Classical Risk Factors of Cardiovascular Diseases (CVDs) in Arkhangelsk: Have They Changed over the Years? Comparison of Cross-sectional Studies: Arkhangelsk Study 2000 and Arkhangelsk Part of Know Your Heart Study 2015-17.

Abstract

Background: According to the World Health Organization, 31% of all deaths worldwide result from cardiovascular diseases (CVDs), mostly in low- and middle-income countries. Even though Russia, an upper-middle income country, still have higher CVD mortality compared to the neighboring countries such as Finland and Norway, it has seen a reduction in CVD mortality since the turn of the millennium. Investigating how risk factors have changed over the years might be beneficial to the explanation of the recent downward of CVD mortality in Russia. Objectives: The objective of this thesis was to see if there have been any changes in the classical risk factors of CVDs since the year 2000 in a north-western city of Arkhangelsk in Russia. Subjects & Methods: A cross-sectional study on CVDs called Arkhangelsk study 2000 (Ark.2000) was performed in Arkhangelsk in 2000. 15 years later, another cross-sectional study called Know Your Heart (KYH) was carried out in Arkhangelsk and Novosibirsk as a part of the International Project on Cardiovascular Disease in Russia (IPCDR). Changes in the classical CVD risk factors since 2000 were investigated by descriptive statistics by comparing these two studies. For the comparison purpose, participants above 40 years of age were included for the analyses in this thesis. 2132 participants (1087 men) from Ark.2000, recruited at a polyclinic while attending annual health checks, and 2222 participants (930 men) from the Arkhangelsk part of KYH, randomly selected from the general population, were included. Raw data was available from KYH, but not from Ark.2000. Therefore, descriptive statistics published from Ark.2000 and raw data from KYH were used for the comparison. Some of the classical risk factors that were comparable between the studies were included. Those were total and high-density lipoprotein (HDL) cholesterol, systolic and diastolic blood pressures (BPs), resting heart rates (RHRs), body mass index (BMI), education, physical activity at work, smoking, alcohol consumption measured by gamma-glutamyl transferase (GGT), Alcohol Use Disorder Identification Test (AUDIT), and the CAGE questionnaire (CAGE). Using those risk factors, Ten-year risk of developing coronary heart disease (CHD) was calculated by Framingham risk scores. Results: For men, total and HDL-cholesterol, systolic BP, GGT, AUDIT, and smoking have improved while diastolic BP, RHR, BMI, physical activity at work, and CAGE have shown opposite trends. Although most of the variables related to alcohol such as GGT and AUDIT decreased, GGT remained still high in all age groups (40-49, 50-59, above 60). Improvements in some of the risk factors improved the risk scores for developing CHD for ages above 60. For women, total and HDL-cholesterol, systolic BP, GGT, AUDIT, CAGE, education, and physical activity at work have shown improvements. However, diastolic BP, RHR, and smoking showed unfavorable trends, and BMI remained similar over the years. Improvements in ten-year risk scores for developing CHD were seen in all age groups, and they were lower for women compared to men. Conclusion: Some of the classical risk factors have shown improvements over the years for both men and women, which has led to improvements in the ten-year risk scores of CHD development. However, those changes are still small, and the factors which have not been improved may be hindering a further reduction in CVD prevalence. For further reduction in risk factors, control of alcohol consumption for men and BMI and smoking for women would be necessary. In order to understand the reasons behind the recent reduction in CVD mortality in Russia, conducting longitudinal studies will be important. In addition, communicating the results of the studies to the general public in Arkhangelsk would be beneficial for the prevention of CVDs.