the challenge of cardiovascular disease in russia · 2017-03-15 · • population-based random...
TRANSCRIPT
The challenge of cardiovascular disease
in Russia David Leon
davidleonlshtmacuk
The 21st Norwegian Conference on Epidemiology Tromsoslash October 30 ndash November 1 2013
Brehznev 1977-85 ldquoEra of stagnationrdquo
Gorbachev 1985-91 ldquoPerestroikardquo and ldquoGlasnostrdquo
Yelstin 1991-99
Major changes in society hellip
Putin 1999-2008
Medvedev 2008-12
Putin 2012-
55
60
65
70
75
80
85
1950 1960 1970 1980 1990 2000 2010
Females
55
60
65
70
75
80
85
1950 1960 1970 1980 1990 2000 2010
Males
Life expectancy at birth 1955 - 2010
Russia
EU members (pre-2005)
3
55
60
65
70
75
80
85
1950 1960 1970 1980 1990 2000 2010
Females
55
60
65
70
75
80
85
1950 1960 1970 1980 1990 2000 2010
Males
Life expectancy at birth 1955 - 2010
4
Russia 64 (2011) Norway 79 (2011)
Russia 76 (2011) Norway 84 (2011)
Russia has the highest cardiovascular mortality rate in
the world
5
6
Russia highest out of all 33 countries for men and women
Cardiovascular disease mortality in Russia is atypical
7
Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010
(age lt65 years)
0
50
100
150
200
250
300
1970
1973
1976
1979
1982
1985
1988
1991
1994
1997
2000
2003
2006
2009
Russia
Norway
UK
Women
0
50
100
150
200
250
300
1970
1973
1976
1979
1982
1985
1988
1991
1994
1997
2000
2003
2006
2009
Russia
Norway
UK
Age-
stan
dard
ised
rate
per
100
000
Men
Source WHO HFA database 8
0
2
4
6
8
10
12
Male lt65Male 65+Female lt65Female 65+
Particularly high mortality at working ages compared to other countries Russia Norway 1980 - 2010
Ratio
of m
orta
lity
Rus
sian
Fede
ratio
n N
orw
ay
Source WHO HFA database
Smoking Important but does not explain
fluctuations
10
Trends of adult smoking rates in Russia 1992ndash2009
11 Source Lunze K ampMigliorini L BMC Public Health 20131364
Paradoxical lipid profile relative to other countries
bull Prevalence of raised total cholesterol not high bull Levels of LDL (ldquobadrdquo) cholesterol tend to be
average or below average bull Levels of HDL (ldquogoodrdquo)cholesterol above
average
bull NB national data available bull NB statin use very low
12
Hypertension
bull High rates in Russia compared to other European countries
bull Poor rates of control bull Likely to be an important factor
bull NB comprehensive national data poorly
documented and of questionable quality 13
14
Classic risk factors do not explain international differences
Alcohol A key driver of fluctuations
0
10
20
30
40
50
60
70
80
90
1965 1970 1975 1980 1985 1990 1995 2000 2005
Year
SD
R p
er 1
000
00
56
57
58
59
60
61
62
63
64
65
66
67
Life
exp
ecta
ncy
at b
irth
(yea
rs)
Life expectancy at birth
SDR for alcohol poisonings ages 15+
Males
Strong evidence that alcohol drives fluctuations in male life expectancy in Russia 1965 -2008
Source V Shkolnikov and E Andreev 16
0
20
40
60
80
100
120
140
160
180
0
200
400
600
800
1000
1200
1960 1970 1980 1990 2000 2010
Acut
e al
coho
l poi
soni
ng m
orta
lity
per 1
000
00
Tota
l circ
ulat
ory
dise
ase
mor
talit
y pe
r 100
000
Mortality from circulatory disease and acute alcohol
poisoning among men aged 50-54 years Russia 1960-2008
Total circulatory diseaseAcute alcohol poisoning
Source Data provided by Evgueny Andreev
Individual-level evidence on alcohol
18
Izhevsk Family Study (men aged 25-59 years)
2003-5 and 2008-10
Hazardous drinking and mortality from various types of circulatory disease
Men aged 25-54 years Izhevsk 2003 - 5
Underlying cause of death
Number of deaths
Hazardous drinking (proxy report)
OR (95 CI)
Alcoholic cardiomyopathy 98 1570 (952594)
Other cardiomyopathy 51 384 (205718)
Cerebrovascular disease 90 205 (124340)
Other circulatory disease 28 343 (151781)
Ischaemic heart disease 219 304 (217424)
19 OR adjusted for age smoking and education Source Leon Shkolnikov McKee Kiryanov Andreev IJE 2010
Doubts about the diagnosis
20
A new international project 2014-19
21
University of Tromsoslash Norway
Ministry of Health and Care Services Norway
Cardiovascular disease in Russia strengthening evidence about
causes mechanisms prevention and treatment
Institute of Internal Medicine SBRAMS Novosibirsk Russia
Max Planck Institute for Demographic
Research
Finland
22
Novosibirsk
Arkhangelsk
Moscow Rostock London
Oulu
Tromso
23
Location of study sites and collaborators
Kazan
Four themes
Theme A Levels and trends in cardiovascular disease and associated risk factors
Theme B Understanding the nature and causes of cardiovascular disease in Russia (including cause of death study)
Theme C Barriers opportunities and capacity for improved prevention and treatment (role of health service)
Theme D Capacity development and training
24
Theme B Cross-sectional studies
bull Two locations ndash Arkhangelsk and Novosibirsk bull Population-based random sample
ndash men and women aged 35-69 years ndash attention given to reducing selection bias ndash N=2750 in each city
bull Additional sample heavy alcohol drinkers from medical facility (N=250 in each city)
bull Main field work starts 2015
25
26
Cardiovascular phenotypes Type Source Biomarkerproxy measure
Atherosclerosis
Questionnaire Previous MI
ECG Evidence previous MI
Carotid ultrasound Carotid IMT plaque
Cardiac remodelling
Blood NT-pro BNP HsTnI hsTnT
Echocardiography Myocardial function and size
Arrhythmia ECG Actiwave Cardio
Baseline rhythm heart rate variability
Vascular dysfunction Vicorder Pulse-wave velocity
Cutting edge scientific approaches
27
Serum NMR metabolomics
bull Highly standardised and reproducible platform for 117 primary and 99 derived measures of specific molecular entities (now gt100000 individuals assayed)
Nature Genetics 44 269 2012
28
bull How are alcohol and CVD phenotypes related to 14
lipoprotein subclasses bull Identifying markers of intermediate metabolism associated
with CVD phenotypes
The microbiome
29 Key expertise Vadim Govorun Moscow
Studies in other countries eg Tromsoslash 7
Endogenous exposures a priori CVD risk biomarkers
(including lipoprotein NMR profile)
Socio-demographic + exogenous exposures
CVD phenotypes
Metabolic profile Microbiome
Associations Analytic framework
Thank you
31
Alcohol control policy developments since 2005
bull 2005 Federal law No171 on production and sale of alcohol
bull 2009 Elaboration of the Russian anti-alcohol policy framework (the Conceptual Framework on anti-alcohol policy implementation)
bull 2009 Strengthening of institutional policy control (Establishment of the Federal Alcohol Service)
bull 2011 Introduction of greater controls and restrictions on production and sale of alcohol (Federal law No218)
Tobacco control policy developments since 2005
bull 2005 the Federal law No87 of 2001 ldquoOn limitations of smoking tobaccordquo is in effect
bull 2008 Ratification of the WHO Framework Convention on Tobacco Control by the Russian Federation
bull 2009 Defining the magnitude of the problem 40 smoking prevalence (GATS report on Russia)
bull 2010 Development of the anti-tobacco policy (the Conceptual framework on anti-tobacco policy for 2010-2015
bull 2013 Introduction of restrictions on tobacco sale and smoking in public (Federal law No 15 on ldquoHealth protection of citizens from exposure to tobacco smoke and consequences from tobacco consumptionrdquo)
34
0
20
40
60
80
100
120
140
160
180
Cancer oesophagus
Cancer stomach
Cancer breast
Ischaemic heartdiseaseInjuries poisoningviolence
Mortality from selected causes Women aged 45-59 Russia 1980 - 2009
Age-
stan
dard
ised
mor
talit
y ra
te p
er 1
000
00
Source WHO HFA database
Index of CVD risk - 1 Ratio of apolipoprotein B
to apolipoprotein A1
ldquoAtherogenicrdquo index
Index of CVD risk - 2 B-type natriuretic peptide
Index of stress on ventricles of heart Marker of non-atherosclerotic cardiac damage
Association of pattern of drinking with cardiovascular risk factors
OR (95 CI)
Pattern of drinking
OR top 20 ApoBA1 ratio
OR top 20 B-type natriuretic
peptide (BNP)
Abstains 100 [ref] 100 [ref]
Non-hazardous 034 (021 054) 235 (120 458)
Hazardous 031 (016 059) 431 (214 952)
P-value trend lt0001 lt0001
Adjusted for age BMI and waist-hip ratio
Source Leon DA et al EurJ Epidemiol 28 (5)393-404 2013
- The challenge of cardiovascular disease in Russia
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Russia has the highest cardiovascular mortality rate in the world
- Slide Number 6
- Cardiovascular disease mortality in Russia is atypical
- Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010 (age lt65 years)
- Slide Number 9
- Smoking Important but does not explain fluctuations
- Trends of adult smoking rates in Russia 1992ndash2009
- Paradoxical lipid profile relative to other countries
- Hypertension
- Slide Number 14
- Alcohol A key driver of fluctuations
- Slide Number 16
- Slide Number 17
- Individual-level evidence on alcohol
- Hazardous drinking and mortality from varioustypes of circulatory diseaseMen aged 25-54 years Izhevsk 2003 - 5
- Doubts about the diagnosis
- A new international project2014-19
- Cardiovascular disease in Russia strengthening evidence about causes mechanisms prevention and treatment
- Slide Number 23
- Four themes
- Theme B Cross-sectional studies
- Slide Number 26
- Cutting edge scientific approaches
- Serum NMR metabolomics
- The microbiome
- Slide Number 30
- Thank you
- Alcohol control policy developments since 2005
- Tobacco control policy developments since 2005
- Slide Number 34
- Index of CVD risk - 1Ratio of apolipoprotein B to apolipoprotein A1
- Index of CVD risk - 2 B-type natriuretic peptide
- Association of pattern of drinking with cardiovascular risk factorsOR (95 CI)
-
Brehznev 1977-85 ldquoEra of stagnationrdquo
Gorbachev 1985-91 ldquoPerestroikardquo and ldquoGlasnostrdquo
Yelstin 1991-99
Major changes in society hellip
Putin 1999-2008
Medvedev 2008-12
Putin 2012-
55
60
65
70
75
80
85
1950 1960 1970 1980 1990 2000 2010
Females
55
60
65
70
75
80
85
1950 1960 1970 1980 1990 2000 2010
Males
Life expectancy at birth 1955 - 2010
Russia
EU members (pre-2005)
3
55
60
65
70
75
80
85
1950 1960 1970 1980 1990 2000 2010
Females
55
60
65
70
75
80
85
1950 1960 1970 1980 1990 2000 2010
Males
Life expectancy at birth 1955 - 2010
4
Russia 64 (2011) Norway 79 (2011)
Russia 76 (2011) Norway 84 (2011)
Russia has the highest cardiovascular mortality rate in
the world
5
6
Russia highest out of all 33 countries for men and women
Cardiovascular disease mortality in Russia is atypical
7
Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010
(age lt65 years)
0
50
100
150
200
250
300
1970
1973
1976
1979
1982
1985
1988
1991
1994
1997
2000
2003
2006
2009
Russia
Norway
UK
Women
0
50
100
150
200
250
300
1970
1973
1976
1979
1982
1985
1988
1991
1994
1997
2000
2003
2006
2009
Russia
Norway
UK
Age-
stan
dard
ised
rate
per
100
000
Men
Source WHO HFA database 8
0
2
4
6
8
10
12
Male lt65Male 65+Female lt65Female 65+
Particularly high mortality at working ages compared to other countries Russia Norway 1980 - 2010
Ratio
of m
orta
lity
Rus
sian
Fede
ratio
n N
orw
ay
Source WHO HFA database
Smoking Important but does not explain
fluctuations
10
Trends of adult smoking rates in Russia 1992ndash2009
11 Source Lunze K ampMigliorini L BMC Public Health 20131364
Paradoxical lipid profile relative to other countries
bull Prevalence of raised total cholesterol not high bull Levels of LDL (ldquobadrdquo) cholesterol tend to be
average or below average bull Levels of HDL (ldquogoodrdquo)cholesterol above
average
bull NB national data available bull NB statin use very low
12
Hypertension
bull High rates in Russia compared to other European countries
bull Poor rates of control bull Likely to be an important factor
bull NB comprehensive national data poorly
documented and of questionable quality 13
14
Classic risk factors do not explain international differences
Alcohol A key driver of fluctuations
0
10
20
30
40
50
60
70
80
90
1965 1970 1975 1980 1985 1990 1995 2000 2005
Year
SD
R p
er 1
000
00
56
57
58
59
60
61
62
63
64
65
66
67
Life
exp
ecta
ncy
at b
irth
(yea
rs)
Life expectancy at birth
SDR for alcohol poisonings ages 15+
Males
Strong evidence that alcohol drives fluctuations in male life expectancy in Russia 1965 -2008
Source V Shkolnikov and E Andreev 16
0
20
40
60
80
100
120
140
160
180
0
200
400
600
800
1000
1200
1960 1970 1980 1990 2000 2010
Acut
e al
coho
l poi
soni
ng m
orta
lity
per 1
000
00
Tota
l circ
ulat
ory
dise
ase
mor
talit
y pe
r 100
000
Mortality from circulatory disease and acute alcohol
poisoning among men aged 50-54 years Russia 1960-2008
Total circulatory diseaseAcute alcohol poisoning
Source Data provided by Evgueny Andreev
Individual-level evidence on alcohol
18
Izhevsk Family Study (men aged 25-59 years)
2003-5 and 2008-10
Hazardous drinking and mortality from various types of circulatory disease
Men aged 25-54 years Izhevsk 2003 - 5
Underlying cause of death
Number of deaths
Hazardous drinking (proxy report)
OR (95 CI)
Alcoholic cardiomyopathy 98 1570 (952594)
Other cardiomyopathy 51 384 (205718)
Cerebrovascular disease 90 205 (124340)
Other circulatory disease 28 343 (151781)
Ischaemic heart disease 219 304 (217424)
19 OR adjusted for age smoking and education Source Leon Shkolnikov McKee Kiryanov Andreev IJE 2010
Doubts about the diagnosis
20
A new international project 2014-19
21
University of Tromsoslash Norway
Ministry of Health and Care Services Norway
Cardiovascular disease in Russia strengthening evidence about
causes mechanisms prevention and treatment
Institute of Internal Medicine SBRAMS Novosibirsk Russia
Max Planck Institute for Demographic
Research
Finland
22
Novosibirsk
Arkhangelsk
Moscow Rostock London
Oulu
Tromso
23
Location of study sites and collaborators
Kazan
Four themes
Theme A Levels and trends in cardiovascular disease and associated risk factors
Theme B Understanding the nature and causes of cardiovascular disease in Russia (including cause of death study)
Theme C Barriers opportunities and capacity for improved prevention and treatment (role of health service)
Theme D Capacity development and training
24
Theme B Cross-sectional studies
bull Two locations ndash Arkhangelsk and Novosibirsk bull Population-based random sample
ndash men and women aged 35-69 years ndash attention given to reducing selection bias ndash N=2750 in each city
bull Additional sample heavy alcohol drinkers from medical facility (N=250 in each city)
bull Main field work starts 2015
25
26
Cardiovascular phenotypes Type Source Biomarkerproxy measure
Atherosclerosis
Questionnaire Previous MI
ECG Evidence previous MI
Carotid ultrasound Carotid IMT plaque
Cardiac remodelling
Blood NT-pro BNP HsTnI hsTnT
Echocardiography Myocardial function and size
Arrhythmia ECG Actiwave Cardio
Baseline rhythm heart rate variability
Vascular dysfunction Vicorder Pulse-wave velocity
Cutting edge scientific approaches
27
Serum NMR metabolomics
bull Highly standardised and reproducible platform for 117 primary and 99 derived measures of specific molecular entities (now gt100000 individuals assayed)
Nature Genetics 44 269 2012
28
bull How are alcohol and CVD phenotypes related to 14
lipoprotein subclasses bull Identifying markers of intermediate metabolism associated
with CVD phenotypes
The microbiome
29 Key expertise Vadim Govorun Moscow
Studies in other countries eg Tromsoslash 7
Endogenous exposures a priori CVD risk biomarkers
(including lipoprotein NMR profile)
Socio-demographic + exogenous exposures
CVD phenotypes
Metabolic profile Microbiome
Associations Analytic framework
Thank you
31
Alcohol control policy developments since 2005
bull 2005 Federal law No171 on production and sale of alcohol
bull 2009 Elaboration of the Russian anti-alcohol policy framework (the Conceptual Framework on anti-alcohol policy implementation)
bull 2009 Strengthening of institutional policy control (Establishment of the Federal Alcohol Service)
bull 2011 Introduction of greater controls and restrictions on production and sale of alcohol (Federal law No218)
Tobacco control policy developments since 2005
bull 2005 the Federal law No87 of 2001 ldquoOn limitations of smoking tobaccordquo is in effect
bull 2008 Ratification of the WHO Framework Convention on Tobacco Control by the Russian Federation
bull 2009 Defining the magnitude of the problem 40 smoking prevalence (GATS report on Russia)
bull 2010 Development of the anti-tobacco policy (the Conceptual framework on anti-tobacco policy for 2010-2015
bull 2013 Introduction of restrictions on tobacco sale and smoking in public (Federal law No 15 on ldquoHealth protection of citizens from exposure to tobacco smoke and consequences from tobacco consumptionrdquo)
34
0
20
40
60
80
100
120
140
160
180
Cancer oesophagus
Cancer stomach
Cancer breast
Ischaemic heartdiseaseInjuries poisoningviolence
Mortality from selected causes Women aged 45-59 Russia 1980 - 2009
Age-
stan
dard
ised
mor
talit
y ra
te p
er 1
000
00
Source WHO HFA database
Index of CVD risk - 1 Ratio of apolipoprotein B
to apolipoprotein A1
ldquoAtherogenicrdquo index
Index of CVD risk - 2 B-type natriuretic peptide
Index of stress on ventricles of heart Marker of non-atherosclerotic cardiac damage
Association of pattern of drinking with cardiovascular risk factors
OR (95 CI)
Pattern of drinking
OR top 20 ApoBA1 ratio
OR top 20 B-type natriuretic
peptide (BNP)
Abstains 100 [ref] 100 [ref]
Non-hazardous 034 (021 054) 235 (120 458)
Hazardous 031 (016 059) 431 (214 952)
P-value trend lt0001 lt0001
Adjusted for age BMI and waist-hip ratio
Source Leon DA et al EurJ Epidemiol 28 (5)393-404 2013
- The challenge of cardiovascular disease in Russia
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Russia has the highest cardiovascular mortality rate in the world
- Slide Number 6
- Cardiovascular disease mortality in Russia is atypical
- Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010 (age lt65 years)
- Slide Number 9
- Smoking Important but does not explain fluctuations
- Trends of adult smoking rates in Russia 1992ndash2009
- Paradoxical lipid profile relative to other countries
- Hypertension
- Slide Number 14
- Alcohol A key driver of fluctuations
- Slide Number 16
- Slide Number 17
- Individual-level evidence on alcohol
- Hazardous drinking and mortality from varioustypes of circulatory diseaseMen aged 25-54 years Izhevsk 2003 - 5
- Doubts about the diagnosis
- A new international project2014-19
- Cardiovascular disease in Russia strengthening evidence about causes mechanisms prevention and treatment
- Slide Number 23
- Four themes
- Theme B Cross-sectional studies
- Slide Number 26
- Cutting edge scientific approaches
- Serum NMR metabolomics
- The microbiome
- Slide Number 30
- Thank you
- Alcohol control policy developments since 2005
- Tobacco control policy developments since 2005
- Slide Number 34
- Index of CVD risk - 1Ratio of apolipoprotein B to apolipoprotein A1
- Index of CVD risk - 2 B-type natriuretic peptide
- Association of pattern of drinking with cardiovascular risk factorsOR (95 CI)
-
55
60
65
70
75
80
85
1950 1960 1970 1980 1990 2000 2010
Females
55
60
65
70
75
80
85
1950 1960 1970 1980 1990 2000 2010
Males
Life expectancy at birth 1955 - 2010
Russia
EU members (pre-2005)
3
55
60
65
70
75
80
85
1950 1960 1970 1980 1990 2000 2010
Females
55
60
65
70
75
80
85
1950 1960 1970 1980 1990 2000 2010
Males
Life expectancy at birth 1955 - 2010
4
Russia 64 (2011) Norway 79 (2011)
Russia 76 (2011) Norway 84 (2011)
Russia has the highest cardiovascular mortality rate in
the world
5
6
Russia highest out of all 33 countries for men and women
Cardiovascular disease mortality in Russia is atypical
7
Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010
(age lt65 years)
0
50
100
150
200
250
300
1970
1973
1976
1979
1982
1985
1988
1991
1994
1997
2000
2003
2006
2009
Russia
Norway
UK
Women
0
50
100
150
200
250
300
1970
1973
1976
1979
1982
1985
1988
1991
1994
1997
2000
2003
2006
2009
Russia
Norway
UK
Age-
stan
dard
ised
rate
per
100
000
Men
Source WHO HFA database 8
0
2
4
6
8
10
12
Male lt65Male 65+Female lt65Female 65+
Particularly high mortality at working ages compared to other countries Russia Norway 1980 - 2010
Ratio
of m
orta
lity
Rus
sian
Fede
ratio
n N
orw
ay
Source WHO HFA database
Smoking Important but does not explain
fluctuations
10
Trends of adult smoking rates in Russia 1992ndash2009
11 Source Lunze K ampMigliorini L BMC Public Health 20131364
Paradoxical lipid profile relative to other countries
bull Prevalence of raised total cholesterol not high bull Levels of LDL (ldquobadrdquo) cholesterol tend to be
average or below average bull Levels of HDL (ldquogoodrdquo)cholesterol above
average
bull NB national data available bull NB statin use very low
12
Hypertension
bull High rates in Russia compared to other European countries
bull Poor rates of control bull Likely to be an important factor
bull NB comprehensive national data poorly
documented and of questionable quality 13
14
Classic risk factors do not explain international differences
Alcohol A key driver of fluctuations
0
10
20
30
40
50
60
70
80
90
1965 1970 1975 1980 1985 1990 1995 2000 2005
Year
SD
R p
er 1
000
00
56
57
58
59
60
61
62
63
64
65
66
67
Life
exp
ecta
ncy
at b
irth
(yea
rs)
Life expectancy at birth
SDR for alcohol poisonings ages 15+
Males
Strong evidence that alcohol drives fluctuations in male life expectancy in Russia 1965 -2008
Source V Shkolnikov and E Andreev 16
0
20
40
60
80
100
120
140
160
180
0
200
400
600
800
1000
1200
1960 1970 1980 1990 2000 2010
Acut
e al
coho
l poi
soni
ng m
orta
lity
per 1
000
00
Tota
l circ
ulat
ory
dise
ase
mor
talit
y pe
r 100
000
Mortality from circulatory disease and acute alcohol
poisoning among men aged 50-54 years Russia 1960-2008
Total circulatory diseaseAcute alcohol poisoning
Source Data provided by Evgueny Andreev
Individual-level evidence on alcohol
18
Izhevsk Family Study (men aged 25-59 years)
2003-5 and 2008-10
Hazardous drinking and mortality from various types of circulatory disease
Men aged 25-54 years Izhevsk 2003 - 5
Underlying cause of death
Number of deaths
Hazardous drinking (proxy report)
OR (95 CI)
Alcoholic cardiomyopathy 98 1570 (952594)
Other cardiomyopathy 51 384 (205718)
Cerebrovascular disease 90 205 (124340)
Other circulatory disease 28 343 (151781)
