardiovascular mortality and rates of fatal and non-fatal myocardial infarction and stroke. CONCLUSION: Results of the CLARIFY register showed that continuous monitoring of patients with (annual visit and telephone contact between visits) was associated with reduction of angina in stable coronary artery disease from 75 to 58%. Only 26.6% of patients did not reach HR of 70 bpm. During 5 years of follow up mortality from cardiovascular diseases among patients from Russia did not differ from that among patients from non-European countries and was significantly lower than among patients from Europe (RR=0.83, p<0.05).

[Elevated Level of the Natriuretic Peptide Among Adult Population in Regions Participating in the ESSE-RF Study and Its Association With Cardiovascular Diseases and Risk Factors].

AIM: to study associations between elevated blood plasma concentration of N-terminal pro-brain natriuretic peptide (NT-proBNP), risk factors and cardiovascular diseases (CVD) in samples of adult population of Russian Federation (RF) aged 25-64 years. MATERIALS AND METHODS: We analyzed data of examination of representative samples of population of 5 regions of RF obtained within the framework of the multicenter ESSE-RF study (2012-2013). Number of examined subjects was 8 077 (3 176 men). Methods included use of standard questionnaire, measurements of height, body mass, blood pressure (BP), and plasma NT-proBNP level. The following CVD were included into analysis: arterial hypertension (AH), ischemic heart disease (IHD), atrial fibrillation (AF), and stroke. RESULTS: Women compared to men had higher NT-proBNT concentration was higher in women compared to men, in both genders it rose with age. Overall 17.9 % of examinees had elevated NT-proBNT levels (14.2 and 20.3 % among men and women, respectively). Elevated NTproBNP level was associated in men with age, myocardial infarction, angina pectoris, ischemic ECG changes, left ventricular hypertrophy, AF, bradycardia, smoking, in women with age, IHD, ischemic ECG changes, AF, bradycardia, heart rate ≥80 bpm, BP ≥160/95 mm Hg. CONCLUSION: In studied RF population elevated NT-proBNP level was significantly associated with gender, age, smoking, and CVD.

[The Prediction Model of Cardiovascular Events Among the Russian Population: Methodological Aspects].

Modeling is the common approach for predicting not only the population health, but also the social and economic burden of disease, which is an important argument while making decisions in health care and prevention. AIM: To develop the model for predicting cardiovascular risk, applicable for the assessment of clinical and socio-economic effects of preventive and therapeutic actions at the level of the whole population or part (region, city, group of patients). MATERIAL AND METHODS: An analytical model for making decision was performed by using a Markov model consisting of Markov states and probabilities of transition from one state to another within a certain time interval. The model included risk factors and cardiovascular diseases (blood pressure, cholesterol, smoking) and probabilities of transition between them. Data was standardized by age for both males and females. Multivariate sensitivity analysis was performed. The literature search conducted using eLIBRARY.RU (http://elibrary.ru) and CyberLeninka (http://cyberleninka.ru). Consultations with experts in the field of coronary heart disease, stroke, heart failure were carried out. RESULTS: The model, allowing to compare the outcomes of two scenarios (absence/presence of intervention). The model included risk factors: arterial hypertension, smoking, hypercholesterolemia, and important CVD: coronary artery disease, myocardial infarction, unstable angina, heart failure, chronic heart failure after myocardial infarction, transient ischemic attack, stroke, atrial fibrillation. There was absorbent state - death. At the output from the model the patient state was defined as the sum of the Markov states characteristics during the model time horizon. Each result had the cost and outcome, which values could be calculated by simulation modeling ("cohort simulation"). The data analysis from prospective study had shown that mortality increases with age, as expected, but in different age groups impact of cardiovascular causes was different and declined with age. In the case of the blood pressure there was the expected increase of the death risk with the growth of pressure levels, both for males and females, except for males 60-64 years old who had a minimal risk of death at the blood pressure 140-149/90-99 mmHg, and among males with normal blood pressure the risk was higher. Smoking was associated with an expected increase of the death risk among all age groups in both sexes. In males, aged 40-64 years, the death risk was higher at the normal levels of cholesterol (2-5 mmol/l), than at the cholesterol levels equal 5-7 mmol/l. There were no data sources to assess probability of occurrence of the risk factors (hypertension, smoking, hypercholesterolemia) in patients who did not have these factors previously in our studies, and available literature. This requires the prospective studies on at least two slices of surveys (not just with the endpoint analysis). Analysis of the literature on search of prospective Russian studies that would evaluate the probability of transition from one state to another, and consultations with experts have identified that currently conducted studies do not provide all the necessary probability of transition on the basis of national data. In the absence of local data for the model is acceptable to use the results of meta-analyzes of international studies. CONCLUSION: Markov model will allow for prediction the effectiveness of different interventions, including their socio-economic consequences. The created model will allow in the future to make changes with the appearance of the results of new studies or new data in order to improve modeling accuracy.

[Association of Atrial Fibrillation With Mortality From Various Causes in Population of Russian Federation].

AIM: to elucidate contribution of atrial fibrillation (AF) to mortality from various causes among men and women in Russia. MATERIAL AND METHODS: We analyzed data from samples of population of Moscow and Petersburg (Leningrad) aged 35-74 years examined in different years. Total number of subjects was 20045 (15107 men), response rate was 75%. Examination was carried out according to unified protocol incorporating collection of standard information on social and demographic parameters, smoking status and alcohol consumption, history.

[Potential and Paradoxes of Home Blood Pressure Variability].

We present in this review data on home blood pressure variability (HBPV) with consideration of its definition and threshold values. We also present own classification and discuss analysis of results of HBPV and their interpretation in observational and clinical studies, including own data. Experience in this area accumulated during last 30 years, information on pathophysiological mechanisms, prognostic properties of HBPV may be useful for a physician from practical point of view.