Ischaemic heart disease 219 304 (217424)
19 OR adjusted for age smoking and education Source Leon Shkolnikov McKee Kiryanov Andreev IJE 2010
Doubts about the diagnosis
20
A new international project 2014-19
21
University of Tromsoslash Norway
Ministry of Health and Care Services Norway
Cardiovascular disease in Russia strengthening evidence about
causes mechanisms prevention and treatment
Institute of Internal Medicine SBRAMS Novosibirsk Russia
Max Planck Institute for Demographic
Research
Finland
22
Novosibirsk
Arkhangelsk
Moscow Rostock London
Oulu
Tromso
23
Location of study sites and collaborators
Kazan
Four themes
Theme A Levels and trends in cardiovascular disease and associated risk factors
Theme B Understanding the nature and causes of cardiovascular disease in Russia (including cause of death study)
Theme C Barriers opportunities and capacity for improved prevention and treatment (role of health service)
Theme D Capacity development and training
24
Theme B Cross-sectional studies
bull Two locations ndash Arkhangelsk and Novosibirsk bull Population-based random sample
ndash men and women aged 35-69 years ndash attention given to reducing selection bias ndash N=2750 in each city
bull Additional sample heavy alcohol drinkers from medical facility (N=250 in each city)
bull Main field work starts 2015
25
26
Cardiovascular phenotypes Type Source Biomarkerproxy measure
Atherosclerosis
Questionnaire Previous MI
ECG Evidence previous MI
Carotid ultrasound Carotid IMT plaque
Cardiac remodelling
Blood NT-pro BNP HsTnI hsTnT
Echocardiography Myocardial function and size
Arrhythmia ECG Actiwave Cardio
Baseline rhythm heart rate variability
Vascular dysfunction Vicorder Pulse-wave velocity
Cutting edge scientific approaches
27
Serum NMR metabolomics
bull Highly standardised and reproducible platform for 117 primary and 99 derived measures of specific molecular entities (now gt100000 individuals assayed)
Nature Genetics 44 269 2012
28
bull How are alcohol and CVD phenotypes related to 14
lipoprotein subclasses bull Identifying markers of intermediate metabolism associated
with CVD phenotypes
The microbiome
29 Key expertise Vadim Govorun Moscow
Studies in other countries eg Tromsoslash 7
Endogenous exposures a priori CVD risk biomarkers
(including lipoprotein NMR profile)
Socio-demographic + exogenous exposures
CVD phenotypes
Metabolic profile Microbiome
Associations Analytic framework
Thank you
31
Alcohol control policy developments since 2005
bull 2005 Federal law No171 on production and sale of alcohol
bull 2009 Elaboration of the Russian anti-alcohol policy framework (the Conceptual Framework on anti-alcohol policy implementation)
bull 2009 Strengthening of institutional policy control (Establishment of the Federal Alcohol Service)
bull 2011 Introduction of greater controls and restrictions on production and sale of alcohol (Federal law No218)
Tobacco control policy developments since 2005
bull 2005 the Federal law No87 of 2001 ldquoOn limitations of smoking tobaccordquo is in effect
bull 2008 Ratification of the WHO Framework Convention on Tobacco Control by the Russian Federation
bull 2009 Defining the magnitude of the problem 40 smoking prevalence (GATS report on Russia)
bull 2010 Development of the anti-tobacco policy (the Conceptual framework on anti-tobacco policy for 2010-2015
bull 2013 Introduction of restrictions on tobacco sale and smoking in public (Federal law No 15 on ldquoHealth protection of citizens from exposure to tobacco smoke and consequences from tobacco consumptionrdquo)
34
0
20
40
60
80
100
120
140
160
180
Cancer oesophagus
Cancer stomach
Cancer breast
Ischaemic heartdiseaseInjuries poisoningviolence
Mortality from selected causes Women aged 45-59 Russia 1980 - 2009
Age-
stan
dard
ised
mor
talit
y ra
te p
er 1
000
00
Source WHO HFA database
Index of CVD risk - 1 Ratio of apolipoprotein B
to apolipoprotein A1
ldquoAtherogenicrdquo index
Index of CVD risk - 2 B-type natriuretic peptide
Index of stress on ventricles of heart Marker of non-atherosclerotic cardiac damage
Association of pattern of drinking with cardiovascular risk factors
OR (95 CI)
Pattern of drinking
OR top 20 ApoBA1 ratio
OR top 20 B-type natriuretic
peptide (BNP)
Abstains 100 [ref] 100 [ref]
Non-hazardous 034 (021 054) 235 (120 458)
Hazardous 031 (016 059) 431 (214 952)
P-value trend lt0001 lt0001
Adjusted for age BMI and waist-hip ratio
Source Leon DA et al EurJ Epidemiol 28 (5)393-404 2013
- The challenge of cardiovascular disease in Russia
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Russia has the highest cardiovascular mortality rate in the world
- Slide Number 6
- Cardiovascular disease mortality in Russia is atypical
- Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010 (age lt65 years)
- Slide Number 9
- Smoking Important but does not explain fluctuations
- Trends of adult smoking rates in Russia 1992ndash2009
- Paradoxical lipid profile relative to other countries
- Hypertension
- Slide Number 14
- Alcohol A key driver of fluctuations
- Slide Number 16
- Slide Number 17
- Individual-level evidence on alcohol
- Hazardous drinking and mortality from varioustypes of circulatory diseaseMen aged 25-54 years Izhevsk 2003 - 5
- Doubts about the diagnosis
- A new international project2014-19
- Cardiovascular disease in Russia strengthening evidence about causes mechanisms prevention and treatment
- Slide Number 23
- Four themes
- Theme B Cross-sectional studies
- Slide Number 26
- Cutting edge scientific approaches
- Serum NMR metabolomics
- The microbiome
- Slide Number 30
- Thank you
- Alcohol control policy developments since 2005
- Tobacco control policy developments since 2005
- Slide Number 34
- Index of CVD risk - 1Ratio of apolipoprotein B to apolipoprotein A1
- Index of CVD risk - 2 B-type natriuretic peptide
- Association of pattern of drinking with cardiovascular risk factorsOR (95 CI)
-
55
60
65
70
75
80
85
1950 1960 1970 1980 1990 2000 2010
Females
55
60
65
70
75
80
85
1950 1960 1970 1980 1990 2000 2010
Males
Life expectancy at birth 1955 - 2010
4
Russia 64 (2011) Norway 79 (2011)
Russia 76 (2011) Norway 84 (2011)
Russia has the highest cardiovascular mortality rate in
the world
5
6
Russia highest out of all 33 countries for men and women
Cardiovascular disease mortality in Russia is atypical
7
Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010
(age lt65 years)
0
50
100
150
200
250
300
1970
1973
1976
1979
1982
1985
1988
1991
1994
1997
2000
2003
2006
2009
Russia
Norway
UK
Women
0
50
100
150
200
250
300
1970
1973
1976
1979
1982
1985
1988
1991
1994
1997
2000
2003
2006
2009
Russia
Norway
UK
Age-
stan
dard
ised
rate
per
100
000
Men
Source WHO HFA database 8
0
2
4
6
8
10
12
Male lt65Male 65+Female lt65Female 65+
Particularly high mortality at working ages compared to other countries Russia Norway 1980 - 2010
Ratio
of m
orta
lity
Rus
sian
Fede
ratio
n N
orw
ay
Source WHO HFA database
Smoking Important but does not explain
fluctuations
10
Trends of adult smoking rates in Russia 1992ndash2009
11 Source Lunze K ampMigliorini L BMC Public Health 20131364
Paradoxical lipid profile relative to other countries
bull Prevalence of raised total cholesterol not high bull Levels of LDL (ldquobadrdquo) cholesterol tend to be
average or below average bull Levels of HDL (ldquogoodrdquo)cholesterol above
average
bull NB national data available bull NB statin use very low
12
Hypertension
bull High rates in Russia compared to other European countries
bull Poor rates of control bull Likely to be an important factor
bull NB comprehensive national data poorly
documented and of questionable quality 13
14
Classic risk factors do not explain international differences
Alcohol A key driver of fluctuations
0
10
20
30
40
50
60
70
80
90
1965 1970 1975 1980 1985 1990 1995 2000 2005
Year
SD
R p
er 1
000
00
56
57
58
59
60
61
62
63
64
65
66
67
Life
exp
ecta
ncy
at b
irth
(yea
rs)
Life expectancy at birth
SDR for alcohol poisonings ages 15+
Males
Strong evidence that alcohol drives fluctuations in male life expectancy in Russia 1965 -2008
Source V Shkolnikov and E Andreev 16
0
20
40
60
80
100
120
140
160
180
0
200
400
600
800
1000
1200
1960 1970 1980 1990 2000 2010
Acut
e al
coho
l poi
soni
ng m
orta
lity
per 1
000
00
Tota
l circ
ulat
ory
dise
ase
mor
talit
y pe
r 100
000
Mortality from circulatory disease and acute alcohol
poisoning among men aged 50-54 years Russia 1960-2008
Total circulatory diseaseAcute alcohol poisoning
Source Data provided by Evgueny Andreev
Individual-level evidence on alcohol
18
Izhevsk Family Study (men aged 25-59 years)
2003-5 and 2008-10
Hazardous drinking and mortality from various types of circulatory disease
Men aged 25-54 years Izhevsk 2003 - 5
Underlying cause of death
Number of deaths
Hazardous drinking (proxy report)
OR (95 CI)
Alcoholic cardiomyopathy 98 1570 (952594)
Other cardiomyopathy 51 384 (205718)
Cerebrovascular disease 90 205 (124340)
Other circulatory disease 28 343 (151781)
Ischaemic heart disease 219 304 (217424)
19 OR adjusted for age smoking and education Source Leon Shkolnikov McKee Kiryanov Andreev IJE 2010
Doubts about the diagnosis
20
A new international project 2014-19
21
University of Tromsoslash Norway
Ministry of Health and Care Services Norway
Cardiovascular disease in Russia strengthening evidence about
causes mechanisms prevention and treatment
Institute of Internal Medicine SBRAMS Novosibirsk Russia
Max Planck Institute for Demographic
Research
Finland
22
Novosibirsk
Arkhangelsk
Moscow Rostock London
Oulu
Tromso
23
Location of study sites and collaborators
Kazan
Four themes
Theme A Levels and trends in cardiovascular disease and associated risk factors
Theme B Understanding the nature and causes of cardiovascular disease in Russia (including cause of death study)
Theme C Barriers opportunities and capacity for improved prevention and treatment (role of health service)
Theme D Capacity development and training
24
Theme B Cross-sectional studies
bull Two locations ndash Arkhangelsk and Novosibirsk bull Population-based random sample
ndash men and women aged 35-69 years ndash attention given to reducing selection bias ndash N=2750 in each city
bull Additional sample heavy alcohol drinkers from medical facility (N=250 in each city)
bull Main field work starts 2015
25
26
Cardiovascular phenotypes Type Source Biomarkerproxy measure
Atherosclerosis
Questionnaire Previous MI
ECG Evidence previous MI
Carotid ultrasound Carotid IMT plaque
Cardiac remodelling
Blood NT-pro BNP HsTnI hsTnT
Echocardiography Myocardial function and size
Arrhythmia ECG Actiwave Cardio
Baseline rhythm heart rate variability
Vascular dysfunction Vicorder Pulse-wave velocity
Cutting edge scientific approaches
27
Serum NMR metabolomics
bull Highly standardised and reproducible platform for 117 primary and 99 derived measures of specific molecular entities (now gt100000 individuals assayed)
Nature Genetics 44 269 2012
28
bull How are alcohol and CVD phenotypes related to 14
lipoprotein subclasses bull Identifying markers of intermediate metabolism associated
with CVD phenotypes
The microbiome
29 Key expertise Vadim Govorun Moscow
Studies in other countries eg Tromsoslash 7
Endogenous exposures a priori CVD risk biomarkers
(including lipoprotein NMR profile)
Socio-demographic + exogenous exposures
CVD phenotypes
Metabolic profile Microbiome
Associations Analytic framework
Thank you
31
Alcohol control policy developments since 2005
bull 2005 Federal law No171 on production and sale of alcohol
bull 2009 Elaboration of the Russian anti-alcohol policy framework (the Conceptual Framework on anti-alcohol policy implementation)
bull 2009 Strengthening of institutional policy control (Establishment of the Federal Alcohol Service)
bull 2011 Introduction of greater controls and restrictions on production and sale of alcohol (Federal law No218)
Tobacco control policy developments since 2005
bull 2005 the Federal law No87 of 2001 ldquoOn limitations of smoking tobaccordquo is in effect
bull 2008 Ratification of the WHO Framework Convention on Tobacco Control by the Russian Federation
bull 2009 Defining the magnitude of the problem 40 smoking prevalence (GATS report on Russia)
bull 2010 Development of the anti-tobacco policy (the Conceptual framework on anti-tobacco policy for 2010-2015
bull 2013 Introduction of restrictions on tobacco sale and smoking in public (Federal law No 15 on ldquoHealth protection of citizens from exposure to tobacco smoke and consequences from tobacco consumptionrdquo)
34
0
20
40
60
80
100
120
140
160
180
Cancer oesophagus
Cancer stomach
Cancer breast
Ischaemic heartdiseaseInjuries poisoningviolence
Mortality from selected causes Women aged 45-59 Russia 1980 - 2009
Age-
stan
dard
ised
mor
talit
y ra
te p
er 1
000
00
Source WHO HFA database
Index of CVD risk - 1 Ratio of apolipoprotein B
to apolipoprotein A1
ldquoAtherogenicrdquo index
Index of CVD risk - 2 B-type natriuretic peptide
Index of stress on ventricles of heart Marker of non-atherosclerotic cardiac damage
Association of pattern of drinking with cardiovascular risk factors
OR (95 CI)
Pattern of drinking
OR top 20 ApoBA1 ratio
OR top 20 B-type natriuretic
peptide (BNP)
Abstains 100 [ref] 100 [ref]
Non-hazardous 034 (021 054) 235 (120 458)
Hazardous 031 (016 059) 431 (214 952)
P-value trend lt0001 lt0001
Adjusted for age BMI and waist-hip ratio
Source Leon DA et al EurJ Epidemiol 28 (5)393-404 2013
- The challenge of cardiovascular disease in Russia
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Russia has the highest cardiovascular mortality rate in the world
- Slide Number 6
- Cardiovascular disease mortality in Russia is atypical
- Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010 (age lt65 years)
- Slide Number 9
- Smoking Important but does not explain fluctuations
- Trends of adult smoking rates in Russia 1992ndash2009
- Paradoxical lipid profile relative to other countries
- Hypertension
- Slide Number 14
- Alcohol A key driver of fluctuations
- Slide Number 16
- Slide Number 17
- Individual-level evidence on alcohol
- Hazardous drinking and mortality from varioustypes of circulatory diseaseMen aged 25-54 years Izhevsk 2003 - 5
- Doubts about the diagnosis
- A new international project2014-19
- Cardiovascular disease in Russia strengthening evidence about causes mechanisms prevention and treatment
- Slide Number 23
- Four themes
- Theme B Cross-sectional studies
- Slide Number 26
- Cutting edge scientific approaches
- Serum NMR metabolomics
- The microbiome
- Slide Number 30
- Thank you
- Alcohol control policy developments since 2005
- Tobacco control policy developments since 2005
- Slide Number 34
- Index of CVD risk - 1Ratio of apolipoprotein B to apolipoprotein A1
- Index of CVD risk - 2 B-type natriuretic peptide
- Association of pattern of drinking with cardiovascular risk factorsOR (95 CI)
-
Russia has the highest cardiovascular mortality rate in
the world
5
6
Russia highest out of all 33 countries for men and women
Cardiovascular disease mortality in Russia is atypical
7
Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010
(age lt65 years)
0
50
100
150
200
250
300
1970
1973
1976
1979
1982
1985
1988
1991
1994
1997
2000
2003
2006
2009
Russia
Norway
UK
Women
0
50
100
150
200
250
300
1970
1973
1976
1979
1982
1985
1988
1991
1994
1997
2000
2003
2006
2009
Russia
Norway
UK
Age-
stan
dard
ised
rate
per
100
000
Men
Source WHO HFA database 8
0
2
4
6
8
10
12
Male lt65Male 65+Female lt65Female 65+
Particularly high mortality at working ages compared to other countries Russia Norway 1980 - 2010
Ratio
of m
orta
lity
Rus
sian
Fede
ratio
n N
orw
ay
Source WHO HFA database
Smoking Important but does not explain
fluctuations
10
Trends of adult smoking rates in Russia 1992ndash2009
11 Source Lunze K ampMigliorini L BMC Public Health 20131364
Paradoxical lipid profile relative to other countries
bull Prevalence of raised total cholesterol not high bull Levels of LDL (ldquobadrdquo) cholesterol tend to be
average or below average bull Levels of HDL (ldquogoodrdquo)cholesterol above
average
bull NB national data available bull NB statin use very low
12
Hypertension
bull High rates in Russia compared to other European countries
bull Poor rates of control bull Likely to be an important factor
bull NB comprehensive national data poorly
documented and of questionable quality 13
14
Classic risk factors do not explain international differences
Alcohol A key driver of fluctuations
0
10
20
30
40
50
60
70
80
90
1965 1970 1975 1980 1985 1990 1995 2000 2005
Year
SD
R p
er 1
000
00
56
57
58
59
60
61
62
63
64
65
66
67
Life
exp
ecta
ncy
at b
irth
(yea
rs)
Life expectancy at birth
SDR for alcohol poisonings ages 15+
Males
Strong evidence that alcohol drives fluctuations in male life expectancy in Russia 1965 -2008
Source V Shkolnikov and E Andreev 16
0
20
40
60
80
100
120
140
160
180
0
200
400
600
800
1000
1200
1960 1970 1980 1990 2000 2010
Acut
e al
coho
l poi
soni
ng m
orta
lity
per 1
000
00
Tota
l circ
ulat
ory
dise
ase
mor
talit
y pe
r 100
000
Mortality from circulatory disease and acute alcohol
poisoning among men aged 50-54 years Russia 1960-2008
Total circulatory diseaseAcute alcohol poisoning
Source Data provided by Evgueny Andreev
Individual-level evidence on alcohol
18
Izhevsk Family Study (men aged 25-59 years)
2003-5 and 2008-10
Hazardous drinking and mortality from various types of circulatory disease
Men aged 25-54 years Izhevsk 2003 - 5
Underlying cause of death
Number of deaths
Hazardous drinking (proxy report)
OR (95 CI)
Alcoholic cardiomyopathy 98 1570 (952594)
Other cardiomyopathy 51 384 (205718)
Cerebrovascular disease 90 205 (124340)
Other circulatory disease 28 343 (151781)
Ischaemic heart disease 219 304 (217424)
19 OR adjusted for age smoking and education Source Leon Shkolnikov McKee Kiryanov Andreev IJE 2010
Doubts about the diagnosis
20
A new international project 2014-19
21
University of Tromsoslash Norway
Ministry of Health and Care Services Norway
Cardiovascular disease in Russia strengthening evidence about
causes mechanisms prevention and treatment
Institute of Internal Medicine SBRAMS Novosibirsk Russia
Max Planck Institute for Demographic
Research
Finland
22
Novosibirsk
Arkhangelsk
Moscow Rostock London
Oulu
Tromso
23
Location of study sites and collaborators
Kazan
Four themes
Theme A Levels and trends in cardiovascular disease and associated risk factors
Theme B Understanding the nature and causes of cardiovascular disease in Russia (including cause of death study)
Theme C Barriers opportunities and capacity for improved prevention and treatment (role of health service)
Theme D Capacity development and training
24
Theme B Cross-sectional studies
bull Two locations ndash Arkhangelsk and Novosibirsk bull Population-based random sample
ndash men and women aged 35-69 years ndash attention given to reducing selection bias ndash N=2750 in each city
bull Additional sample heavy alcohol drinkers from medical facility (N=250 in each city)
bull Main field work starts 2015
25
26
Cardiovascular phenotypes Type Source Biomarkerproxy measure
Atherosclerosis
Questionnaire Previous MI
ECG Evidence previous MI
Carotid ultrasound Carotid IMT plaque
Cardiac remodelling
Blood NT-pro BNP HsTnI hsTnT
Echocardiography Myocardial function and size
Arrhythmia ECG Actiwave Cardio
Baseline rhythm heart rate variability
Vascular dysfunction Vicorder Pulse-wave velocity
Cutting edge scientific approaches
27
Serum NMR metabolomics
bull Highly standardised and reproducible platform for 117 primary and 99 derived measures of specific molecular entities (now gt100000 individuals assayed)
Nature Genetics 44 269 2012
28
bull How are alcohol and CVD phenotypes related to 14
lipoprotein subclasses bull Identifying markers of intermediate metabolism associated
with CVD phenotypes
The microbiome
29 Key expertise Vadim Govorun Moscow
Studies in other countries eg Tromsoslash 7
Endogenous exposures a priori CVD risk biomarkers
(including lipoprotein NMR profile)
Socio-demographic + exogenous exposures
CVD phenotypes
Metabolic profile Microbiome
Associations Analytic framework
Thank you
31
Alcohol control policy developments since 2005
bull 2005 Federal law No171 on production and sale of alcohol
bull 2009 Elaboration of the Russian anti-alcohol policy framework (the Conceptual Framework on anti-alcohol policy implementation)
bull 2009 Strengthening of institutional policy control (Establishment of the Federal Alcohol Service)
bull 2011 Introduction of greater controls and restrictions on production and sale of alcohol (Federal law No218)
Tobacco control policy developments since 2005
bull 2005 the Federal law No87 of 2001 ldquoOn limitations of smoking tobaccordquo is in effect
bull 2008 Ratification of the WHO Framework Convention on Tobacco Control by the Russian Federation
bull 2009 Defining the magnitude of the problem 40 smoking prevalence (GATS report on Russia)
bull 2010 Development of the anti-tobacco policy (the Conceptual framework on anti-tobacco policy for 2010-2015
bull 2013 Introduction of restrictions on tobacco sale and smoking in public (Federal law No 15 on ldquoHealth protection of citizens from exposure to tobacco smoke and consequences from tobacco consumptionrdquo)
34
0
20
40
60
80
100
120
140
160
180
Cancer oesophagus
Cancer stomach
Cancer breast
Ischaemic heartdiseaseInjuries poisoningviolence
Mortality from selected causes Women aged 45-59 Russia 1980 - 2009
Age-
stan
dard
ised
mor
talit
y ra
te p
er 1
000
00
Source WHO HFA database
Index of CVD risk - 1 Ratio of apolipoprotein B
to apolipoprotein A1
ldquoAtherogenicrdquo index
Index of CVD risk - 2 B-type natriuretic peptide
Index of stress on ventricles of heart Marker of non-atherosclerotic cardiac damage
Association of pattern of drinking with cardiovascular risk factors
OR (95 CI)
Pattern of drinking
OR top 20 ApoBA1 ratio
OR top 20 B-type natriuretic
peptide (BNP)
Abstains 100 [ref] 100 [ref]
Non-hazardous 034 (021 054) 235 (120 458)
Hazardous 031 (016 059) 431 (214 952)
P-value trend lt0001 lt0001
Adjusted for age BMI and waist-hip ratio
Source Leon DA et al EurJ Epidemiol 28 (5)393-404 2013
- The challenge of cardiovascular disease in Russia
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Russia has the highest cardiovascular mortality rate in the world
- Slide Number 6
- Cardiovascular disease mortality in Russia is atypical
- Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010 (age lt65 years)
- Slide Number 9
- Smoking Important but does not explain fluctuations
- Trends of adult smoking rates in Russia 1992ndash2009
- Paradoxical lipid profile relative to other countries
- Hypertension
- Slide Number 14
- Alcohol A key driver of fluctuations
- Slide Number 16
- Slide Number 17
- Individual-level evidence on alcohol
- Hazardous drinking and mortality from varioustypes of circulatory diseaseMen aged 25-54 years Izhevsk 2003 - 5
- Doubts about the diagnosis
- A new international project2014-19
- Cardiovascular disease in Russia strengthening evidence about causes mechanisms prevention and treatment
- Slide Number 23
- Four themes
- Theme B Cross-sectional studies
- Slide Number 26
- Cutting edge scientific approaches
- Serum NMR metabolomics
- The microbiome
- Slide Number 30
- Thank you
- Alcohol control policy developments since 2005
- Tobacco control policy developments since 2005
- Slide Number 34
- Index of CVD risk - 1Ratio of apolipoprotein B to apolipoprotein A1
- Index of CVD risk - 2 B-type natriuretic peptide
- Association of pattern of drinking with cardiovascular risk factorsOR (95 CI)
-
6
Russia highest out of all 33 countries for men and women
Cardiovascular disease mortality in Russia is atypical
7
Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010
(age lt65 years)
0
50
100
150
200
250
300
1970
1973
1976
1979
1982
1985
1988
1991
1994
1997
2000
2003
2006
2009
Russia
Norway
UK
Women
0
50
100
150
200
250
300
1970
1973
1976
1979
1982
1985
1988
1991
1994
1997
2000
2003
2006
2009
Russia
Norway
UK
Age-
stan
dard
ised
rate
per
100
000
Men
Source WHO HFA database 8
0
2
4
6
8
10
12
Male lt65Male 65+Female lt65Female 65+
Particularly high mortality at working ages compared to other countries Russia Norway 1980 - 2010
Ratio
of m
orta
lity
Rus
sian
Fede
ratio
n N
orw
ay
Source WHO HFA database
Smoking Important but does not explain
fluctuations
10
Trends of adult smoking rates in Russia 1992ndash2009
11 Source Lunze K ampMigliorini L BMC Public Health 20131364
Paradoxical lipid profile relative to other countries
bull Prevalence of raised total cholesterol not high bull Levels of LDL (ldquobadrdquo) cholesterol tend to be
average or below average bull Levels of HDL (ldquogoodrdquo)cholesterol above
average
bull NB national data available bull NB statin use very low
12
Hypertension
bull High rates in Russia compared to other European countries
bull Poor rates of control bull Likely to be an important factor
bull NB comprehensive national data poorly
documented and of questionable quality 13
14
Classic risk factors do not explain international differences
Alcohol A key driver of fluctuations
0
10
20
30
40
50
60
70
80
90
1965 1970 1975 1980 1985 1990 1995 2000 2005
Year
SD
R p
er 1
000
00
56
57
58
59
60
61
62
63
64
65
66
67
Life
exp
ecta
ncy
at b
irth
(yea
rs)
Life expectancy at birth
SDR for alcohol poisonings ages 15+
Males
Strong evidence that alcohol drives fluctuations in male life expectancy in Russia 1965 -2008
Source V Shkolnikov and E Andreev 16
0
20
40
60
80
100
120
140
160
180
0
200
400
600
800
1000
1200
1960 1970 1980 1990 2000 2010
Acut
e al
coho
l poi
soni
ng m
orta
lity
per 1
000
00
Tota
l circ
ulat
ory
dise
ase
mor
talit
y pe
r 100
000
Mortality from circulatory disease and acute alcohol
poisoning among men aged 50-54 years Russia 1960-2008
Total circulatory diseaseAcute alcohol poisoning
Source Data provided by Evgueny Andreev
Individual-level evidence on alcohol
18
Izhevsk Family Study (men aged 25-59 years)
2003-5 and 2008-10
Hazardous drinking and mortality from various types of circulatory disease
Men aged 25-54 years Izhevsk 2003 - 5
Underlying cause of death
Number of deaths
Hazardous drinking (proxy report)
OR (95 CI)
Alcoholic cardiomyopathy 98 1570 (952594)
Other cardiomyopathy 51 384 (205718)
Cerebrovascular disease 90 205 (124340)
Other circulatory disease 28 343 (151781)
Ischaemic heart disease 219 304 (217424)
19 OR adjusted for age smoking and education Source Leon Shkolnikov McKee Kiryanov Andreev IJE 2010
Doubts about the diagnosis
20
A new international project 2014-19
21
University of Tromsoslash Norway
Ministry of Health and Care Services Norway
Cardiovascular disease in Russia strengthening evidence about
causes mechanisms prevention and treatment
Institute of Internal Medicine SBRAMS Novosibirsk Russia
Max Planck Institute for Demographic
Research
Finland
22
Novosibirsk
Arkhangelsk
Moscow Rostock London
Oulu
Tromso
23
Location of study sites and collaborators
Kazan
Four themes
Theme A Levels and trends in cardiovascular disease and associated risk factors
Theme B Understanding the nature and causes of cardiovascular disease in Russia (including cause of death study)
Theme C Barriers opportunities and capacity for improved prevention and treatment (role of health service)
Theme D Capacity development and training
24
Theme B Cross-sectional studies
bull Two locations ndash Arkhangelsk and Novosibirsk bull Population-based random sample
ndash men and women aged 35-69 years ndash attention given to reducing selection bias ndash N=2750 in each city
bull Additional sample heavy alcohol drinkers from medical facility (N=250 in each city)
bull Main field work starts 2015
25
26
Cardiovascular phenotypes Type Source Biomarkerproxy measure
Atherosclerosis
Questionnaire Previous MI
ECG Evidence previous MI
Carotid ultrasound Carotid IMT plaque
Cardiac remodelling
Blood NT-pro BNP HsTnI hsTnT
Echocardiography Myocardial function and size
Arrhythmia ECG Actiwave Cardio
Baseline rhythm heart rate variability
Vascular dysfunction Vicorder Pulse-wave velocity
Cutting edge scientific approaches
27
Serum NMR metabolomics
bull Highly standardised and reproducible platform for 117 primary and 99 derived measures of specific molecular entities (now gt100000 individuals assayed)
Nature Genetics 44 269 2012
28
bull How are alcohol and CVD phenotypes related to 14
lipoprotein subclasses bull Identifying markers of intermediate metabolism associated
with CVD phenotypes
The microbiome
29 Key expertise Vadim Govorun Moscow
Studies in other countries eg Tromsoslash 7
Endogenous exposures a priori CVD risk biomarkers
(including lipoprotein NMR profile)
Socio-demographic + exogenous exposures
CVD phenotypes
Metabolic profile Microbiome
Associations Analytic framework
Thank you
31
Alcohol control policy developments since 2005
bull 2005 Federal law No171 on production and sale of alcohol
bull 2009 Elaboration of the Russian anti-alcohol policy framework (the Conceptual Framework on anti-alcohol policy implementation)
bull 2009 Strengthening of institutional policy control (Establishment of the Federal Alcohol Service)
bull 2011 Introduction of greater controls and restrictions on production and sale of alcohol (Federal law No218)
Tobacco control policy developments since 2005
bull 2005 the Federal law No87 of 2001 ldquoOn limitations of smoking tobaccordquo is in effect
bull 2008 Ratification of the WHO Framework Convention on Tobacco Control by the Russian Federation
bull 2009 Defining the magnitude of the problem 40 smoking prevalence (GATS report on Russia)
bull 2010 Development of the anti-tobacco policy (the Conceptual framework on anti-tobacco policy for 2010-2015
bull 2013 Introduction of restrictions on tobacco sale and smoking in public (Federal law No 15 on ldquoHealth protection of citizens from exposure to tobacco smoke and consequences from tobacco consumptionrdquo)
34
0
20
40
60
80
100
120
140
160
180
Cancer oesophagus
Cancer stomach
Cancer breast
Ischaemic heartdiseaseInjuries poisoningviolence
Mortality from selected causes Women aged 45-59 Russia 1980 - 2009
Age-
stan
dard
ised
mor
talit
y ra
te p
er 1
000
00
Source WHO HFA database
Index of CVD risk - 1 Ratio of apolipoprotein B
to apolipoprotein A1
ldquoAtherogenicrdquo index
Index of CVD risk - 2 B-type natriuretic peptide
Index of stress on ventricles of heart Marker of non-atherosclerotic cardiac damage
Association of pattern of drinking with cardiovascular risk factors
OR (95 CI)
Pattern of drinking
OR top 20 ApoBA1 ratio
OR top 20 B-type natriuretic
peptide (BNP)
Abstains 100 [ref] 100 [ref]
Non-hazardous 034 (021 054) 235 (120 458)
Hazardous 031 (016 059) 431 (214 952)
P-value trend lt0001 lt0001
Adjusted for age BMI and waist-hip ratio
Source Leon DA et al EurJ Epidemiol 28 (5)393-404 2013
- The challenge of cardiovascular disease in Russia
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Russia has the highest cardiovascular mortality rate in the world
- Slide Number 6
- Cardiovascular disease mortality in Russia is atypical
- Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010 (age lt65 years)
- Slide Number 9
- Smoking Important but does not explain fluctuations
- Trends of adult smoking rates in Russia 1992ndash2009
- Paradoxical lipid profile relative to other countries
- Hypertension
- Slide Number 14
- Alcohol A key driver of fluctuations
- Slide Number 16
- Slide Number 17
- Individual-level evidence on alcohol
- Hazardous drinking and mortality from varioustypes of circulatory diseaseMen aged 25-54 years Izhevsk 2003 - 5
- Doubts about the diagnosis
- A new international project2014-19
- Cardiovascular disease in Russia strengthening evidence about causes mechanisms prevention and treatment
- Slide Number 23
- Four themes
- Theme B Cross-sectional studies
- Slide Number 26
- Cutting edge scientific approaches
- Serum NMR metabolomics
- The microbiome
- Slide Number 30
- Thank you
- Alcohol control policy developments since 2005
- Tobacco control policy developments since 2005
- Slide Number 34
- Index of CVD risk - 1Ratio of apolipoprotein B to apolipoprotein A1
- Index of CVD risk - 2 B-type natriuretic peptide
- Association of pattern of drinking with cardiovascular risk factorsOR (95 CI)
-
Cardiovascular disease mortality in Russia is atypical
7
Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010
(age lt65 years)
0
50
100
150
200
250
300
1970
1973
1976
1979
1982
1985
1988
1991
1994
1997
2000
2003
2006
2009
Russia
Norway
UK
Women
0
50
100
150
200
250
300
1970
1973
1976
1979
1982
1985
1988
1991
1994
1997
2000
2003
2006
2009
Russia
Norway
UK
Age-
stan
dard
ised
rate
per
100
000
Men
Source WHO HFA database 8
0
2
4
6
8
10
12
Male lt65Male 65+Female lt65Female 65+
Particularly high mortality at working ages compared to other countries Russia Norway 1980 - 2010
Ratio
of m
orta
lity
Rus
sian
Fede
ratio
n N
orw
ay
Source WHO HFA database
Smoking Important but does not explain
fluctuations
10
Trends of adult smoking rates in Russia 1992ndash2009
11 Source Lunze K ampMigliorini L BMC Public Health 20131364
Paradoxical lipid profile relative to other countries
bull Prevalence of raised total cholesterol not high bull Levels of LDL (ldquobadrdquo) cholesterol tend to be
average or below average bull Levels of HDL (ldquogoodrdquo)cholesterol above
average
bull NB national data available bull NB statin use very low
12
Hypertension
bull High rates in Russia compared to other European countries
bull Poor rates of control bull Likely to be an important factor
bull NB comprehensive national data poorly
documented and of questionable quality 13
14
Classic risk factors do not explain international differences
Alcohol A key driver of fluctuations
0
10
20
30
40
50
60
70
80
90
1965 1970 1975 1980 1985 1990 1995 2000 2005
Year
SD
R p
er 1
000
00
56
57
58
59
60
61
62
63
64
65
66
67
Life
exp
ecta
ncy
at b
irth
(yea
rs)
Life expectancy at birth
SDR for alcohol poisonings ages 15+
Males
Strong evidence that alcohol drives fluctuations in male life expectancy in Russia 1965 -2008
Source V Shkolnikov and E Andreev 16
0
20
40
60
80
100
120
140
160
180
0
200
400
600
800
1000
1200
1960 1970 1980 1990 2000 2010
Acut
e al
coho
l poi
soni
ng m
orta
lity
per 1
000
00
Tota
l circ
ulat
ory
dise
ase
mor
talit
y pe
r 100
000
Mortality from circulatory disease and acute alcohol
poisoning among men aged 50-54 years Russia 1960-2008
Total circulatory diseaseAcute alcohol poisoning
Source Data provided by Evgueny Andreev
Individual-level evidence on alcohol
18
Izhevsk Family Study (men aged 25-59 years)
2003-5 and 2008-10
Hazardous drinking and mortality from various types of circulatory disease
Men aged 25-54 years Izhevsk 2003 - 5
Underlying cause of death
Number of deaths
Hazardous drinking (proxy report)
OR (95 CI)
Alcoholic cardiomyopathy 98 1570 (952594)
Other cardiomyopathy 51 384 (205718)
Cerebrovascular disease 90 205 (124340)
Other circulatory disease 28 343 (151781)
Ischaemic heart disease 219 304 (217424)
19 OR adjusted for age smoking and education Source Leon Shkolnikov McKee Kiryanov Andreev IJE 2010
Doubts about the diagnosis
20
A new international project 2014-19
21
University of Tromsoslash Norway
Ministry of Health and Care Services Norway
Cardiovascular disease in Russia strengthening evidence about
causes mechanisms prevention and treatment
Institute of Internal Medicine SBRAMS Novosibirsk Russia
Max Planck Institute for Demographic
Research
Finland
22
Novosibirsk
Arkhangelsk
Moscow Rostock London
Oulu
Tromso
23
Location of study sites and collaborators
Kazan
Four themes
Theme A Levels and trends in cardiovascular disease and associated risk factors
Theme B Understanding the nature and causes of cardiovascular disease in Russia (including cause of death study)
Theme C Barriers opportunities and capacity for improved prevention and treatment (role of health service)
Theme D Capacity development and training
24
Theme B Cross-sectional studies
bull Two locations ndash Arkhangelsk and Novosibirsk bull Population-based random sample
ndash men and women aged 35-69 years ndash attention given to reducing selection bias ndash N=2750 in each city
bull Additional sample heavy alcohol drinkers from medical facility (N=250 in each city)
bull Main field work starts 2015
25
26
Cardiovascular phenotypes Type Source Biomarkerproxy measure
Atherosclerosis
Questionnaire Previous MI
ECG Evidence previous MI
Carotid ultrasound Carotid IMT plaque
Cardiac remodelling
Blood NT-pro BNP HsTnI hsTnT
Echocardiography Myocardial function and size
Arrhythmia ECG Actiwave Cardio
Baseline rhythm heart rate variability
Vascular dysfunction Vicorder Pulse-wave velocity
Cutting edge scientific approaches
27
Serum NMR metabolomics
bull Highly standardised and reproducible platform for 117 primary and 99 derived measures of specific molecular entities (now gt100000 individuals assayed)
Nature Genetics 44 269 2012
28
bull How are alcohol and CVD phenotypes related to 14
lipoprotein subclasses bull Identifying markers of intermediate metabolism associated
with CVD phenotypes
The microbiome
29 Key expertise Vadim Govorun Moscow
Studies in other countries eg Tromsoslash 7
Endogenous exposures a priori CVD risk biomarkers
(including lipoprotein NMR profile)
Socio-demographic + exogenous exposures
CVD phenotypes
Metabolic profile Microbiome
Associations Analytic framework
Thank you
31
Alcohol control policy developments since 2005
bull 2005 Federal law No171 on production and sale of alcohol
bull 2009 Elaboration of the Russian anti-alcohol policy framework (the Conceptual Framework on anti-alcohol policy implementation)
bull 2009 Strengthening of institutional policy control (Establishment of the Federal Alcohol Service)
bull 2011 Introduction of greater controls and restrictions on production and sale of alcohol (Federal law No218)
Tobacco control policy developments since 2005
bull 2005 the Federal law No87 of 2001 ldquoOn limitations of smoking tobaccordquo is in effect
bull 2008 Ratification of the WHO Framework Convention on Tobacco Control by the Russian Federation
bull 2009 Defining the magnitude of the problem 40 smoking prevalence (GATS report on Russia)
bull 2010 Development of the anti-tobacco policy (the Conceptual framework on anti-tobacco policy for 2010-2015
bull 2013 Introduction of restrictions on tobacco sale and smoking in public (Federal law No 15 on ldquoHealth protection of citizens from exposure to tobacco smoke and consequences from tobacco consumptionrdquo)
34
0
20
40
60
80
100
120
140
160
180
Cancer oesophagus
Cancer stomach
Cancer breast
Ischaemic heartdiseaseInjuries poisoningviolence
Mortality from selected causes Women aged 45-59 Russia 1980 - 2009
Age-
stan
dard
ised
mor
talit
y ra
te p
er 1
000
00
Source WHO HFA database
Index of CVD risk - 1 Ratio of apolipoprotein B
to apolipoprotein A1
ldquoAtherogenicrdquo index
Index of CVD risk - 2 B-type natriuretic peptide
Index of stress on ventricles of heart Marker of non-atherosclerotic cardiac damage
Association of pattern of drinking with cardiovascular risk factors
OR (95 CI)
Pattern of drinking
OR top 20 ApoBA1 ratio
OR top 20 B-type natriuretic
peptide (BNP)
Abstains 100 [ref] 100 [ref]
Non-hazardous 034 (021 054) 235 (120 458)
Hazardous 031 (016 059) 431 (214 952)
P-value trend lt0001 lt0001
Adjusted for age BMI and waist-hip ratio
Source Leon DA et al EurJ Epidemiol 28 (5)393-404 2013
- The challenge of cardiovascular disease in Russia
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Russia has the highest cardiovascular mortality rate in the world
- Slide Number 6
- Cardiovascular disease mortality in Russia is atypical
- Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010 (age lt65 years)
- Slide Number 9
- Smoking Important but does not explain fluctuations
- Trends of adult smoking rates in Russia 1992ndash2009
- Paradoxical lipid profile relative to other countries
- Hypertension
- Slide Number 14
- Alcohol A key driver of fluctuations
- Slide Number 16
- Slide Number 17
- Individual-level evidence on alcohol
- Hazardous drinking and mortality from varioustypes of circulatory diseaseMen aged 25-54 years Izhevsk 2003 - 5
- Doubts about the diagnosis
- A new international project2014-19
- Cardiovascular disease in Russia strengthening evidence about causes mechanisms prevention and treatment
- Slide Number 23
- Four themes
- Theme B Cross-sectional studies
- Slide Number 26
- Cutting edge scientific approaches
- Serum NMR metabolomics
- The microbiome
- Slide Number 30
- Thank you
- Alcohol control policy developments since 2005
- Tobacco control policy developments since 2005
- Slide Number 34
- Index of CVD risk - 1Ratio of apolipoprotein B to apolipoprotein A1
- Index of CVD risk - 2 B-type natriuretic peptide
- Association of pattern of drinking with cardiovascular risk factorsOR (95 CI)
-
Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010
(age lt65 years)
0
50
100
150
200
250
300
1970
1973
1976
1979
1982
1985
1988
1991
1994
1997
2000
2003
2006
2009
Russia
Norway
UK
Women
0
50
100
150
200
250
300
1970
1973
1976
1979
1982
1985
1988
1991
1994
1997
2000
2003
2006
2009
Russia
Norway
UK
Age-
stan
dard
ised
rate
per
100
000
Men
Source WHO HFA database 8
0
2
4
6
8
10
12
Male lt65Male 65+Female lt65Female 65+
Particularly high mortality at working ages compared to other countries Russia Norway 1980 - 2010
Ratio
of m
orta
lity
Rus
sian
Fede
ratio
n N
orw
ay
Source WHO HFA database
Smoking Important but does not explain
fluctuations
10
Trends of adult smoking rates in Russia 1992ndash2009
11 Source Lunze K ampMigliorini L BMC Public Health 20131364
Paradoxical lipid profile relative to other countries
bull Prevalence of raised total cholesterol not high bull Levels of LDL (ldquobadrdquo) cholesterol tend to be
average or below average bull Levels of HDL (ldquogoodrdquo)cholesterol above
average
bull NB national data available bull NB statin use very low
12
Hypertension
bull High rates in Russia compared to other European countries
bull Poor rates of control bull Likely to be an important factor
bull NB comprehensive national data poorly
documented and of questionable quality 13
14
Classic risk factors do not explain international differences
Alcohol A key driver of fluctuations
0
10
20
30
40
50
60
70
80
90
1965 1970 1975 1980 1985 1990 1995 2000 2005
Year
SD
R p
er 1
000
00
56
57
58
59
60
61
62
63
64
65
66
67
Life
exp
ecta
ncy
at b
irth
(yea
rs)
Life expectancy at birth
SDR for alcohol poisonings ages 15+
Males
Strong evidence that alcohol drives fluctuations in male life expectancy in Russia 1965 -2008
Source V Shkolnikov and E Andreev 16
0
20
40
60
80
100
120
140
160
180
0
200
400
600
800
1000
1200
1960 1970 1980 1990 2000 2010
Acut
e al
coho
l poi
soni
ng m
orta
lity
per 1
000
00
Tota
l circ
ulat
ory
dise
ase
mor
talit
y pe
r 100
000
Mortality from circulatory disease and acute alcohol
poisoning among men aged 50-54 years Russia 1960-2008
Total circulatory diseaseAcute alcohol poisoning
Source Data provided by Evgueny Andreev
Individual-level evidence on alcohol
18
Izhevsk Family Study (men aged 25-59 years)
2003-5 and 2008-10
Hazardous drinking and mortality from various types of circulatory disease
Men aged 25-54 years Izhevsk 2003 - 5
Underlying cause of death
Number of deaths
Hazardous drinking (proxy report)
OR (95 CI)
Alcoholic cardiomyopathy 98 1570 (952594)
Other cardiomyopathy 51 384 (205718)
Cerebrovascular disease 90 205 (124340)
Other circulatory disease 28 343 (151781)
Ischaemic heart disease 219 304 (217424)
19 OR adjusted for age smoking and education Source Leon Shkolnikov McKee Kiryanov Andreev IJE 2010
Doubts about the diagnosis
20
A new international project 2014-19
21
University of Tromsoslash Norway
Ministry of Health and Care Services Norway
Cardiovascular disease in Russia strengthening evidence about
causes mechanisms prevention and treatment
Institute of Internal Medicine SBRAMS Novosibirsk Russia
Max Planck Institute for Demographic
Research
Finland
22
Novosibirsk
Arkhangelsk
Moscow Rostock London
Oulu
Tromso
23
Location of study sites and collaborators
Kazan
Four themes
Theme A Levels and trends in cardiovascular disease and associated risk factors
Theme B Understanding the nature and causes of cardiovascular disease in Russia (including cause of death study)
Theme C Barriers opportunities and capacity for improved prevention and treatment (role of health service)
Theme D Capacity development and training
24
Theme B Cross-sectional studies
bull Two locations ndash Arkhangelsk and Novosibirsk bull Population-based random sample
ndash men and women aged 35-69 years ndash attention given to reducing selection bias ndash N=2750 in each city
bull Additional sample heavy alcohol drinkers from medical facility (N=250 in each city)
bull Main field work starts 2015
25
26
Cardiovascular phenotypes Type Source Biomarkerproxy measure
Atherosclerosis
Questionnaire Previous MI
ECG Evidence previous MI
Carotid ultrasound Carotid IMT plaque
Cardiac remodelling
Blood NT-pro BNP HsTnI hsTnT
Echocardiography Myocardial function and size
Arrhythmia ECG Actiwave Cardio
Baseline rhythm heart rate variability
Vascular dysfunction Vicorder Pulse-wave velocity
Cutting edge scientific approaches
27
Serum NMR metabolomics
bull Highly standardised and reproducible platform for 117 primary and 99 derived measures of specific molecular entities (now gt100000 individuals assayed)
Nature Genetics 44 269 2012
28
bull How are alcohol and CVD phenotypes related to 14
lipoprotein subclasses bull Identifying markers of intermediate metabolism associated
with CVD phenotypes
The microbiome
29 Key expertise Vadim Govorun Moscow
Studies in other countries eg Tromsoslash 7
Endogenous exposures a priori CVD risk biomarkers
(including lipoprotein NMR profile)
Socio-demographic + exogenous exposures
CVD phenotypes
Metabolic profile Microbiome
Associations Analytic framework
Thank you
31
Alcohol control policy developments since 2005
bull 2005 Federal law No171 on production and sale of alcohol
bull 2009 Elaboration of the Russian anti-alcohol policy framework (the Conceptual Framework on anti-alcohol policy implementation)
bull 2009 Strengthening of institutional policy control (Establishment of the Federal Alcohol Service)
bull 2011 Introduction of greater controls and restrictions on production and sale of alcohol (Federal law No218)
Tobacco control policy developments since 2005
bull 2005 the Federal law No87 of 2001 ldquoOn limitations of smoking tobaccordquo is in effect
bull 2008 Ratification of the WHO Framework Convention on Tobacco Control by the Russian Federation
bull 2009 Defining the magnitude of the problem 40 smoking prevalence (GATS report on Russia)
bull 2010 Development of the anti-tobacco policy (the Conceptual framework on anti-tobacco policy for 2010-2015
bull 2013 Introduction of restrictions on tobacco sale and smoking in public (Federal law No 15 on ldquoHealth protection of citizens from exposure to tobacco smoke and consequences from tobacco consumptionrdquo)
34
0
20
40
60
80
100
120
140
160
180
Cancer oesophagus
Cancer stomach
Cancer breast
Ischaemic heartdiseaseInjuries poisoningviolence
Mortality from selected causes Women aged 45-59 Russia 1980 - 2009
Age-
stan
dard
ised
mor
talit
y ra
te p
er 1
000
00
Source WHO HFA database
Index of CVD risk - 1 Ratio of apolipoprotein B
to apolipoprotein A1
ldquoAtherogenicrdquo index
Index of CVD risk - 2 B-type natriuretic peptide
Index of stress on ventricles of heart Marker of non-atherosclerotic cardiac damage
Association of pattern of drinking with cardiovascular risk factors
OR (95 CI)
Pattern of drinking
OR top 20 ApoBA1 ratio
OR top 20 B-type natriuretic
peptide (BNP)
Abstains 100 [ref] 100 [ref]
Non-hazardous 034 (021 054) 235 (120 458)
Hazardous 031 (016 059) 431 (214 952)
P-value trend lt0001 lt0001
Adjusted for age BMI and waist-hip ratio
Source Leon DA et al EurJ Epidemiol 28 (5)393-404 2013
- The challenge of cardiovascular disease in Russia
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Russia has the highest cardiovascular mortality rate in the world
- Slide Number 6
- Cardiovascular disease mortality in Russia is atypical
- Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010 (age lt65 years)
- Slide Number 9
- Smoking Important but does not explain fluctuations
- Trends of adult smoking rates in Russia 1992ndash2009
- Paradoxical lipid profile relative to other countries
- Hypertension
- Slide Number 14
- Alcohol A key driver of fluctuations
- Slide Number 16
- Slide Number 17
- Individual-level evidence on alcohol
- Hazardous drinking and mortality from varioustypes of circulatory diseaseMen aged 25-54 years Izhevsk 2003 - 5
- Doubts about the diagnosis
- A new international project2014-19
- Cardiovascular disease in Russia strengthening evidence about causes mechanisms prevention and treatment
- Slide Number 23
- Four themes
- Theme B Cross-sectional studies
- Slide Number 26
- Cutting edge scientific approaches
- Serum NMR metabolomics
- The microbiome
- Slide Number 30
- Thank you
- Alcohol control policy developments since 2005
- Tobacco control policy developments since 2005
- Slide Number 34
- Index of CVD risk - 1Ratio of apolipoprotein B to apolipoprotein A1
- Index of CVD risk - 2 B-type natriuretic peptide
- Association of pattern of drinking with cardiovascular risk factorsOR (95 CI)
-
0
2
4
6
8
10
12
Male lt65Male 65+Female lt65Female 65+
Particularly high mortality at working ages compared to other countries Russia Norway 1980 - 2010
Ratio
of m
orta
lity
Rus
sian
Fede
ratio
n N
orw
ay
Source WHO HFA database
Smoking Important but does not explain
fluctuations
10
Trends of adult smoking rates in Russia 1992ndash2009
11 Source Lunze K ampMigliorini L BMC Public Health 20131364
Paradoxical lipid profile relative to other countries
bull Prevalence of raised total cholesterol not high bull Levels of LDL (ldquobadrdquo) cholesterol tend to be
average or below average bull Levels of HDL (ldquogoodrdquo)cholesterol above
average
bull NB national data available bull NB statin use very low
12
Hypertension
bull High rates in Russia compared to other European countries
bull Poor rates of control bull Likely to be an important factor
bull NB comprehensive national data poorly
documented and of questionable quality 13
14
Classic risk factors do not explain international differences
Alcohol A key driver of fluctuations
0
10
20
30
40
50
60
70
80
90
1965 1970 1975 1980 1985 1990 1995 2000 2005
Year
SD
R p
er 1
000
00
56
57
58
59
60
61
62
63
64
65
66
67
Life
exp
ecta
ncy
at b
irth
(yea
rs)
Life expectancy at birth
SDR for alcohol poisonings ages 15+
Males
Strong evidence that alcohol drives fluctuations in male life expectancy in Russia 1965 -2008
Source V Shkolnikov and E Andreev 16
0
20
40
60
80
100
120
140
160
180
0
200
400
600
800
1000
1200
1960 1970 1980 1990 2000 2010
Acut
e al
coho
l poi
soni
ng m
orta
lity
per 1
000
00
Tota
l circ
ulat
ory
dise
ase
mor
talit
y pe
r 100
000
Mortality from circulatory disease and acute alcohol
poisoning among men aged 50-54 years Russia 1960-2008
Total circulatory diseaseAcute alcohol poisoning
Source Data provided by Evgueny Andreev
Individual-level evidence on alcohol
18
Izhevsk Family Study (men aged 25-59 years)
2003-5 and 2008-10
Hazardous drinking and mortality from various types of circulatory disease
Men aged 25-54 years Izhevsk 2003 - 5
Underlying cause of death
Number of deaths
Hazardous drinking (proxy report)
OR (95 CI)
Alcoholic cardiomyopathy 98 1570 (952594)
Other cardiomyopathy 51 384 (205718)
Cerebrovascular disease 90 205 (124340)
Other circulatory disease 28 343 (151781)
Ischaemic heart disease 219 304 (217424)
19 OR adjusted for age smoking and education Source Leon Shkolnikov McKee Kiryanov Andreev IJE 2010
Doubts about the diagnosis
20
A new international project 2014-19
21
University of Tromsoslash Norway
Ministry of Health and Care Services Norway
Cardiovascular disease in Russia strengthening evidence about
causes mechanisms prevention and treatment
Institute of Internal Medicine SBRAMS Novosibirsk Russia
Max Planck Institute for Demographic
Research
Finland
22
Novosibirsk
Arkhangelsk
Moscow Rostock London
Oulu
Tromso
23
Location of study sites and collaborators
Kazan
Four themes
Theme A Levels and trends in cardiovascular disease and associated risk factors
Theme B Understanding the nature and causes of cardiovascular disease in Russia (including cause of death study)
Theme C Barriers opportunities and capacity for improved prevention and treatment (role of health service)
Theme D Capacity development and training
24
Theme B Cross-sectional studies
bull Two locations ndash Arkhangelsk and Novosibirsk bull Population-based random sample
ndash men and women aged 35-69 years ndash attention given to reducing selection bias ndash N=2750 in each city
bull Additional sample heavy alcohol drinkers from medical facility (N=250 in each city)
bull Main field work starts 2015
25
26
Cardiovascular phenotypes Type Source Biomarkerproxy measure
Atherosclerosis
Questionnaire Previous MI
ECG Evidence previous MI
Carotid ultrasound Carotid IMT plaque
Cardiac remodelling
Blood NT-pro BNP HsTnI hsTnT
Echocardiography Myocardial function and size
Arrhythmia ECG Actiwave Cardio
Baseline rhythm heart rate variability
Vascular dysfunction Vicorder Pulse-wave velocity
Cutting edge scientific approaches
27
Serum NMR metabolomics
bull Highly standardised and reproducible platform for 117 primary and 99 derived measures of specific molecular entities (now gt100000 individuals assayed)
Nature Genetics 44 269 2012
28
bull How are alcohol and CVD phenotypes related to 14
lipoprotein subclasses bull Identifying markers of intermediate metabolism associated
with CVD phenotypes
The microbiome
29 Key expertise Vadim Govorun Moscow
Studies in other countries eg Tromsoslash 7
Endogenous exposures a priori CVD risk biomarkers
(including lipoprotein NMR profile)
Socio-demographic + exogenous exposures
CVD phenotypes
Metabolic profile Microbiome
Associations Analytic framework
Thank you
31
Alcohol control policy developments since 2005
bull 2005 Federal law No171 on production and sale of alcohol
bull 2009 Elaboration of the Russian anti-alcohol policy framework (the Conceptual Framework on anti-alcohol policy implementation)
bull 2009 Strengthening of institutional policy control (Establishment of the Federal Alcohol Service)
bull 2011 Introduction of greater controls and restrictions on production and sale of alcohol (Federal law No218)
Tobacco control policy developments since 2005
bull 2005 the Federal law No87 of 2001 ldquoOn limitations of smoking tobaccordquo is in effect
bull 2008 Ratification of the WHO Framework Convention on Tobacco Control by the Russian Federation
bull 2009 Defining the magnitude of the problem 40 smoking prevalence (GATS report on Russia)
bull 2010 Development of the anti-tobacco policy (the Conceptual framework on anti-tobacco policy for 2010-2015
bull 2013 Introduction of restrictions on tobacco sale and smoking in public (Federal law No 15 on ldquoHealth protection of citizens from exposure to tobacco smoke and consequences from tobacco consumptionrdquo)
34
0
20
40
60
80
100
120
140
160
180
Cancer oesophagus
Cancer stomach
Cancer breast
Ischaemic heartdiseaseInjuries poisoningviolence
Mortality from selected causes Women aged 45-59 Russia 1980 - 2009
Age-
stan
dard
ised
mor
talit
y ra
te p
er 1
000
00
Source WHO HFA database
Index of CVD risk - 1 Ratio of apolipoprotein B
to apolipoprotein A1
ldquoAtherogenicrdquo index
Index of CVD risk - 2 B-type natriuretic peptide
Index of stress on ventricles of heart Marker of non-atherosclerotic cardiac damage
Association of pattern of drinking with cardiovascular risk factors
OR (95 CI)
Pattern of drinking
OR top 20 ApoBA1 ratio
OR top 20 B-type natriuretic
peptide (BNP)
Abstains 100 [ref] 100 [ref]
Non-hazardous 034 (021 054) 235 (120 458)
Hazardous 031 (016 059) 431 (214 952)
P-value trend lt0001 lt0001
Adjusted for age BMI and waist-hip ratio
Source Leon DA et al EurJ Epidemiol 28 (5)393-404 2013
- The challenge of cardiovascular disease in Russia
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Russia has the highest cardiovascular mortality rate in the world
- Slide Number 6
- Cardiovascular disease mortality in Russia is atypical
- Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010 (age lt65 years)
- Slide Number 9
- Smoking Important but does not explain fluctuations
- Trends of adult smoking rates in Russia 1992ndash2009
- Paradoxical lipid profile relative to other countries
- Hypertension
- Slide Number 14
- Alcohol A key driver of fluctuations
- Slide Number 16
- Slide Number 17
- Individual-level evidence on alcohol
- Hazardous drinking and mortality from varioustypes of circulatory diseaseMen aged 25-54 years Izhevsk 2003 - 5
- Doubts about the diagnosis
- A new international project2014-19
- Cardiovascular disease in Russia strengthening evidence about causes mechanisms prevention and treatment
- Slide Number 23
- Four themes
- Theme B Cross-sectional studies
- Slide Number 26
- Cutting edge scientific approaches
- Serum NMR metabolomics
- The microbiome
- Slide Number 30
- Thank you
- Alcohol control policy developments since 2005
- Tobacco control policy developments since 2005
- Slide Number 34
- Index of CVD risk - 1Ratio of apolipoprotein B to apolipoprotein A1
- Index of CVD risk - 2 B-type natriuretic peptide
- Association of pattern of drinking with cardiovascular risk factorsOR (95 CI)
-
Smoking Important but does not explain
fluctuations
10
Trends of adult smoking rates in Russia 1992ndash2009
11 Source Lunze K ampMigliorini L BMC Public Health 20131364
Paradoxical lipid profile relative to other countries
bull Prevalence of raised total cholesterol not high bull Levels of LDL (ldquobadrdquo) cholesterol tend to be
average or below average bull Levels of HDL (ldquogoodrdquo)cholesterol above
average
bull NB national data available bull NB statin use very low
12
Hypertension
bull High rates in Russia compared to other European countries
bull Poor rates of control bull Likely to be an important factor
bull NB comprehensive national data poorly
documented and of questionable quality 13
14
Classic risk factors do not explain international differences
Alcohol A key driver of fluctuations
0
10
20
30
40
50
60
70
80
90
1965 1970 1975 1980 1985 1990 1995 2000 2005
Year
SD
R p
er 1
000
00
56
57
58
59
60
61
62
63
64
65
66
67
Life
exp
ecta
ncy
at b
irth
(yea
rs)
Life expectancy at birth
SDR for alcohol poisonings ages 15+
Males
Strong evidence that alcohol drives fluctuations in male life expectancy in Russia 1965 -2008
Source V Shkolnikov and E Andreev 16
0
20
40
60
80
100
120
140
160
180
0
200
400
600
800
1000
1200
1960 1970 1980 1990 2000 2010
Acut
e al
coho
l poi
soni
ng m
orta
lity
per 1
000
00
Tota
l circ
ulat
ory
dise
ase
mor
talit
y pe
r 100
000
Mortality from circulatory disease and acute alcohol
poisoning among men aged 50-54 years Russia 1960-2008
Total circulatory diseaseAcute alcohol poisoning
Source Data provided by Evgueny Andreev
Individual-level evidence on alcohol
18
Izhevsk Family Study (men aged 25-59 years)
2003-5 and 2008-10
Hazardous drinking and mortality from various types of circulatory disease
Men aged 25-54 years Izhevsk 2003 - 5
Underlying cause of death
Number of deaths
Hazardous drinking (proxy report)
OR (95 CI)
Alcoholic cardiomyopathy 98 1570 (952594)
Other cardiomyopathy 51 384 (205718)
Cerebrovascular disease 90 205 (124340)
Other circulatory disease 28 343 (151781)
Ischaemic heart disease 219 304 (217424)
19 OR adjusted for age smoking and education Source Leon Shkolnikov McKee Kiryanov Andreev IJE 2010
Doubts about the diagnosis
20
A new international project 2014-19
21
University of Tromsoslash Norway
Ministry of Health and Care Services Norway
Cardiovascular disease in Russia strengthening evidence about
causes mechanisms prevention and treatment
Institute of Internal Medicine SBRAMS Novosibirsk Russia
Max Planck Institute for Demographic
Research
Finland
22
Novosibirsk
Arkhangelsk
Moscow Rostock London
Oulu
Tromso
23
Location of study sites and collaborators
Kazan
Four themes
Theme A Levels and trends in cardiovascular disease and associated risk factors
Theme B Understanding the nature and causes of cardiovascular disease in Russia (including cause of death study)
Theme C Barriers opportunities and capacity for improved prevention and treatment (role of health service)
Theme D Capacity development and training
24
Theme B Cross-sectional studies
bull Two locations ndash Arkhangelsk and Novosibirsk bull Population-based random sample
ndash men and women aged 35-69 years ndash attention given to reducing selection bias ndash N=2750 in each city
bull Additional sample heavy alcohol drinkers from medical facility (N=250 in each city)
bull Main field work starts 2015
25
26
Cardiovascular phenotypes Type Source Biomarkerproxy measure
Atherosclerosis
Questionnaire Previous MI
ECG Evidence previous MI
Carotid ultrasound Carotid IMT plaque
Cardiac remodelling
Blood NT-pro BNP HsTnI hsTnT
Echocardiography Myocardial function and size
Arrhythmia ECG Actiwave Cardio
Baseline rhythm heart rate variability
Vascular dysfunction Vicorder Pulse-wave velocity
Cutting edge scientific approaches
27
Serum NMR metabolomics
bull Highly standardised and reproducible platform for 117 primary and 99 derived measures of specific molecular entities (now gt100000 individuals assayed)
Nature Genetics 44 269 2012
28
bull How are alcohol and CVD phenotypes related to 14
lipoprotein subclasses bull Identifying markers of intermediate metabolism associated
with CVD phenotypes
The microbiome
29 Key expertise Vadim Govorun Moscow
Studies in other countries eg Tromsoslash 7
Endogenous exposures a priori CVD risk biomarkers
(including lipoprotein NMR profile)
Socio-demographic + exogenous exposures
CVD phenotypes
Metabolic profile Microbiome
Associations Analytic framework
Thank you
31
Alcohol control policy developments since 2005
bull 2005 Federal law No171 on production and sale of alcohol
bull 2009 Elaboration of the Russian anti-alcohol policy framework (the Conceptual Framework on anti-alcohol policy implementation)
bull 2009 Strengthening of institutional policy control (Establishment of the Federal Alcohol Service)
bull 2011 Introduction of greater controls and restrictions on production and sale of alcohol (Federal law No218)
Tobacco control policy developments since 2005
bull 2005 the Federal law No87 of 2001 ldquoOn limitations of smoking tobaccordquo is in effect
bull 2008 Ratification of the WHO Framework Convention on Tobacco Control by the Russian Federation
bull 2009 Defining the magnitude of the problem 40 smoking prevalence (GATS report on Russia)
bull 2010 Development of the anti-tobacco policy (the Conceptual framework on anti-tobacco policy for 2010-2015
bull 2013 Introduction of restrictions on tobacco sale and smoking in public (Federal law No 15 on ldquoHealth protection of citizens from exposure to tobacco smoke and consequences from tobacco consumptionrdquo)
34
0
20
40
60
80
100
120
140
160
180
Cancer oesophagus
Cancer stomach
Cancer breast
Ischaemic heartdiseaseInjuries poisoningviolence
Mortality from selected causes Women aged 45-59 Russia 1980 - 2009
Age-
stan
dard
ised
mor
talit
y ra
te p
er 1
000
00
Source WHO HFA database
Index of CVD risk - 1 Ratio of apolipoprotein B
to apolipoprotein A1
ldquoAtherogenicrdquo index
Index of CVD risk - 2 B-type natriuretic peptide
Index of stress on ventricles of heart Marker of non-atherosclerotic cardiac damage
Association of pattern of drinking with cardiovascular risk factors
OR (95 CI)
Pattern of drinking
OR top 20 ApoBA1 ratio
OR top 20 B-type natriuretic
peptide (BNP)
Abstains 100 [ref] 100 [ref]
Non-hazardous 034 (021 054) 235 (120 458)
Hazardous 031 (016 059) 431 (214 952)
P-value trend lt0001 lt0001
Adjusted for age BMI and waist-hip ratio
Source Leon DA et al EurJ Epidemiol 28 (5)393-404 2013
- The challenge of cardiovascular disease in Russia
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Russia has the highest cardiovascular mortality rate in the world
- Slide Number 6
- Cardiovascular disease mortality in Russia is atypical
- Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010 (age lt65 years)
- Slide Number 9
- Smoking Important but does not explain fluctuations
- Trends of adult smoking rates in Russia 1992ndash2009
- Paradoxical lipid profile relative to other countries
- Hypertension
- Slide Number 14
- Alcohol A key driver of fluctuations
- Slide Number 16
- Slide Number 17
- Individual-level evidence on alcohol
- Hazardous drinking and mortality from varioustypes of circulatory diseaseMen aged 25-54 years Izhevsk 2003 - 5
- Doubts about the diagnosis
- A new international project2014-19
- Cardiovascular disease in Russia strengthening evidence about causes mechanisms prevention and treatment
- Slide Number 23
- Four themes
- Theme B Cross-sectional studies
- Slide Number 26
- Cutting edge scientific approaches
- Serum NMR metabolomics
- The microbiome
- Slide Number 30
- Thank you
- Alcohol control policy developments since 2005
- Tobacco control policy developments since 2005
- Slide Number 34
- Index of CVD risk - 1Ratio of apolipoprotein B to apolipoprotein A1
- Index of CVD risk - 2 B-type natriuretic peptide
- Association of pattern of drinking with cardiovascular risk factorsOR (95 CI)
-
Trends of adult smoking rates in Russia 1992ndash2009
11 Source Lunze K ampMigliorini L BMC Public Health 20131364
Paradoxical lipid profile relative to other countries
bull Prevalence of raised total cholesterol not high bull Levels of LDL (ldquobadrdquo) cholesterol tend to be
average or below average bull Levels of HDL (ldquogoodrdquo)cholesterol above
average
bull NB national data available bull NB statin use very low
12
Hypertension
bull High rates in Russia compared to other European countries
bull Poor rates of control bull Likely to be an important factor
bull NB comprehensive national data poorly
documented and of questionable quality 13
14
Classic risk factors do not explain international differences
Alcohol A key driver of fluctuations
0
10
20
30
40
50
60
70
80
90
1965 1970 1975 1980 1985 1990 1995 2000 2005
Year
SD
R p
er 1
000
00
56
57
58
59
60
61
62
63
64
65
66
67
Life
exp
ecta
ncy
at b
irth
(yea
rs)
Life expectancy at birth
SDR for alcohol poisonings ages 15+
Males
Strong evidence that alcohol drives fluctuations in male life expectancy in Russia 1965 -2008
Source V Shkolnikov and E Andreev 16
0
20
40
60
80
100
120
140
160
180
0
200
400
600
800
1000
1200
1960 1970 1980 1990 2000 2010
Acut
e al
coho
l poi
soni
ng m
orta
lity
per 1
000
00
Tota
l circ
ulat
ory
dise
ase
mor
talit
y pe
r 100
000
Mortality from circulatory disease and acute alcohol
poisoning among men aged 50-54 years Russia 1960-2008
Total circulatory diseaseAcute alcohol poisoning
Source Data provided by Evgueny Andreev
Individual-level evidence on alcohol
18
Izhevsk Family Study (men aged 25-59 years)
2003-5 and 2008-10
Hazardous drinking and mortality from various types of circulatory disease
Men aged 25-54 years Izhevsk 2003 - 5
Underlying cause of death
Number of deaths
Hazardous drinking (proxy report)
OR (95 CI)
Alcoholic cardiomyopathy 98 1570 (952594)
Other cardiomyopathy 51 384 (205718)
Cerebrovascular disease 90 205 (124340)
Other circulatory disease 28 343 (151781)
Ischaemic heart disease 219 304 (217424)
19 OR adjusted for age smoking and education Source Leon Shkolnikov McKee Kiryanov Andreev IJE 2010
Doubts about the diagnosis
20
A new international project 2014-19
21
University of Tromsoslash Norway
Ministry of Health and Care Services Norway
Cardiovascular disease in Russia strengthening evidence about
causes mechanisms prevention and treatment
Institute of Internal Medicine SBRAMS Novosibirsk Russia
Max Planck Institute for Demographic
Research
Finland
22
Novosibirsk
Arkhangelsk
Moscow Rostock London
Oulu
Tromso
23
Location of study sites and collaborators
Kazan
Four themes
Theme A Levels and trends in cardiovascular disease and associated risk factors
Theme B Understanding the nature and causes of cardiovascular disease in Russia (including cause of death study)
Theme C Barriers opportunities and capacity for improved prevention and treatment (role of health service)
Theme D Capacity development and training
24
Theme B Cross-sectional studies
bull Two locations ndash Arkhangelsk and Novosibirsk bull Population-based random sample
ndash men and women aged 35-69 years ndash attention given to reducing selection bias ndash N=2750 in each city
bull Additional sample heavy alcohol drinkers from medical facility (N=250 in each city)
bull Main field work starts 2015
25
26
Cardiovascular phenotypes Type Source Biomarkerproxy measure
Atherosclerosis
Questionnaire Previous MI
ECG Evidence previous MI
Carotid ultrasound Carotid IMT plaque
Cardiac remodelling
Blood NT-pro BNP HsTnI hsTnT
Echocardiography Myocardial function and size
Arrhythmia ECG Actiwave Cardio
Baseline rhythm heart rate variability
Vascular dysfunction Vicorder Pulse-wave velocity
Cutting edge scientific approaches
27
Serum NMR metabolomics
bull Highly standardised and reproducible platform for 117 primary and 99 derived measures of specific molecular entities (now gt100000 individuals assayed)
Nature Genetics 44 269 2012
28
bull How are alcohol and CVD phenotypes related to 14
lipoprotein subclasses bull Identifying markers of intermediate metabolism associated
with CVD phenotypes
The microbiome
29 Key expertise Vadim Govorun Moscow
Studies in other countries eg Tromsoslash 7
Endogenous exposures a priori CVD risk biomarkers
(including lipoprotein NMR profile)
Socio-demographic + exogenous exposures
CVD phenotypes
Metabolic profile Microbiome
Associations Analytic framework
Thank you
31
Alcohol control policy developments since 2005
bull 2005 Federal law No171 on production and sale of alcohol
bull 2009 Elaboration of the Russian anti-alcohol policy framework (the Conceptual Framework on anti-alcohol policy implementation)
bull 2009 Strengthening of institutional policy control (Establishment of the Federal Alcohol Service)
bull 2011 Introduction of greater controls and restrictions on production and sale of alcohol (Federal law No218)
Tobacco control policy developments since 2005
bull 2005 the Federal law No87 of 2001 ldquoOn limitations of smoking tobaccordquo is in effect
bull 2008 Ratification of the WHO Framework Convention on Tobacco Control by the Russian Federation
bull 2009 Defining the magnitude of the problem 40 smoking prevalence (GATS report on Russia)
bull 2010 Development of the anti-tobacco policy (the Conceptual framework on anti-tobacco policy for 2010-2015
bull 2013 Introduction of restrictions on tobacco sale and smoking in public (Federal law No 15 on ldquoHealth protection of citizens from exposure to tobacco smoke and consequences from tobacco consumptionrdquo)
34
0
20
40
60
80
100
120
140
160
180
Cancer oesophagus
Cancer stomach
Cancer breast
Ischaemic heartdiseaseInjuries poisoningviolence
Mortality from selected causes Women aged 45-59 Russia 1980 - 2009
Age-
stan
dard
ised
mor
talit
y ra
te p
er 1
000
00
Source WHO HFA database
Index of CVD risk - 1 Ratio of apolipoprotein B
to apolipoprotein A1
ldquoAtherogenicrdquo index
Index of CVD risk - 2 B-type natriuretic peptide
Index of stress on ventricles of heart Marker of non-atherosclerotic cardiac damage
Association of pattern of drinking with cardiovascular risk factors
OR (95 CI)
Pattern of drinking
OR top 20 ApoBA1 ratio
OR top 20 B-type natriuretic
peptide (BNP)
Abstains 100 [ref] 100 [ref]
Non-hazardous 034 (021 054) 235 (120 458)
Hazardous 031 (016 059) 431 (214 952)
P-value trend lt0001 lt0001
Adjusted for age BMI and waist-hip ratio
Source Leon DA et al EurJ Epidemiol 28 (5)393-404 2013
- The challenge of cardiovascular disease in Russia
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Russia has the highest cardiovascular mortality rate in the world
- Slide Number 6
- Cardiovascular disease mortality in Russia is atypical
- Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010 (age lt65 years)
- Slide Number 9
- Smoking Important but does not explain fluctuations
- Trends of adult smoking rates in Russia 1992ndash2009
- Paradoxical lipid profile relative to other countries
- Hypertension
- Slide Number 14
- Alcohol A key driver of fluctuations
- Slide Number 16
- Slide Number 17
- Individual-level evidence on alcohol
- Hazardous drinking and mortality from varioustypes of circulatory diseaseMen aged 25-54 years Izhevsk 2003 - 5
- Doubts about the diagnosis
- A new international project2014-19
- Cardiovascular disease in Russia strengthening evidence about causes mechanisms prevention and treatment
- Slide Number 23
- Four themes
- Theme B Cross-sectional studies
- Slide Number 26
- Cutting edge scientific approaches
- Serum NMR metabolomics
- The microbiome
- Slide Number 30
- Thank you
- Alcohol control policy developments since 2005
- Tobacco control policy developments since 2005
- Slide Number 34
- Index of CVD risk - 1Ratio of apolipoprotein B to apolipoprotein A1
- Index of CVD risk - 2 B-type natriuretic peptide
- Association of pattern of drinking with cardiovascular risk factorsOR (95 CI)
-
Paradoxical lipid profile relative to other countries
bull Prevalence of raised total cholesterol not high bull Levels of LDL (ldquobadrdquo) cholesterol tend to be
average or below average bull Levels of HDL (ldquogoodrdquo)cholesterol above
average
bull NB national data available bull NB statin use very low
12
Hypertension
bull High rates in Russia compared to other European countries
bull Poor rates of control bull Likely to be an important factor
bull NB comprehensive national data poorly
documented and of questionable quality 13
14
Classic risk factors do not explain international differences
Alcohol A key driver of fluctuations
0
10
20
30
40
50
60
70
80
90
1965 1970 1975 1980 1985 1990 1995 2000 2005
Year
SD
R p
er 1
000
00
56
57
58
59
60
61
62
63
64
65
66
67
Life
exp
ecta
ncy
at b
irth
(yea
rs)
Life expectancy at birth
SDR for alcohol poisonings ages 15+
Males
Strong evidence that alcohol drives fluctuations in male life expectancy in Russia 1965 -2008
Source V Shkolnikov and E Andreev 16
0
20
40
60
80
100
120
140
160
180
0
200
400
600
800
1000
1200
1960 1970 1980 1990 2000 2010
Acut
e al
coho
l poi
soni
ng m
orta
lity
per 1
000
00
Tota
l circ
ulat
ory
dise
ase
mor
talit
y pe
r 100
000
Mortality from circulatory disease and acute alcohol
poisoning among men aged 50-54 years Russia 1960-2008
Total circulatory diseaseAcute alcohol poisoning
Source Data provided by Evgueny Andreev
Individual-level evidence on alcohol
18
Izhevsk Family Study (men aged 25-59 years)
2003-5 and 2008-10
Hazardous drinking and mortality from various types of circulatory disease
Men aged 25-54 years Izhevsk 2003 - 5
Underlying cause of death
Number of deaths
Hazardous drinking (proxy report)
OR (95 CI)
Alcoholic cardiomyopathy 98 1570 (952594)
Other cardiomyopathy 51 384 (205718)
Cerebrovascular disease 90 205 (124340)
Other circulatory disease 28 343 (151781)
Ischaemic heart disease 219 304 (217424)
19 OR adjusted for age smoking and education Source Leon Shkolnikov McKee Kiryanov Andreev IJE 2010
Doubts about the diagnosis
20
A new international project 2014-19
21
University of Tromsoslash Norway
Ministry of Health and Care Services Norway
Cardiovascular disease in Russia strengthening evidence about
causes mechanisms prevention and treatment
Institute of Internal Medicine SBRAMS Novosibirsk Russia
Max Planck Institute for Demographic
Research
Finland
22
Novosibirsk
Arkhangelsk
Moscow Rostock London
Oulu
Tromso
23
Location of study sites and collaborators
Kazan
Four themes
Theme A Levels and trends in cardiovascular disease and associated risk factors
Theme B Understanding the nature and causes of cardiovascular disease in Russia (including cause of death study)
Theme C Barriers opportunities and capacity for improved prevention and treatment (role of health service)
Theme D Capacity development and training
24
Theme B Cross-sectional studies
bull Two locations ndash Arkhangelsk and Novosibirsk bull Population-based random sample
ndash men and women aged 35-69 years ndash attention given to reducing selection bias ndash N=2750 in each city
bull Additional sample heavy alcohol drinkers from medical facility (N=250 in each city)
bull Main field work starts 2015
25
26
Cardiovascular phenotypes Type Source Biomarkerproxy measure
Atherosclerosis
Questionnaire Previous MI
ECG Evidence previous MI
Carotid ultrasound Carotid IMT plaque
Cardiac remodelling
Blood NT-pro BNP HsTnI hsTnT
Echocardiography Myocardial function and size
Arrhythmia ECG Actiwave Cardio
Baseline rhythm heart rate variability
Vascular dysfunction Vicorder Pulse-wave velocity
Cutting edge scientific approaches
27
Serum NMR metabolomics
bull Highly standardised and reproducible platform for 117 primary and 99 derived measures of specific molecular entities (now gt100000 individuals assayed)
Nature Genetics 44 269 2012
28
bull How are alcohol and CVD phenotypes related to 14
lipoprotein subclasses bull Identifying markers of intermediate metabolism associated
with CVD phenotypes
The microbiome
29 Key expertise Vadim Govorun Moscow
Studies in other countries eg Tromsoslash 7
Endogenous exposures a priori CVD risk biomarkers
(including lipoprotein NMR profile)
Socio-demographic + exogenous exposures
CVD phenotypes
Metabolic profile Microbiome
Associations Analytic framework
Thank you
31
Alcohol control policy developments since 2005
bull 2005 Federal law No171 on production and sale of alcohol
bull 2009 Elaboration of the Russian anti-alcohol policy framework (the Conceptual Framework on anti-alcohol policy implementation)
bull 2009 Strengthening of institutional policy control (Establishment of the Federal Alcohol Service)
bull 2011 Introduction of greater controls and restrictions on production and sale of alcohol (Federal law No218)
Tobacco control policy developments since 2005
bull 2005 the Federal law No87 of 2001 ldquoOn limitations of smoking tobaccordquo is in effect
bull 2008 Ratification of the WHO Framework Convention on Tobacco Control by the Russian Federation
bull 2009 Defining the magnitude of the problem 40 smoking prevalence (GATS report on Russia)
bull 2010 Development of the anti-tobacco policy (the Conceptual framework on anti-tobacco policy for 2010-2015
bull 2013 Introduction of restrictions on tobacco sale and smoking in public (Federal law No 15 on ldquoHealth protection of citizens from exposure to tobacco smoke and consequences from tobacco consumptionrdquo)
34
0
20
40
60
80
100
120
140
160
180
Cancer oesophagus
Cancer stomach
Cancer breast
Ischaemic heartdiseaseInjuries poisoningviolence
Mortality from selected causes Women aged 45-59 Russia 1980 - 2009
Age-
stan
dard
ised
mor
talit
y ra
te p
er 1
000
00
Source WHO HFA database
Index of CVD risk - 1 Ratio of apolipoprotein B
to apolipoprotein A1
ldquoAtherogenicrdquo index
Index of CVD risk - 2 B-type natriuretic peptide
Index of stress on ventricles of heart Marker of non-atherosclerotic cardiac damage
Association of pattern of drinking with cardiovascular risk factors
OR (95 CI)
Pattern of drinking
OR top 20 ApoBA1 ratio
OR top 20 B-type natriuretic
peptide (BNP)
Abstains 100 [ref] 100 [ref]
Non-hazardous 034 (021 054) 235 (120 458)
Hazardous 031 (016 059) 431 (214 952)
P-value trend lt0001 lt0001
Adjusted for age BMI and waist-hip ratio
Source Leon DA et al EurJ Epidemiol 28 (5)393-404 2013
- The challenge of cardiovascular disease in Russia
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Russia has the highest cardiovascular mortality rate in the world
- Slide Number 6
- Cardiovascular disease mortality in Russia is atypical
- Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010 (age lt65 years)
- Slide Number 9
- Smoking Important but does not explain fluctuations
- Trends of adult smoking rates in Russia 1992ndash2009
- Paradoxical lipid profile relative to other countries
- Hypertension
- Slide Number 14
- Alcohol A key driver of fluctuations
- Slide Number 16
- Slide Number 17
- Individual-level evidence on alcohol
- Hazardous drinking and mortality from varioustypes of circulatory diseaseMen aged 25-54 years Izhevsk 2003 - 5
- Doubts about the diagnosis
- A new international project2014-19
- Cardiovascular disease in Russia strengthening evidence about causes mechanisms prevention and treatment
- Slide Number 23
- Four themes
- Theme B Cross-sectional studies
- Slide Number 26
- Cutting edge scientific approaches
- Serum NMR metabolomics
- The microbiome
- Slide Number 30
- Thank you
- Alcohol control policy developments since 2005
- Tobacco control policy developments since 2005
- Slide Number 34
- Index of CVD risk - 1Ratio of apolipoprotein B to apolipoprotein A1
- Index of CVD risk - 2 B-type natriuretic peptide
- Association of pattern of drinking with cardiovascular risk factorsOR (95 CI)
-
Hypertension
bull High rates in Russia compared to other European countries
bull Poor rates of control bull Likely to be an important factor
bull NB comprehensive national data poorly
documented and of questionable quality 13
14
Classic risk factors do not explain international differences
Alcohol A key driver of fluctuations
0
10
20
30
40
50
60
70
80
90
1965 1970 1975 1980 1985 1990 1995 2000 2005
Year
SD
R p
er 1
000
00
56
57
58
59
60
61
62
63
64
65
66
67
Life
exp
ecta
ncy
at b
irth
(yea
rs)
Life expectancy at birth
SDR for alcohol poisonings ages 15+
Males
Strong evidence that alcohol drives fluctuations in male life expectancy in Russia 1965 -2008
Source V Shkolnikov and E Andreev 16
0
20
40
60
80
100
120
140
160
180
0
200
400
600
800
1000
1200
1960 1970 1980 1990 2000 2010
Acut
e al
coho
l poi
soni
ng m
orta
lity
per 1
000
00
Tota
l circ
ulat
ory
dise
ase
mor
talit
y pe
r 100
000
Mortality from circulatory disease and acute alcohol
poisoning among men aged 50-54 years Russia 1960-2008
Total circulatory diseaseAcute alcohol poisoning
Source Data provided by Evgueny Andreev
Individual-level evidence on alcohol
18
Izhevsk Family Study (men aged 25-59 years)
2003-5 and 2008-10
Hazardous drinking and mortality from various types of circulatory disease
Men aged 25-54 years Izhevsk 2003 - 5
Underlying cause of death
Number of deaths
Hazardous drinking (proxy report)
OR (95 CI)
Alcoholic cardiomyopathy 98 1570 (952594)
Other cardiomyopathy 51 384 (205718)
Cerebrovascular disease 90 205 (124340)
Other circulatory disease 28 343 (151781)
Ischaemic heart disease 219 304 (217424)
19 OR adjusted for age smoking and education Source Leon Shkolnikov McKee Kiryanov Andreev IJE 2010
Doubts about the diagnosis
20
A new international project 2014-19
21
University of Tromsoslash Norway
Ministry of Health and Care Services Norway
Cardiovascular disease in Russia strengthening evidence about
causes mechanisms prevention and treatment
Institute of Internal Medicine SBRAMS Novosibirsk Russia
Max Planck Institute for Demographic
Research
Finland
22
Novosibirsk
Arkhangelsk
Moscow Rostock London
Oulu
Tromso
23
Location of study sites and collaborators
Kazan
Four themes
Theme A Levels and trends in cardiovascular disease and associated risk factors
Theme B Understanding the nature and causes of cardiovascular disease in Russia (including cause of death study)
Theme C Barriers opportunities and capacity for improved prevention and treatment (role of health service)
Theme D Capacity development and training
24
Theme B Cross-sectional studies
bull Two locations ndash Arkhangelsk and Novosibirsk bull Population-based random sample
ndash men and women aged 35-69 years ndash attention given to reducing selection bias ndash N=2750 in each city
bull Additional sample heavy alcohol drinkers from medical facility (N=250 in each city)
bull Main field work starts 2015
25
26
Cardiovascular phenotypes Type Source Biomarkerproxy measure
Atherosclerosis
Questionnaire Previous MI
ECG Evidence previous MI
Carotid ultrasound Carotid IMT plaque
Cardiac remodelling
Blood NT-pro BNP HsTnI hsTnT
Echocardiography Myocardial function and size
Arrhythmia ECG Actiwave Cardio
Baseline rhythm heart rate variability
Vascular dysfunction Vicorder Pulse-wave velocity
Cutting edge scientific approaches
27
Serum NMR metabolomics
bull Highly standardised and reproducible platform for 117 primary and 99 derived measures of specific molecular entities (now gt100000 individuals assayed)
Nature Genetics 44 269 2012
28
bull How are alcohol and CVD phenotypes related to 14
lipoprotein subclasses bull Identifying markers of intermediate metabolism associated
with CVD phenotypes
The microbiome
29 Key expertise Vadim Govorun Moscow
Studies in other countries eg Tromsoslash 7
Endogenous exposures a priori CVD risk biomarkers
(including lipoprotein NMR profile)
Socio-demographic + exogenous exposures
CVD phenotypes
Metabolic profile Microbiome
Associations Analytic framework
Thank you
31
Alcohol control policy developments since 2005
bull 2005 Federal law No171 on production and sale of alcohol
bull 2009 Elaboration of the Russian anti-alcohol policy framework (the Conceptual Framework on anti-alcohol policy implementation)
bull 2009 Strengthening of institutional policy control (Establishment of the Federal Alcohol Service)
bull 2011 Introduction of greater controls and restrictions on production and sale of alcohol (Federal law No218)
Tobacco control policy developments since 2005
bull 2005 the Federal law No87 of 2001 ldquoOn limitations of smoking tobaccordquo is in effect
bull 2008 Ratification of the WHO Framework Convention on Tobacco Control by the Russian Federation
bull 2009 Defining the magnitude of the problem 40 smoking prevalence (GATS report on Russia)
bull 2010 Development of the anti-tobacco policy (the Conceptual framework on anti-tobacco policy for 2010-2015
bull 2013 Introduction of restrictions on tobacco sale and smoking in public (Federal law No 15 on ldquoHealth protection of citizens from exposure to tobacco smoke and consequences from tobacco consumptionrdquo)
34
0
20
40
60
80
100
120
140
160
180
Cancer oesophagus
Cancer stomach
Cancer breast
Ischaemic heartdiseaseInjuries poisoningviolence
Mortality from selected causes Women aged 45-59 Russia 1980 - 2009
Age-
stan
dard
ised
mor
talit
y ra
te p
er 1
000
00
Source WHO HFA database
Index of CVD risk - 1 Ratio of apolipoprotein B
to apolipoprotein A1
ldquoAtherogenicrdquo index
Index of CVD risk - 2 B-type natriuretic peptide
Index of stress on ventricles of heart Marker of non-atherosclerotic cardiac damage
Association of pattern of drinking with cardiovascular risk factors
OR (95 CI)
Pattern of drinking
OR top 20 ApoBA1 ratio
OR top 20 B-type natriuretic
peptide (BNP)
Abstains 100 [ref] 100 [ref]
Non-hazardous 034 (021 054) 235 (120 458)
Hazardous 031 (016 059) 431 (214 952)
P-value trend lt0001 lt0001
Adjusted for age BMI and waist-hip ratio
Source Leon DA et al EurJ Epidemiol 28 (5)393-404 2013
- The challenge of cardiovascular disease in Russia
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Russia has the highest cardiovascular mortality rate in the world
- Slide Number 6
- Cardiovascular disease mortality in Russia is atypical
- Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010 (age lt65 years)
- Slide Number 9
- Smoking Important but does not explain fluctuations
- Trends of adult smoking rates in Russia 1992ndash2009
- Paradoxical lipid profile relative to other countries
- Hypertension
- Slide Number 14
- Alcohol A key driver of fluctuations
- Slide Number 16
- Slide Number 17
- Individual-level evidence on alcohol
- Hazardous drinking and mortality from varioustypes of circulatory diseaseMen aged 25-54 years Izhevsk 2003 - 5
- Doubts about the diagnosis
- A new international project2014-19
- Cardiovascular disease in Russia strengthening evidence about causes mechanisms prevention and treatment
- Slide Number 23
- Four themes
- Theme B Cross-sectional studies
- Slide Number 26
- Cutting edge scientific approaches
- Serum NMR metabolomics
- The microbiome
- Slide Number 30
- Thank you
- Alcohol control policy developments since 2005
- Tobacco control policy developments since 2005
- Slide Number 34
- Index of CVD risk - 1Ratio of apolipoprotein B to apolipoprotein A1
- Index of CVD risk - 2 B-type natriuretic peptide
- Association of pattern of drinking with cardiovascular risk factorsOR (95 CI)
-
14
Classic risk factors do not explain international differences
Alcohol A key driver of fluctuations
0
10
20
30
40
50
60
70
80
90
1965 1970 1975 1980 1985 1990 1995 2000 2005
Year
SD
R p
er 1
000
00
56
57
58
59
60
61
62
63
64
65
66
67
Life
exp
ecta
ncy
at b
irth
(yea
rs)
Life expectancy at birth
SDR for alcohol poisonings ages 15+
Males
Strong evidence that alcohol drives fluctuations in male life expectancy in Russia 1965 -2008
Source V Shkolnikov and E Andreev 16
0
20
40
60
80
100
120
140
160
180
0
200
400
600
800
1000
1200
1960 1970 1980 1990 2000 2010
Acut
e al
coho
l poi
soni
ng m
orta
lity
per 1
000
00
Tota
l circ
ulat
ory
dise
ase
mor
talit
y pe
r 100
000
Mortality from circulatory disease and acute alcohol
poisoning among men aged 50-54 years Russia 1960-2008
Total circulatory diseaseAcute alcohol poisoning
Source Data provided by Evgueny Andreev
Individual-level evidence on alcohol
18
Izhevsk Family Study (men aged 25-59 years)
2003-5 and 2008-10
Hazardous drinking and mortality from various types of circulatory disease
Men aged 25-54 years Izhevsk 2003 - 5
Underlying cause of death
Number of deaths
Hazardous drinking (proxy report)
OR (95 CI)
Alcoholic cardiomyopathy 98 1570 (952594)
Other cardiomyopathy 51 384 (205718)
Cerebrovascular disease 90 205 (124340)
Other circulatory disease 28 343 (151781)
Ischaemic heart disease 219 304 (217424)
19 OR adjusted for age smoking and education Source Leon Shkolnikov McKee Kiryanov Andreev IJE 2010
Doubts about the diagnosis
20
A new international project 2014-19
21
University of Tromsoslash Norway
Ministry of Health and Care Services Norway
Cardiovascular disease in Russia strengthening evidence about
causes mechanisms prevention and treatment
Institute of Internal Medicine SBRAMS Novosibirsk Russia
Max Planck Institute for Demographic
Research
Finland
22
Novosibirsk
Arkhangelsk
Moscow Rostock London
Oulu
Tromso
23
Location of study sites and collaborators
Kazan
Four themes
Theme A Levels and trends in cardiovascular disease and associated risk factors
Theme B Understanding the nature and causes of cardiovascular disease in Russia (including cause of death study)
Theme C Barriers opportunities and capacity for improved prevention and treatment (role of health service)
Theme D Capacity development and training
24
Theme B Cross-sectional studies
bull Two locations ndash Arkhangelsk and Novosibirsk bull Population-based random sample
ndash men and women aged 35-69 years ndash attention given to reducing selection bias ndash N=2750 in each city
bull Additional sample heavy alcohol drinkers from medical facility (N=250 in each city)
bull Main field work starts 2015
25
26
Cardiovascular phenotypes Type Source Biomarkerproxy measure
Atherosclerosis
Questionnaire Previous MI
ECG Evidence previous MI
Carotid ultrasound Carotid IMT plaque
Cardiac remodelling
Blood NT-pro BNP HsTnI hsTnT
Echocardiography Myocardial function and size
Arrhythmia ECG Actiwave Cardio
Baseline rhythm heart rate variability
Vascular dysfunction Vicorder Pulse-wave velocity
Cutting edge scientific approaches
27
Serum NMR metabolomics
bull Highly standardised and reproducible platform for 117 primary and 99 derived measures of specific molecular entities (now gt100000 individuals assayed)
Nature Genetics 44 269 2012
28
bull How are alcohol and CVD phenotypes related to 14
lipoprotein subclasses bull Identifying markers of intermediate metabolism associated
with CVD phenotypes
The microbiome
29 Key expertise Vadim Govorun Moscow
Studies in other countries eg Tromsoslash 7
Endogenous exposures a priori CVD risk biomarkers
(including lipoprotein NMR profile)
Socio-demographic + exogenous exposures
CVD phenotypes
Metabolic profile Microbiome
Associations Analytic framework
Thank you
31
Alcohol control policy developments since 2005
bull 2005 Federal law No171 on production and sale of alcohol
bull 2009 Elaboration of the Russian anti-alcohol policy framework (the Conceptual Framework on anti-alcohol policy implementation)
bull 2009 Strengthening of institutional policy control (Establishment of the Federal Alcohol Service)
bull 2011 Introduction of greater controls and restrictions on production and sale of alcohol (Federal law No218)
Tobacco control policy developments since 2005
bull 2005 the Federal law No87 of 2001 ldquoOn limitations of smoking tobaccordquo is in effect
bull 2008 Ratification of the WHO Framework Convention on Tobacco Control by the Russian Federation
bull 2009 Defining the magnitude of the problem 40 smoking prevalence (GATS report on Russia)
bull 2010 Development of the anti-tobacco policy (the Conceptual framework on anti-tobacco policy for 2010-2015
bull 2013 Introduction of restrictions on tobacco sale and smoking in public (Federal law No 15 on ldquoHealth protection of citizens from exposure to tobacco smoke and consequences from tobacco consumptionrdquo)
34
0
20
40
60
80
100
120
140
160
180
Cancer oesophagus
Cancer stomach
Cancer breast
Ischaemic heartdiseaseInjuries poisoningviolence
Mortality from selected causes Women aged 45-59 Russia 1980 - 2009
Age-
stan
dard
ised
mor
talit
y ra
te p
er 1
000
00
Source WHO HFA database
Index of CVD risk - 1 Ratio of apolipoprotein B
to apolipoprotein A1
ldquoAtherogenicrdquo index
Index of CVD risk - 2 B-type natriuretic peptide
Index of stress on ventricles of heart Marker of non-atherosclerotic cardiac damage
Association of pattern of drinking with cardiovascular risk factors
OR (95 CI)
Pattern of drinking
OR top 20 ApoBA1 ratio
OR top 20 B-type natriuretic
peptide (BNP)
Abstains 100 [ref] 100 [ref]
Non-hazardous 034 (021 054) 235 (120 458)
Hazardous 031 (016 059) 431 (214 952)
P-value trend lt0001 lt0001
Adjusted for age BMI and waist-hip ratio
Source Leon DA et al EurJ Epidemiol 28 (5)393-404 2013
- The challenge of cardiovascular disease in Russia
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Russia has the highest cardiovascular mortality rate in the world
- Slide Number 6
- Cardiovascular disease mortality in Russia is atypical
- Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010 (age lt65 years)
- Slide Number 9
- Smoking Important but does not explain fluctuations
- Trends of adult smoking rates in Russia 1992ndash2009
- Paradoxical lipid profile relative to other countries
- Hypertension
- Slide Number 14
- Alcohol A key driver of fluctuations
- Slide Number 16
- Slide Number 17
- Individual-level evidence on alcohol
- Hazardous drinking and mortality from varioustypes of circulatory diseaseMen aged 25-54 years Izhevsk 2003 - 5
- Doubts about the diagnosis
- A new international project2014-19
- Cardiovascular disease in Russia strengthening evidence about causes mechanisms prevention and treatment
- Slide Number 23
- Four themes
- Theme B Cross-sectional studies
- Slide Number 26
- Cutting edge scientific approaches
- Serum NMR metabolomics
- The microbiome
- Slide Number 30
- Thank you
- Alcohol control policy developments since 2005
- Tobacco control policy developments since 2005
- Slide Number 34
- Index of CVD risk - 1Ratio of apolipoprotein B to apolipoprotein A1
- Index of CVD risk - 2 B-type natriuretic peptide
- Association of pattern of drinking with cardiovascular risk factorsOR (95 CI)
-
Alcohol A key driver of fluctuations
0
10
20
30
40
50
60
70
80
90
1965 1970 1975 1980 1985 1990 1995 2000 2005
Year
SD
R p
er 1
000
00
56
57
58
59
60
61
62
63
64
65
66
67
Life
exp
ecta
ncy
at b
irth
(yea
rs)
Life expectancy at birth
SDR for alcohol poisonings ages 15+
Males
Strong evidence that alcohol drives fluctuations in male life expectancy in Russia 1965 -2008
Source V Shkolnikov and E Andreev 16
0
20
40
60
80
100
120
140
160
180
0
200
400
600
800
1000
1200
1960 1970 1980 1990 2000 2010
Acut
e al
coho
l poi
soni
ng m
orta
lity
per 1
000
00
Tota
l circ
ulat
ory
dise
ase
mor
talit
y pe
r 100
000
Mortality from circulatory disease and acute alcohol
poisoning among men aged 50-54 years Russia 1960-2008
Total circulatory diseaseAcute alcohol poisoning
Source Data provided by Evgueny Andreev
Individual-level evidence on alcohol
18
Izhevsk Family Study (men aged 25-59 years)
2003-5 and 2008-10
Hazardous drinking and mortality from various types of circulatory disease
Men aged 25-54 years Izhevsk 2003 - 5
Underlying cause of death
Number of deaths
Hazardous drinking (proxy report)
OR (95 CI)
Alcoholic cardiomyopathy 98 1570 (952594)
Other cardiomyopathy 51 384 (205718)
Cerebrovascular disease 90 205 (124340)
Other circulatory disease 28 343 (151781)
Ischaemic heart disease 219 304 (217424)
19 OR adjusted for age smoking and education Source Leon Shkolnikov McKee Kiryanov Andreev IJE 2010
Doubts about the diagnosis
20
A new international project 2014-19
21
University of Tromsoslash Norway
Ministry of Health and Care Services Norway
Cardiovascular disease in Russia strengthening evidence about
causes mechanisms prevention and treatment
Institute of Internal Medicine SBRAMS Novosibirsk Russia
Max Planck Institute for Demographic
Research
Finland
22
Novosibirsk
Arkhangelsk
Moscow Rostock London
Oulu
Tromso
23
Location of study sites and collaborators
Kazan
Four themes
Theme A Levels and trends in cardiovascular disease and associated risk factors
Theme B Understanding the nature and causes of cardiovascular disease in Russia (including cause of death study)
Theme C Barriers opportunities and capacity for improved prevention and treatment (role of health service)
Theme D Capacity development and training
24
Theme B Cross-sectional studies
bull Two locations ndash Arkhangelsk and Novosibirsk bull Population-based random sample
ndash men and women aged 35-69 years ndash attention given to reducing selection bias ndash N=2750 in each city
bull Additional sample heavy alcohol drinkers from medical facility (N=250 in each city)
bull Main field work starts 2015
25
26
Cardiovascular phenotypes Type Source Biomarkerproxy measure
Atherosclerosis
Questionnaire Previous MI
ECG Evidence previous MI
Carotid ultrasound Carotid IMT plaque
Cardiac remodelling
Blood NT-pro BNP HsTnI hsTnT
Echocardiography Myocardial function and size
Arrhythmia ECG Actiwave Cardio
Baseline rhythm heart rate variability
Vascular dysfunction Vicorder Pulse-wave velocity
Cutting edge scientific approaches
27
Serum NMR metabolomics
bull Highly standardised and reproducible platform for 117 primary and 99 derived measures of specific molecular entities (now gt100000 individuals assayed)
Nature Genetics 44 269 2012
28
bull How are alcohol and CVD phenotypes related to 14
lipoprotein subclasses bull Identifying markers of intermediate metabolism associated
with CVD phenotypes
The microbiome
29 Key expertise Vadim Govorun Moscow
Studies in other countries eg Tromsoslash 7
Endogenous exposures a priori CVD risk biomarkers
(including lipoprotein NMR profile)
Socio-demographic + exogenous exposures
CVD phenotypes
Metabolic profile Microbiome
Associations Analytic framework
Thank you
31
Alcohol control policy developments since 2005
bull 2005 Federal law No171 on production and sale of alcohol
bull 2009 Elaboration of the Russian anti-alcohol policy framework (the Conceptual Framework on anti-alcohol policy implementation)
bull 2009 Strengthening of institutional policy control (Establishment of the Federal Alcohol Service)
bull 2011 Introduction of greater controls and restrictions on production and sale of alcohol (Federal law No218)
Tobacco control policy developments since 2005
bull 2005 the Federal law No87 of 2001 ldquoOn limitations of smoking tobaccordquo is in effect
bull 2008 Ratification of the WHO Framework Convention on Tobacco Control by the Russian Federation
bull 2009 Defining the magnitude of the problem 40 smoking prevalence (GATS report on Russia)
bull 2010 Development of the anti-tobacco policy (the Conceptual framework on anti-tobacco policy for 2010-2015
bull 2013 Introduction of restrictions on tobacco sale and smoking in public (Federal law No 15 on ldquoHealth protection of citizens from exposure to tobacco smoke and consequences from tobacco consumptionrdquo)
34
0
20
40
60
80
100
120
140
160
180
Cancer oesophagus
Cancer stomach
Cancer breast
Ischaemic heartdiseaseInjuries poisoningviolence
Mortality from selected causes Women aged 45-59 Russia 1980 - 2009
Age-
stan
dard
ised
mor
talit
y ra
te p
er 1
000
00
Source WHO HFA database
Index of CVD risk - 1 Ratio of apolipoprotein B
to apolipoprotein A1
ldquoAtherogenicrdquo index
Index of CVD risk - 2 B-type natriuretic peptide
Index of stress on ventricles of heart Marker of non-atherosclerotic cardiac damage
Association of pattern of drinking with cardiovascular risk factors
OR (95 CI)
Pattern of drinking
OR top 20 ApoBA1 ratio
OR top 20 B-type natriuretic
peptide (BNP)
Abstains 100 [ref] 100 [ref]
Non-hazardous 034 (021 054) 235 (120 458)
Hazardous 031 (016 059) 431 (214 952)
P-value trend lt0001 lt0001
Adjusted for age BMI and waist-hip ratio
Source Leon DA et al EurJ Epidemiol 28 (5)393-404 2013
- The challenge of cardiovascular disease in Russia
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Russia has the highest cardiovascular mortality rate in the world
- Slide Number 6
- Cardiovascular disease mortality in Russia is atypical
- Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010 (age lt65 years)
- Slide Number 9
- Smoking Important but does not explain fluctuations
- Trends of adult smoking rates in Russia 1992ndash2009
- Paradoxical lipid profile relative to other countries
- Hypertension
- Slide Number 14
- Alcohol A key driver of fluctuations
- Slide Number 16
- Slide Number 17
- Individual-level evidence on alcohol
- Hazardous drinking and mortality from varioustypes of circulatory diseaseMen aged 25-54 years Izhevsk 2003 - 5
- Doubts about the diagnosis
- A new international project2014-19
- Cardiovascular disease in Russia strengthening evidence about causes mechanisms prevention and treatment
- Slide Number 23
- Four themes
- Theme B Cross-sectional studies
- Slide Number 26
- Cutting edge scientific approaches
- Serum NMR metabolomics
- The microbiome
- Slide Number 30
- Thank you
- Alcohol control policy developments since 2005
- Tobacco control policy developments since 2005
- Slide Number 34
- Index of CVD risk - 1Ratio of apolipoprotein B to apolipoprotein A1
- Index of CVD risk - 2 B-type natriuretic peptide
- Association of pattern of drinking with cardiovascular risk factorsOR (95 CI)
-
0
10
20
30
40
50
60
70
80
90
1965 1970 1975 1980 1985 1990 1995 2000 2005
Year
SD
R p
er 1
000
00
56
57
58
59
60
61
62
63
64
65
66
67
Life
exp
ecta
ncy
at b
irth
(yea
rs)
Life expectancy at birth
SDR for alcohol poisonings ages 15+
Males
Strong evidence that alcohol drives fluctuations in male life expectancy in Russia 1965 -2008
Source V Shkolnikov and E Andreev 16
0
20
40
60
80
100
120
140
160
180
0
200
400
600
800
1000
1200
1960 1970 1980 1990 2000 2010
Acut
e al
coho
l poi
soni
ng m
orta
lity
per 1
000
00
Tota
l circ
ulat
ory
dise
ase
mor
talit
y pe
r 100
000
Mortality from circulatory disease and acute alcohol
poisoning among men aged 50-54 years Russia 1960-2008
Total circulatory diseaseAcute alcohol poisoning
Source Data provided by Evgueny Andreev
Individual-level evidence on alcohol
18
Izhevsk Family Study (men aged 25-59 years)
2003-5 and 2008-10
Hazardous drinking and mortality from various types of circulatory disease
Men aged 25-54 years Izhevsk 2003 - 5
Underlying cause of death
Number of deaths
Hazardous drinking (proxy report)
OR (95 CI)
Alcoholic cardiomyopathy 98 1570 (952594)
Other cardiomyopathy 51 384 (205718)
Cerebrovascular disease 90 205 (124340)
Other circulatory disease 28 343 (151781)
Ischaemic heart disease 219 304 (217424)
19 OR adjusted for age smoking and education Source Leon Shkolnikov McKee Kiryanov Andreev IJE 2010
Doubts about the diagnosis
20
A new international project 2014-19
21
University of Tromsoslash Norway
Ministry of Health and Care Services Norway
Cardiovascular disease in Russia strengthening evidence about
causes mechanisms prevention and treatment
Institute of Internal Medicine SBRAMS Novosibirsk Russia
Max Planck Institute for Demographic
Research
Finland
22
Novosibirsk
Arkhangelsk
Moscow Rostock London
Oulu
Tromso
23
Location of study sites and collaborators
Kazan
Four themes
Theme A Levels and trends in cardiovascular disease and associated risk factors
Theme B Understanding the nature and causes of cardiovascular disease in Russia (including cause of death study)
Theme C Barriers opportunities and capacity for improved prevention and treatment (role of health service)
Theme D Capacity development and training
24
Theme B Cross-sectional studies
bull Two locations ndash Arkhangelsk and Novosibirsk bull Population-based random sample
ndash men and women aged 35-69 years ndash attention given to reducing selection bias ndash N=2750 in each city
bull Additional sample heavy alcohol drinkers from medical facility (N=250 in each city)
bull Main field work starts 2015
25
26
Cardiovascular phenotypes Type Source Biomarkerproxy measure
Atherosclerosis
Questionnaire Previous MI
ECG Evidence previous MI
Carotid ultrasound Carotid IMT plaque
Cardiac remodelling
Blood NT-pro BNP HsTnI hsTnT
Echocardiography Myocardial function and size
Arrhythmia ECG Actiwave Cardio
Baseline rhythm heart rate variability
Vascular dysfunction Vicorder Pulse-wave velocity
Cutting edge scientific approaches
27
Serum NMR metabolomics
bull Highly standardised and reproducible platform for 117 primary and 99 derived measures of specific molecular entities (now gt100000 individuals assayed)
Nature Genetics 44 269 2012
28
bull How are alcohol and CVD phenotypes related to 14
lipoprotein subclasses bull Identifying markers of intermediate metabolism associated
with CVD phenotypes
The microbiome
29 Key expertise Vadim Govorun Moscow
Studies in other countries eg Tromsoslash 7
Endogenous exposures a priori CVD risk biomarkers
(including lipoprotein NMR profile)
Socio-demographic + exogenous exposures
CVD phenotypes
Metabolic profile Microbiome
Associations Analytic framework
Thank you
31
Alcohol control policy developments since 2005
bull 2005 Federal law No171 on production and sale of alcohol
bull 2009 Elaboration of the Russian anti-alcohol policy framework (the Conceptual Framework on anti-alcohol policy implementation)
bull 2009 Strengthening of institutional policy control (Establishment of the Federal Alcohol Service)
bull 2011 Introduction of greater controls and restrictions on production and sale of alcohol (Federal law No218)
Tobacco control policy developments since 2005
bull 2005 the Federal law No87 of 2001 ldquoOn limitations of smoking tobaccordquo is in effect
bull 2008 Ratification of the WHO Framework Convention on Tobacco Control by the Russian Federation
bull 2009 Defining the magnitude of the problem 40 smoking prevalence (GATS report on Russia)
bull 2010 Development of the anti-tobacco policy (the Conceptual framework on anti-tobacco policy for 2010-2015
bull 2013 Introduction of restrictions on tobacco sale and smoking in public (Federal law No 15 on ldquoHealth protection of citizens from exposure to tobacco smoke and consequences from tobacco consumptionrdquo)
34
0
20
40
60
80
100
120
140
160
180
Cancer oesophagus
Cancer stomach
Cancer breast
Ischaemic heartdiseaseInjuries poisoningviolence
Mortality from selected causes Women aged 45-59 Russia 1980 - 2009
Age-
stan
dard
ised
mor
talit
y ra
te p
er 1
000
00
Source WHO HFA database
Index of CVD risk - 1 Ratio of apolipoprotein B
to apolipoprotein A1
ldquoAtherogenicrdquo index
Index of CVD risk - 2 B-type natriuretic peptide
Index of stress on ventricles of heart Marker of non-atherosclerotic cardiac damage
Association of pattern of drinking with cardiovascular risk factors
OR (95 CI)
Pattern of drinking
OR top 20 ApoBA1 ratio
OR top 20 B-type natriuretic
peptide (BNP)
Abstains 100 [ref] 100 [ref]
Non-hazardous 034 (021 054) 235 (120 458)
Hazardous 031 (016 059) 431 (214 952)
P-value trend lt0001 lt0001
Adjusted for age BMI and waist-hip ratio
Source Leon DA et al EurJ Epidemiol 28 (5)393-404 2013
- The challenge of cardiovascular disease in Russia
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Russia has the highest cardiovascular mortality rate in the world
- Slide Number 6
- Cardiovascular disease mortality in Russia is atypical
- Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010 (age lt65 years)
- Slide Number 9
- Smoking Important but does not explain fluctuations
- Trends of adult smoking rates in Russia 1992ndash2009
- Paradoxical lipid profile relative to other countries
- Hypertension
- Slide Number 14
- Alcohol A key driver of fluctuations
- Slide Number 16
- Slide Number 17
- Individual-level evidence on alcohol
- Hazardous drinking and mortality from varioustypes of circulatory diseaseMen aged 25-54 years Izhevsk 2003 - 5
- Doubts about the diagnosis
- A new international project2014-19
- Cardiovascular disease in Russia strengthening evidence about causes mechanisms prevention and treatment
- Slide Number 23
- Four themes
- Theme B Cross-sectional studies
- Slide Number 26
- Cutting edge scientific approaches
- Serum NMR metabolomics
- The microbiome
- Slide Number 30
- Thank you
- Alcohol control policy developments since 2005
- Tobacco control policy developments since 2005
- Slide Number 34
- Index of CVD risk - 1Ratio of apolipoprotein B to apolipoprotein A1
- Index of CVD risk - 2 B-type natriuretic peptide
- Association of pattern of drinking with cardiovascular risk factorsOR (95 CI)
-
0
20
40
60
80
100
120
140
160
180
0
200
400
600
800
1000
1200
1960 1970 1980 1990 2000 2010
Acut
e al
coho
l poi
soni
ng m
orta
lity
per 1
000
00
Tota
l circ
ulat
ory
dise
ase
mor
talit
y pe
r 100
000
Mortality from circulatory disease and acute alcohol
poisoning among men aged 50-54 years Russia 1960-2008
Total circulatory diseaseAcute alcohol poisoning
Source Data provided by Evgueny Andreev
Individual-level evidence on alcohol
18
Izhevsk Family Study (men aged 25-59 years)
2003-5 and 2008-10
Hazardous drinking and mortality from various types of circulatory disease
Men aged 25-54 years Izhevsk 2003 - 5
Underlying cause of death
Number of deaths
Hazardous drinking (proxy report)
OR (95 CI)
Alcoholic cardiomyopathy 98 1570 (952594)
Other cardiomyopathy 51 384 (205718)
Cerebrovascular disease 90 205 (124340)
Other circulatory disease 28 343 (151781)
Ischaemic heart disease 219 304 (217424)
19 OR adjusted for age smoking and education Source Leon Shkolnikov McKee Kiryanov Andreev IJE 2010
Doubts about the diagnosis
20
A new international project 2014-19
21
University of Tromsoslash Norway
Ministry of Health and Care Services Norway
Cardiovascular disease in Russia strengthening evidence about
causes mechanisms prevention and treatment
Institute of Internal Medicine SBRAMS Novosibirsk Russia
Max Planck Institute for Demographic
Research
Finland
22
Novosibirsk
Arkhangelsk
Moscow Rostock London
Oulu
Tromso
23
Location of study sites and collaborators
Kazan
Four themes
Theme A Levels and trends in cardiovascular disease and associated risk factors
Theme B Understanding the nature and causes of cardiovascular disease in Russia (including cause of death study)
Theme C Barriers opportunities and capacity for improved prevention and treatment (role of health service)
Theme D Capacity development and training
24
Theme B Cross-sectional studies
bull Two locations ndash Arkhangelsk and Novosibirsk bull Population-based random sample
ndash men and women aged 35-69 years ndash attention given to reducing selection bias ndash N=2750 in each city
bull Additional sample heavy alcohol drinkers from medical facility (N=250 in each city)
bull Main field work starts 2015
25
26
Cardiovascular phenotypes Type Source Biomarkerproxy measure
Atherosclerosis
Questionnaire Previous MI
ECG Evidence previous MI
Carotid ultrasound Carotid IMT plaque
Cardiac remodelling
Blood NT-pro BNP HsTnI hsTnT
Echocardiography Myocardial function and size
Arrhythmia ECG Actiwave Cardio
Baseline rhythm heart rate variability
Vascular dysfunction Vicorder Pulse-wave velocity
Cutting edge scientific approaches
27
Serum NMR metabolomics
bull Highly standardised and reproducible platform for 117 primary and 99 derived measures of specific molecular entities (now gt100000 individuals assayed)
Nature Genetics 44 269 2012
28
bull How are alcohol and CVD phenotypes related to 14
lipoprotein subclasses bull Identifying markers of intermediate metabolism associated
with CVD phenotypes
The microbiome
29 Key expertise Vadim Govorun Moscow
Studies in other countries eg Tromsoslash 7
Endogenous exposures a priori CVD risk biomarkers
(including lipoprotein NMR profile)
Socio-demographic + exogenous exposures
CVD phenotypes
Metabolic profile Microbiome
Associations Analytic framework
Thank you
31
Alcohol control policy developments since 2005
bull 2005 Federal law No171 on production and sale of alcohol
bull 2009 Elaboration of the Russian anti-alcohol policy framework (the Conceptual Framework on anti-alcohol policy implementation)
bull 2009 Strengthening of institutional policy control (Establishment of the Federal Alcohol Service)
bull 2011 Introduction of greater controls and restrictions on production and sale of alcohol (Federal law No218)
Tobacco control policy developments since 2005
bull 2005 the Federal law No87 of 2001 ldquoOn limitations of smoking tobaccordquo is in effect
bull 2008 Ratification of the WHO Framework Convention on Tobacco Control by the Russian Federation
bull 2009 Defining the magnitude of the problem 40 smoking prevalence (GATS report on Russia)
bull 2010 Development of the anti-tobacco policy (the Conceptual framework on anti-tobacco policy for 2010-2015
bull 2013 Introduction of restrictions on tobacco sale and smoking in public (Federal law No 15 on ldquoHealth protection of citizens from exposure to tobacco smoke and consequences from tobacco consumptionrdquo)
34
0
20
40
60
80
100
120
140
160
180
Cancer oesophagus
Cancer stomach
Cancer breast
Ischaemic heartdiseaseInjuries poisoningviolence
Mortality from selected causes Women aged 45-59 Russia 1980 - 2009
Age-
stan
dard
ised
mor
talit
y ra
te p
er 1
000
00
Source WHO HFA database
Index of CVD risk - 1 Ratio of apolipoprotein B
to apolipoprotein A1
ldquoAtherogenicrdquo index
Index of CVD risk - 2 B-type natriuretic peptide
Index of stress on ventricles of heart Marker of non-atherosclerotic cardiac damage
Association of pattern of drinking with cardiovascular risk factors
OR (95 CI)
Pattern of drinking
OR top 20 ApoBA1 ratio
OR top 20 B-type natriuretic
peptide (BNP)
Abstains 100 [ref] 100 [ref]
Non-hazardous 034 (021 054) 235 (120 458)
Hazardous 031 (016 059) 431 (214 952)
P-value trend lt0001 lt0001
Adjusted for age BMI and waist-hip ratio
Source Leon DA et al EurJ Epidemiol 28 (5)393-404 2013
- The challenge of cardiovascular disease in Russia
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Russia has the highest cardiovascular mortality rate in the world
- Slide Number 6
- Cardiovascular disease mortality in Russia is atypical
- Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010 (age lt65 years)
- Slide Number 9
- Smoking Important but does not explain fluctuations
- Trends of adult smoking rates in Russia 1992ndash2009
- Paradoxical lipid profile relative to other countries
- Hypertension
- Slide Number 14
- Alcohol A key driver of fluctuations
- Slide Number 16
- Slide Number 17
- Individual-level evidence on alcohol
- Hazardous drinking and mortality from varioustypes of circulatory diseaseMen aged 25-54 years Izhevsk 2003 - 5
- Doubts about the diagnosis
- A new international project2014-19
- Cardiovascular disease in Russia strengthening evidence about causes mechanisms prevention and treatment
- Slide Number 23
- Four themes
- Theme B Cross-sectional studies
- Slide Number 26
- Cutting edge scientific approaches
- Serum NMR metabolomics
- The microbiome
- Slide Number 30
- Thank you
- Alcohol control policy developments since 2005
- Tobacco control policy developments since 2005
- Slide Number 34
- Index of CVD risk - 1Ratio of apolipoprotein B to apolipoprotein A1
- Index of CVD risk - 2 B-type natriuretic peptide
- Association of pattern of drinking with cardiovascular risk factorsOR (95 CI)
-
Individual-level evidence on alcohol
18
Izhevsk Family Study (men aged 25-59 years)
2003-5 and 2008-10
Hazardous drinking and mortality from various types of circulatory disease
Men aged 25-54 years Izhevsk 2003 - 5
Underlying cause of death
Number of deaths
Hazardous drinking (proxy report)
OR (95 CI)
Alcoholic cardiomyopathy 98 1570 (952594)
Other cardiomyopathy 51 384 (205718)
Cerebrovascular disease 90 205 (124340)
Other circulatory disease 28 343 (151781)
Ischaemic heart disease 219 304 (217424)
19 OR adjusted for age smoking and education Source Leon Shkolnikov McKee Kiryanov Andreev IJE 2010
Doubts about the diagnosis
20
A new international project 2014-19
21
University of Tromsoslash Norway
Ministry of Health and Care Services Norway
Cardiovascular disease in Russia strengthening evidence about
causes mechanisms prevention and treatment
Institute of Internal Medicine SBRAMS Novosibirsk Russia
Max Planck Institute for Demographic
Research
Finland
22
Novosibirsk
Arkhangelsk
Moscow Rostock London
Oulu
Tromso
23
Location of study sites and collaborators
Kazan
Four themes
Theme A Levels and trends in cardiovascular disease and associated risk factors
Theme B Understanding the nature and causes of cardiovascular disease in Russia (including cause of death study)
Theme C Barriers opportunities and capacity for improved prevention and treatment (role of health service)
Theme D Capacity development and training
24
Theme B Cross-sectional studies
bull Two locations ndash Arkhangelsk and Novosibirsk bull Population-based random sample
ndash men and women aged 35-69 years ndash attention given to reducing selection bias ndash N=2750 in each city
bull Additional sample heavy alcohol drinkers from medical facility (N=250 in each city)
bull Main field work starts 2015
25
26
Cardiovascular phenotypes Type Source Biomarkerproxy measure
Atherosclerosis
Questionnaire Previous MI
ECG Evidence previous MI
Carotid ultrasound Carotid IMT plaque
Cardiac remodelling
Blood NT-pro BNP HsTnI hsTnT
Echocardiography Myocardial function and size
Arrhythmia ECG Actiwave Cardio
Baseline rhythm heart rate variability
Vascular dysfunction Vicorder Pulse-wave velocity
Cutting edge scientific approaches
27
Serum NMR metabolomics
bull Highly standardised and reproducible platform for 117 primary and 99 derived measures of specific molecular entities (now gt100000 individuals assayed)
Nature Genetics 44 269 2012
28
bull How are alcohol and CVD phenotypes related to 14
lipoprotein subclasses bull Identifying markers of intermediate metabolism associated
with CVD phenotypes
The microbiome
29 Key expertise Vadim Govorun Moscow
Studies in other countries eg Tromsoslash 7
Endogenous exposures a priori CVD risk biomarkers
(including lipoprotein NMR profile)
Socio-demographic + exogenous exposures
CVD phenotypes
Metabolic profile Microbiome
Associations Analytic framework
Thank you
31
Alcohol control policy developments since 2005
bull 2005 Federal law No171 on production and sale of alcohol
bull 2009 Elaboration of the Russian anti-alcohol policy framework (the Conceptual Framework on anti-alcohol policy implementation)
bull 2009 Strengthening of institutional policy control (Establishment of the Federal Alcohol Service)
bull 2011 Introduction of greater controls and restrictions on production and sale of alcohol (Federal law No218)
Tobacco control policy developments since 2005
bull 2005 the Federal law No87 of 2001 ldquoOn limitations of smoking tobaccordquo is in effect
bull 2008 Ratification of the WHO Framework Convention on Tobacco Control by the Russian Federation
bull 2009 Defining the magnitude of the problem 40 smoking prevalence (GATS report on Russia)
bull 2010 Development of the anti-tobacco policy (the Conceptual framework on anti-tobacco policy for 2010-2015
bull 2013 Introduction of restrictions on tobacco sale and smoking in public (Federal law No 15 on ldquoHealth protection of citizens from exposure to tobacco smoke and consequences from tobacco consumptionrdquo)
34
0
20
40
60
80
100
120
140
160
180
Cancer oesophagus
Cancer stomach
Cancer breast
Ischaemic heartdiseaseInjuries poisoningviolence
Mortality from selected causes Women aged 45-59 Russia 1980 - 2009
Age-
stan
dard
ised
mor
talit
y ra
te p
er 1
000
00
Source WHO HFA database
Index of CVD risk - 1 Ratio of apolipoprotein B
to apolipoprotein A1
ldquoAtherogenicrdquo index
Index of CVD risk - 2 B-type natriuretic peptide
Index of stress on ventricles of heart Marker of non-atherosclerotic cardiac damage
Association of pattern of drinking with cardiovascular risk factors
OR (95 CI)
Pattern of drinking
OR top 20 ApoBA1 ratio
OR top 20 B-type natriuretic
peptide (BNP)
Abstains 100 [ref] 100 [ref]
Non-hazardous 034 (021 054) 235 (120 458)
Hazardous 031 (016 059) 431 (214 952)
P-value trend lt0001 lt0001
Adjusted for age BMI and waist-hip ratio
Source Leon DA et al EurJ Epidemiol 28 (5)393-404 2013
- The challenge of cardiovascular disease in Russia
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Russia has the highest cardiovascular mortality rate in the world
- Slide Number 6
- Cardiovascular disease mortality in Russia is atypical
- Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010 (age lt65 years)
- Slide Number 9
- Smoking Important but does not explain fluctuations
- Trends of adult smoking rates in Russia 1992ndash2009
- Paradoxical lipid profile relative to other countries
- Hypertension
- Slide Number 14
- Alcohol A key driver of fluctuations
- Slide Number 16
- Slide Number 17
- Individual-level evidence on alcohol
- Hazardous drinking and mortality from varioustypes of circulatory diseaseMen aged 25-54 years Izhevsk 2003 - 5
- Doubts about the diagnosis
- A new international project2014-19
- Cardiovascular disease in Russia strengthening evidence about causes mechanisms prevention and treatment
- Slide Number 23
- Four themes
- Theme B Cross-sectional studies
- Slide Number 26
- Cutting edge scientific approaches
- Serum NMR metabolomics
- The microbiome
- Slide Number 30
- Thank you
- Alcohol control policy developments since 2005
- Tobacco control policy developments since 2005
- Slide Number 34
- Index of CVD risk - 1Ratio of apolipoprotein B to apolipoprotein A1
- Index of CVD risk - 2 B-type natriuretic peptide
- Association of pattern of drinking with cardiovascular risk factorsOR (95 CI)
-
Hazardous drinking and mortality from various types of circulatory disease
Men aged 25-54 years Izhevsk 2003 - 5
Underlying cause of death
Number of deaths
Hazardous drinking (proxy report)
OR (95 CI)
Alcoholic cardiomyopathy 98 1570 (952594)
Other cardiomyopathy 51 384 (205718)
Cerebrovascular disease 90 205 (124340)
Other circulatory disease 28 343 (151781)
Ischaemic heart disease 219 304 (217424)
19 OR adjusted for age smoking and education Source Leon Shkolnikov McKee Kiryanov Andreev IJE 2010
Doubts about the diagnosis
20
A new international project 2014-19
21
University of Tromsoslash Norway
Ministry of Health and Care Services Norway
Cardiovascular disease in Russia strengthening evidence about
causes mechanisms prevention and treatment
Institute of Internal Medicine SBRAMS Novosibirsk Russia
Max Planck Institute for Demographic
Research
Finland
22
Novosibirsk
Arkhangelsk
Moscow Rostock London
Oulu
Tromso
23
Location of study sites and collaborators
Kazan
Four themes
Theme A Levels and trends in cardiovascular disease and associated risk factors
Theme B Understanding the nature and causes of cardiovascular disease in Russia (including cause of death study)
Theme C Barriers opportunities and capacity for improved prevention and treatment (role of health service)
Theme D Capacity development and training
24
Theme B Cross-sectional studies
bull Two locations ndash Arkhangelsk and Novosibirsk bull Population-based random sample
ndash men and women aged 35-69 years ndash attention given to reducing selection bias ndash N=2750 in each city
bull Additional sample heavy alcohol drinkers from medical facility (N=250 in each city)
bull Main field work starts 2015
25
26
Cardiovascular phenotypes Type Source Biomarkerproxy measure
Atherosclerosis
Questionnaire Previous MI
ECG Evidence previous MI
Carotid ultrasound Carotid IMT plaque
Cardiac remodelling
Blood NT-pro BNP HsTnI hsTnT
Echocardiography Myocardial function and size
Arrhythmia ECG Actiwave Cardio
Baseline rhythm heart rate variability
Vascular dysfunction Vicorder Pulse-wave velocity
Cutting edge scientific approaches
27
Serum NMR metabolomics
bull Highly standardised and reproducible platform for 117 primary and 99 derived measures of specific molecular entities (now gt100000 individuals assayed)
Nature Genetics 44 269 2012
28
bull How are alcohol and CVD phenotypes related to 14
lipoprotein subclasses bull Identifying markers of intermediate metabolism associated
with CVD phenotypes
The microbiome
29 Key expertise Vadim Govorun Moscow
Studies in other countries eg Tromsoslash 7
Endogenous exposures a priori CVD risk biomarkers
(including lipoprotein NMR profile)
Socio-demographic + exogenous exposures
CVD phenotypes
Metabolic profile Microbiome
Associations Analytic framework
Thank you
31
Alcohol control policy developments since 2005
bull 2005 Federal law No171 on production and sale of alcohol
bull 2009 Elaboration of the Russian anti-alcohol policy framework (the Conceptual Framework on anti-alcohol policy implementation)
bull 2009 Strengthening of institutional policy control (Establishment of the Federal Alcohol Service)
bull 2011 Introduction of greater controls and restrictions on production and sale of alcohol (Federal law No218)
Tobacco control policy developments since 2005
bull 2005 the Federal law No87 of 2001 ldquoOn limitations of smoking tobaccordquo is in effect
bull 2008 Ratification of the WHO Framework Convention on Tobacco Control by the Russian Federation
bull 2009 Defining the magnitude of the problem 40 smoking prevalence (GATS report on Russia)
bull 2010 Development of the anti-tobacco policy (the Conceptual framework on anti-tobacco policy for 2010-2015
bull 2013 Introduction of restrictions on tobacco sale and smoking in public (Federal law No 15 on ldquoHealth protection of citizens from exposure to tobacco smoke and consequences from tobacco consumptionrdquo)
34
0
20
40
60
80
100
120
140
160
180
Cancer oesophagus
Cancer stomach
Cancer breast
Ischaemic heartdiseaseInjuries poisoningviolence
Mortality from selected causes Women aged 45-59 Russia 1980 - 2009
Age-
stan
dard
ised
mor
talit
y ra
te p
er 1
000
00
Source WHO HFA database
Index of CVD risk - 1 Ratio of apolipoprotein B
to apolipoprotein A1
ldquoAtherogenicrdquo index
Index of CVD risk - 2 B-type natriuretic peptide
Index of stress on ventricles of heart Marker of non-atherosclerotic cardiac damage
Association of pattern of drinking with cardiovascular risk factors
OR (95 CI)
Pattern of drinking
OR top 20 ApoBA1 ratio
OR top 20 B-type natriuretic
peptide (BNP)
Abstains 100 [ref] 100 [ref]
Non-hazardous 034 (021 054) 235 (120 458)
Hazardous 031 (016 059) 431 (214 952)
P-value trend lt0001 lt0001
Adjusted for age BMI and waist-hip ratio
Source Leon DA et al EurJ Epidemiol 28 (5)393-404 2013
- The challenge of cardiovascular disease in Russia
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Russia has the highest cardiovascular mortality rate in the world
- Slide Number 6
- Cardiovascular disease mortality in Russia is atypical
- Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010 (age lt65 years)
- Slide Number 9
- Smoking Important but does not explain fluctuations
- Trends of adult smoking rates in Russia 1992ndash2009
- Paradoxical lipid profile relative to other countries
- Hypertension
- Slide Number 14
- Alcohol A key driver of fluctuations
- Slide Number 16
- Slide Number 17
- Individual-level evidence on alcohol
- Hazardous drinking and mortality from varioustypes of circulatory diseaseMen aged 25-54 years Izhevsk 2003 - 5
- Doubts about the diagnosis
- A new international project2014-19
- Cardiovascular disease in Russia strengthening evidence about causes mechanisms prevention and treatment
- Slide Number 23
- Four themes
- Theme B Cross-sectional studies
- Slide Number 26
- Cutting edge scientific approaches
- Serum NMR metabolomics
- The microbiome
- Slide Number 30
- Thank you
- Alcohol control policy developments since 2005
- Tobacco control policy developments since 2005
- Slide Number 34
- Index of CVD risk - 1Ratio of apolipoprotein B to apolipoprotein A1
- Index of CVD risk - 2 B-type natriuretic peptide
- Association of pattern of drinking with cardiovascular risk factorsOR (95 CI)
-
Doubts about the diagnosis
20
A new international project 2014-19
21
University of Tromsoslash Norway
Ministry of Health and Care Services Norway
Cardiovascular disease in Russia strengthening evidence about
causes mechanisms prevention and treatment
Institute of Internal Medicine SBRAMS Novosibirsk Russia
Max Planck Institute for Demographic
Research
Finland
22
Novosibirsk
Arkhangelsk
Moscow Rostock London
Oulu
Tromso
23
Location of study sites and collaborators
Kazan
Four themes
Theme A Levels and trends in cardiovascular disease and associated risk factors
Theme B Understanding the nature and causes of cardiovascular disease in Russia (including cause of death study)
Theme C Barriers opportunities and capacity for improved prevention and treatment (role of health service)
Theme D Capacity development and training
24
Theme B Cross-sectional studies
bull Two locations ndash Arkhangelsk and Novosibirsk bull Population-based random sample
ndash men and women aged 35-69 years ndash attention given to reducing selection bias ndash N=2750 in each city
bull Additional sample heavy alcohol drinkers from medical facility (N=250 in each city)
bull Main field work starts 2015
25
26
Cardiovascular phenotypes Type Source Biomarkerproxy measure
Atherosclerosis
Questionnaire Previous MI
ECG Evidence previous MI
Carotid ultrasound Carotid IMT plaque
Cardiac remodelling
Blood NT-pro BNP HsTnI hsTnT
Echocardiography Myocardial function and size
Arrhythmia ECG Actiwave Cardio
Baseline rhythm heart rate variability
Vascular dysfunction Vicorder Pulse-wave velocity
Cutting edge scientific approaches
27
Serum NMR metabolomics
bull Highly standardised and reproducible platform for 117 primary and 99 derived measures of specific molecular entities (now gt100000 individuals assayed)
Nature Genetics 44 269 2012
28
bull How are alcohol and CVD phenotypes related to 14
lipoprotein subclasses bull Identifying markers of intermediate metabolism associated
with CVD phenotypes
The microbiome
29 Key expertise Vadim Govorun Moscow
Studies in other countries eg Tromsoslash 7
Endogenous exposures a priori CVD risk biomarkers
(including lipoprotein NMR profile)
Socio-demographic + exogenous exposures
CVD phenotypes
Metabolic profile Microbiome
Associations Analytic framework
Thank you
31
Alcohol control policy developments since 2005
bull 2005 Federal law No171 on production and sale of alcohol
bull 2009 Elaboration of the Russian anti-alcohol policy framework (the Conceptual Framework on anti-alcohol policy implementation)
bull 2009 Strengthening of institutional policy control (Establishment of the Federal Alcohol Service)
bull 2011 Introduction of greater controls and restrictions on production and sale of alcohol (Federal law No218)
Tobacco control policy developments since 2005
bull 2005 the Federal law No87 of 2001 ldquoOn limitations of smoking tobaccordquo is in effect
bull 2008 Ratification of the WHO Framework Convention on Tobacco Control by the Russian Federation
bull 2009 Defining the magnitude of the problem 40 smoking prevalence (GATS report on Russia)
bull 2010 Development of the anti-tobacco policy (the Conceptual framework on anti-tobacco policy for 2010-2015
bull 2013 Introduction of restrictions on tobacco sale and smoking in public (Federal law No 15 on ldquoHealth protection of citizens from exposure to tobacco smoke and consequences from tobacco consumptionrdquo)
34
0
20
40
60
80
100
120
140
160
180
Cancer oesophagus
Cancer stomach
Cancer breast
Ischaemic heartdiseaseInjuries poisoningviolence
Mortality from selected causes Women aged 45-59 Russia 1980 - 2009
Age-
stan
dard
ised
mor
talit
y ra
te p
er 1
000
00
Source WHO HFA database
Index of CVD risk - 1 Ratio of apolipoprotein B
to apolipoprotein A1
ldquoAtherogenicrdquo index
Index of CVD risk - 2 B-type natriuretic peptide
Index of stress on ventricles of heart Marker of non-atherosclerotic cardiac damage
Association of pattern of drinking with cardiovascular risk factors
OR (95 CI)
Pattern of drinking
OR top 20 ApoBA1 ratio
OR top 20 B-type natriuretic
peptide (BNP)
Abstains 100 [ref] 100 [ref]
Non-hazardous 034 (021 054) 235 (120 458)
Hazardous 031 (016 059) 431 (214 952)
P-value trend lt0001 lt0001
Adjusted for age BMI and waist-hip ratio
Source Leon DA et al EurJ Epidemiol 28 (5)393-404 2013
- The challenge of cardiovascular disease in Russia
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Russia has the highest cardiovascular mortality rate in the world
- Slide Number 6
- Cardiovascular disease mortality in Russia is atypical
- Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010 (age lt65 years)
- Slide Number 9
- Smoking Important but does not explain fluctuations
- Trends of adult smoking rates in Russia 1992ndash2009
- Paradoxical lipid profile relative to other countries
- Hypertension
- Slide Number 14
- Alcohol A key driver of fluctuations
- Slide Number 16
- Slide Number 17
- Individual-level evidence on alcohol
- Hazardous drinking and mortality from varioustypes of circulatory diseaseMen aged 25-54 years Izhevsk 2003 - 5
- Doubts about the diagnosis
- A new international project2014-19
- Cardiovascular disease in Russia strengthening evidence about causes mechanisms prevention and treatment
- Slide Number 23
- Four themes
- Theme B Cross-sectional studies
- Slide Number 26
- Cutting edge scientific approaches
- Serum NMR metabolomics
- The microbiome
- Slide Number 30
- Thank you
- Alcohol control policy developments since 2005
- Tobacco control policy developments since 2005
- Slide Number 34
- Index of CVD risk - 1Ratio of apolipoprotein B to apolipoprotein A1
- Index of CVD risk - 2 B-type natriuretic peptide
- Association of pattern of drinking with cardiovascular risk factorsOR (95 CI)
-
A new international project 2014-19
21
University of Tromsoslash Norway
Ministry of Health and Care Services Norway
Cardiovascular disease in Russia strengthening evidence about
causes mechanisms prevention and treatment
Institute of Internal Medicine SBRAMS Novosibirsk Russia
Max Planck Institute for Demographic
Research
Finland
22
Novosibirsk
Arkhangelsk
Moscow Rostock London
Oulu
Tromso
23
Location of study sites and collaborators
Kazan
Four themes
Theme A Levels and trends in cardiovascular disease and associated risk factors
Theme B Understanding the nature and causes of cardiovascular disease in Russia (including cause of death study)
Theme C Barriers opportunities and capacity for improved prevention and treatment (role of health service)
Theme D Capacity development and training
24
Theme B Cross-sectional studies
bull Two locations ndash Arkhangelsk and Novosibirsk bull Population-based random sample
ndash men and women aged 35-69 years ndash attention given to reducing selection bias ndash N=2750 in each city
bull Additional sample heavy alcohol drinkers from medical facility (N=250 in each city)
bull Main field work starts 2015
25
26
Cardiovascular phenotypes Type Source Biomarkerproxy measure
Atherosclerosis
Questionnaire Previous MI
ECG Evidence previous MI
Carotid ultrasound Carotid IMT plaque
Cardiac remodelling
Blood NT-pro BNP HsTnI hsTnT
Echocardiography Myocardial function and size
Arrhythmia ECG Actiwave Cardio
Baseline rhythm heart rate variability
Vascular dysfunction Vicorder Pulse-wave velocity
Cutting edge scientific approaches
27
Serum NMR metabolomics
bull Highly standardised and reproducible platform for 117 primary and 99 derived measures of specific molecular entities (now gt100000 individuals assayed)
Nature Genetics 44 269 2012
28
bull How are alcohol and CVD phenotypes related to 14
lipoprotein subclasses bull Identifying markers of intermediate metabolism associated
with CVD phenotypes
The microbiome
29 Key expertise Vadim Govorun Moscow
Studies in other countries eg Tromsoslash 7
Endogenous exposures a priori CVD risk biomarkers
(including lipoprotein NMR profile)
Socio-demographic + exogenous exposures
CVD phenotypes
Metabolic profile Microbiome
Associations Analytic framework
Thank you
31
Alcohol control policy developments since 2005
bull 2005 Federal law No171 on production and sale of alcohol
bull 2009 Elaboration of the Russian anti-alcohol policy framework (the Conceptual Framework on anti-alcohol policy implementation)
bull 2009 Strengthening of institutional policy control (Establishment of the Federal Alcohol Service)
bull 2011 Introduction of greater controls and restrictions on production and sale of alcohol (Federal law No218)
Tobacco control policy developments since 2005
bull 2005 the Federal law No87 of 2001 ldquoOn limitations of smoking tobaccordquo is in effect
bull 2008 Ratification of the WHO Framework Convention on Tobacco Control by the Russian Federation
bull 2009 Defining the magnitude of the problem 40 smoking prevalence (GATS report on Russia)
bull 2010 Development of the anti-tobacco policy (the Conceptual framework on anti-tobacco policy for 2010-2015
bull 2013 Introduction of restrictions on tobacco sale and smoking in public (Federal law No 15 on ldquoHealth protection of citizens from exposure to tobacco smoke and consequences from tobacco consumptionrdquo)
34
0
20
40
60
80
100
120
140
160
180
Cancer oesophagus
Cancer stomach
Cancer breast
Ischaemic heartdiseaseInjuries poisoningviolence
Mortality from selected causes Women aged 45-59 Russia 1980 - 2009
Age-
stan
dard
ised
mor
talit
y ra
te p
er 1
000
00
Source WHO HFA database
Index of CVD risk - 1 Ratio of apolipoprotein B
to apolipoprotein A1
ldquoAtherogenicrdquo index
Index of CVD risk - 2 B-type natriuretic peptide
Index of stress on ventricles of heart Marker of non-atherosclerotic cardiac damage
Association of pattern of drinking with cardiovascular risk factors
OR (95 CI)
Pattern of drinking
OR top 20 ApoBA1 ratio
OR top 20 B-type natriuretic
peptide (BNP)
Abstains 100 [ref] 100 [ref]
Non-hazardous 034 (021 054) 235 (120 458)
Hazardous 031 (016 059) 431 (214 952)
P-value trend lt0001 lt0001
Adjusted for age BMI and waist-hip ratio
Source Leon DA et al EurJ Epidemiol 28 (5)393-404 2013
- The challenge of cardiovascular disease in Russia
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Russia has the highest cardiovascular mortality rate in the world
- Slide Number 6
- Cardiovascular disease mortality in Russia is atypical
- Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010 (age lt65 years)
- Slide Number 9
- Smoking Important but does not explain fluctuations
- Trends of adult smoking rates in Russia 1992ndash2009
- Paradoxical lipid profile relative to other countries
- Hypertension
- Slide Number 14
- Alcohol A key driver of fluctuations
- Slide Number 16
- Slide Number 17
- Individual-level evidence on alcohol
- Hazardous drinking and mortality from varioustypes of circulatory diseaseMen aged 25-54 years Izhevsk 2003 - 5
- Doubts about the diagnosis
- A new international project2014-19
- Cardiovascular disease in Russia strengthening evidence about causes mechanisms prevention and treatment
- Slide Number 23
- Four themes
- Theme B Cross-sectional studies
- Slide Number 26
- Cutting edge scientific approaches
- Serum NMR metabolomics
- The microbiome
- Slide Number 30
- Thank you
- Alcohol control policy developments since 2005
- Tobacco control policy developments since 2005
- Slide Number 34
- Index of CVD risk - 1Ratio of apolipoprotein B to apolipoprotein A1
- Index of CVD risk - 2 B-type natriuretic peptide
- Association of pattern of drinking with cardiovascular risk factorsOR (95 CI)
-
Cardiovascular disease in Russia strengthening evidence about
causes mechanisms prevention and treatment
Institute of Internal Medicine SBRAMS Novosibirsk Russia
Max Planck Institute for Demographic
Research
Finland
22
Novosibirsk
Arkhangelsk
Moscow Rostock London
Oulu
Tromso
23
Location of study sites and collaborators
Kazan
Four themes
Theme A Levels and trends in cardiovascular disease and associated risk factors
Theme B Understanding the nature and causes of cardiovascular disease in Russia (including cause of death study)
Theme C Barriers opportunities and capacity for improved prevention and treatment (role of health service)
Theme D Capacity development and training
24
Theme B Cross-sectional studies
bull Two locations ndash Arkhangelsk and Novosibirsk bull Population-based random sample
ndash men and women aged 35-69 years ndash attention given to reducing selection bias ndash N=2750 in each city
bull Additional sample heavy alcohol drinkers from medical facility (N=250 in each city)
bull Main field work starts 2015
25
26
Cardiovascular phenotypes Type Source Biomarkerproxy measure
Atherosclerosis
Questionnaire Previous MI
ECG Evidence previous MI
Carotid ultrasound Carotid IMT plaque
Cardiac remodelling
Blood NT-pro BNP HsTnI hsTnT
Echocardiography Myocardial function and size
Arrhythmia ECG Actiwave Cardio
Baseline rhythm heart rate variability
Vascular dysfunction Vicorder Pulse-wave velocity
Cutting edge scientific approaches
27
Serum NMR metabolomics
bull Highly standardised and reproducible platform for 117 primary and 99 derived measures of specific molecular entities (now gt100000 individuals assayed)
Nature Genetics 44 269 2012
28
bull How are alcohol and CVD phenotypes related to 14
lipoprotein subclasses bull Identifying markers of intermediate metabolism associated
with CVD phenotypes
The microbiome
29 Key expertise Vadim Govorun Moscow
Studies in other countries eg Tromsoslash 7
Endogenous exposures a priori CVD risk biomarkers
(including lipoprotein NMR profile)
Socio-demographic + exogenous exposures
CVD phenotypes
Metabolic profile Microbiome
Associations Analytic framework
Thank you
31
Alcohol control policy developments since 2005
bull 2005 Federal law No171 on production and sale of alcohol
bull 2009 Elaboration of the Russian anti-alcohol policy framework (the Conceptual Framework on anti-alcohol policy implementation)
bull 2009 Strengthening of institutional policy control (Establishment of the Federal Alcohol Service)
bull 2011 Introduction of greater controls and restrictions on production and sale of alcohol (Federal law No218)
Tobacco control policy developments since 2005
bull 2005 the Federal law No87 of 2001 ldquoOn limitations of smoking tobaccordquo is in effect
bull 2008 Ratification of the WHO Framework Convention on Tobacco Control by the Russian Federation
bull 2009 Defining the magnitude of the problem 40 smoking prevalence (GATS report on Russia)
bull 2010 Development of the anti-tobacco policy (the Conceptual framework on anti-tobacco policy for 2010-2015
bull 2013 Introduction of restrictions on tobacco sale and smoking in public (Federal law No 15 on ldquoHealth protection of citizens from exposure to tobacco smoke and consequences from tobacco consumptionrdquo)
34
0
20
40
60
80
100
120
140
160
180
Cancer oesophagus
Cancer stomach
Cancer breast
Ischaemic heartdiseaseInjuries poisoningviolence
Mortality from selected causes Women aged 45-59 Russia 1980 - 2009
Age-
stan
dard
ised
mor
talit
y ra
te p
er 1
000
00
Source WHO HFA database
Index of CVD risk - 1 Ratio of apolipoprotein B
to apolipoprotein A1
ldquoAtherogenicrdquo index
Index of CVD risk - 2 B-type natriuretic peptide
Index of stress on ventricles of heart Marker of non-atherosclerotic cardiac damage
Association of pattern of drinking with cardiovascular risk factors
OR (95 CI)
Pattern of drinking
OR top 20 ApoBA1 ratio
OR top 20 B-type natriuretic
peptide (BNP)
Abstains 100 [ref] 100 [ref]
Non-hazardous 034 (021 054) 235 (120 458)
Hazardous 031 (016 059) 431 (214 952)
P-value trend lt0001 lt0001
Adjusted for age BMI and waist-hip ratio
Source Leon DA et al EurJ Epidemiol 28 (5)393-404 2013
- The challenge of cardiovascular disease in Russia
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Russia has the highest cardiovascular mortality rate in the world
- Slide Number 6
- Cardiovascular disease mortality in Russia is atypical
- Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010 (age lt65 years)
- Slide Number 9
- Smoking Important but does not explain fluctuations
- Trends of adult smoking rates in Russia 1992ndash2009
- Paradoxical lipid profile relative to other countries
- Hypertension
- Slide Number 14
- Alcohol A key driver of fluctuations
- Slide Number 16
- Slide Number 17
- Individual-level evidence on alcohol
- Hazardous drinking and mortality from varioustypes of circulatory diseaseMen aged 25-54 years Izhevsk 2003 - 5
- Doubts about the diagnosis
- A new international project2014-19
- Cardiovascular disease in Russia strengthening evidence about causes mechanisms prevention and treatment
- Slide Number 23
- Four themes
- Theme B Cross-sectional studies
- Slide Number 26
- Cutting edge scientific approaches
- Serum NMR metabolomics
- The microbiome
- Slide Number 30
- Thank you
- Alcohol control policy developments since 2005
- Tobacco control policy developments since 2005
- Slide Number 34
- Index of CVD risk - 1Ratio of apolipoprotein B to apolipoprotein A1
- Index of CVD risk - 2 B-type natriuretic peptide
- Association of pattern of drinking with cardiovascular risk factorsOR (95 CI)
-
Novosibirsk
Arkhangelsk
Moscow Rostock London
Oulu
Tromso
23
Location of study sites and collaborators
Kazan
Four themes
Theme A Levels and trends in cardiovascular disease and associated risk factors
Theme B Understanding the nature and causes of cardiovascular disease in Russia (including cause of death study)
Theme C Barriers opportunities and capacity for improved prevention and treatment (role of health service)
Theme D Capacity development and training
24
Theme B Cross-sectional studies
bull Two locations ndash Arkhangelsk and Novosibirsk bull Population-based random sample
ndash men and women aged 35-69 years ndash attention given to reducing selection bias ndash N=2750 in each city
bull Additional sample heavy alcohol drinkers from medical facility (N=250 in each city)
bull Main field work starts 2015
25
26
Cardiovascular phenotypes Type Source Biomarkerproxy measure
Atherosclerosis
Questionnaire Previous MI
ECG Evidence previous MI
Carotid ultrasound Carotid IMT plaque
Cardiac remodelling
Blood NT-pro BNP HsTnI hsTnT
Echocardiography Myocardial function and size
Arrhythmia ECG Actiwave Cardio
Baseline rhythm heart rate variability
Vascular dysfunction Vicorder Pulse-wave velocity
Cutting edge scientific approaches
27
Serum NMR metabolomics
bull Highly standardised and reproducible platform for 117 primary and 99 derived measures of specific molecular entities (now gt100000 individuals assayed)
Nature Genetics 44 269 2012
28
bull How are alcohol and CVD phenotypes related to 14
lipoprotein subclasses bull Identifying markers of intermediate metabolism associated
with CVD phenotypes
The microbiome
29 Key expertise Vadim Govorun Moscow
Studies in other countries eg Tromsoslash 7
Endogenous exposures a priori CVD risk biomarkers
(including lipoprotein NMR profile)
Socio-demographic + exogenous exposures
CVD phenotypes
Metabolic profile Microbiome
Associations Analytic framework
Thank you
31
Alcohol control policy developments since 2005
bull 2005 Federal law No171 on production and sale of alcohol
bull 2009 Elaboration of the Russian anti-alcohol policy framework (the Conceptual Framework on anti-alcohol policy implementation)
bull 2009 Strengthening of institutional policy control (Establishment of the Federal Alcohol Service)
bull 2011 Introduction of greater controls and restrictions on production and sale of alcohol (Federal law No218)
Tobacco control policy developments since 2005
bull 2005 the Federal law No87 of 2001 ldquoOn limitations of smoking tobaccordquo is in effect
bull 2008 Ratification of the WHO Framework Convention on Tobacco Control by the Russian Federation
bull 2009 Defining the magnitude of the problem 40 smoking prevalence (GATS report on Russia)
bull 2010 Development of the anti-tobacco policy (the Conceptual framework on anti-tobacco policy for 2010-2015
bull 2013 Introduction of restrictions on tobacco sale and smoking in public (Federal law No 15 on ldquoHealth protection of citizens from exposure to tobacco smoke and consequences from tobacco consumptionrdquo)
34
0
20
40
60
80
100
120
140
160
180
Cancer oesophagus
Cancer stomach
Cancer breast
Ischaemic heartdiseaseInjuries poisoningviolence
Mortality from selected causes Women aged 45-59 Russia 1980 - 2009
Age-
stan
dard
ised
mor
talit
y ra
te p
er 1
000
00
Source WHO HFA database
Index of CVD risk - 1 Ratio of apolipoprotein B
to apolipoprotein A1
ldquoAtherogenicrdquo index
Index of CVD risk - 2 B-type natriuretic peptide
Index of stress on ventricles of heart Marker of non-atherosclerotic cardiac damage
Association of pattern of drinking with cardiovascular risk factors
OR (95 CI)
Pattern of drinking
OR top 20 ApoBA1 ratio
OR top 20 B-type natriuretic
peptide (BNP)
Abstains 100 [ref] 100 [ref]
Non-hazardous 034 (021 054) 235 (120 458)
Hazardous 031 (016 059) 431 (214 952)
P-value trend lt0001 lt0001
Adjusted for age BMI and waist-hip ratio
Source Leon DA et al EurJ Epidemiol 28 (5)393-404 2013
- The challenge of cardiovascular disease in Russia
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Russia has the highest cardiovascular mortality rate in the world
- Slide Number 6
- Cardiovascular disease mortality in Russia is atypical
- Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010 (age lt65 years)
- Slide Number 9
- Smoking Important but does not explain fluctuations
- Trends of adult smoking rates in Russia 1992ndash2009
- Paradoxical lipid profile relative to other countries
- Hypertension
- Slide Number 14
- Alcohol A key driver of fluctuations
- Slide Number 16
- Slide Number 17
- Individual-level evidence on alcohol
- Hazardous drinking and mortality from varioustypes of circulatory diseaseMen aged 25-54 years Izhevsk 2003 - 5
- Doubts about the diagnosis
- A new international project2014-19
- Cardiovascular disease in Russia strengthening evidence about causes mechanisms prevention and treatment
- Slide Number 23
- Four themes
- Theme B Cross-sectional studies
- Slide Number 26
- Cutting edge scientific approaches
- Serum NMR metabolomics
- The microbiome
- Slide Number 30
- Thank you
- Alcohol control policy developments since 2005
- Tobacco control policy developments since 2005
- Slide Number 34
- Index of CVD risk - 1Ratio of apolipoprotein B to apolipoprotein A1
- Index of CVD risk - 2 B-type natriuretic peptide
- Association of pattern of drinking with cardiovascular risk factorsOR (95 CI)
-
Four themes
Theme A Levels and trends in cardiovascular disease and associated risk factors
Theme B Understanding the nature and causes of cardiovascular disease in Russia (including cause of death study)
Theme C Barriers opportunities and capacity for improved prevention and treatment (role of health service)
Theme D Capacity development and training
24
Theme B Cross-sectional studies
bull Two locations ndash Arkhangelsk and Novosibirsk bull Population-based random sample
ndash men and women aged 35-69 years ndash attention given to reducing selection bias ndash N=2750 in each city
bull Additional sample heavy alcohol drinkers from medical facility (N=250 in each city)
bull Main field work starts 2015
25
26
Cardiovascular phenotypes Type Source Biomarkerproxy measure
Atherosclerosis
Questionnaire Previous MI
ECG Evidence previous MI
Carotid ultrasound Carotid IMT plaque
Cardiac remodelling
Blood NT-pro BNP HsTnI hsTnT
Echocardiography Myocardial function and size
Arrhythmia ECG Actiwave Cardio
Baseline rhythm heart rate variability
Vascular dysfunction Vicorder Pulse-wave velocity
Cutting edge scientific approaches
27
Serum NMR metabolomics
bull Highly standardised and reproducible platform for 117 primary and 99 derived measures of specific molecular entities (now gt100000 individuals assayed)
Nature Genetics 44 269 2012
28
bull How are alcohol and CVD phenotypes related to 14
lipoprotein subclasses bull Identifying markers of intermediate metabolism associated
with CVD phenotypes
The microbiome
29 Key expertise Vadim Govorun Moscow
Studies in other countries eg Tromsoslash 7
Endogenous exposures a priori CVD risk biomarkers
(including lipoprotein NMR profile)
Socio-demographic + exogenous exposures
CVD phenotypes
Metabolic profile Microbiome
Associations Analytic framework
Thank you
31
Alcohol control policy developments since 2005
bull 2005 Federal law No171 on production and sale of alcohol
bull 2009 Elaboration of the Russian anti-alcohol policy framework (the Conceptual Framework on anti-alcohol policy implementation)
bull 2009 Strengthening of institutional policy control (Establishment of the Federal Alcohol Service)
bull 2011 Introduction of greater controls and restrictions on production and sale of alcohol (Federal law No218)
Tobacco control policy developments since 2005
bull 2005 the Federal law No87 of 2001 ldquoOn limitations of smoking tobaccordquo is in effect
bull 2008 Ratification of the WHO Framework Convention on Tobacco Control by the Russian Federation
bull 2009 Defining the magnitude of the problem 40 smoking prevalence (GATS report on Russia)
bull 2010 Development of the anti-tobacco policy (the Conceptual framework on anti-tobacco policy for 2010-2015
bull 2013 Introduction of restrictions on tobacco sale and smoking in public (Federal law No 15 on ldquoHealth protection of citizens from exposure to tobacco smoke and consequences from tobacco consumptionrdquo)
34
0
20
40
60
80
100
120
140
160
180
Cancer oesophagus
Cancer stomach
Cancer breast
Ischaemic heartdiseaseInjuries poisoningviolence
Mortality from selected causes Women aged 45-59 Russia 1980 - 2009
Age-
stan
dard
ised
mor
talit
y ra
te p
er 1
000
00
Source WHO HFA database
Index of CVD risk - 1 Ratio of apolipoprotein B
to apolipoprotein A1
ldquoAtherogenicrdquo index
Index of CVD risk - 2 B-type natriuretic peptide
Index of stress on ventricles of heart Marker of non-atherosclerotic cardiac damage
Association of pattern of drinking with cardiovascular risk factors
OR (95 CI)
Pattern of drinking
OR top 20 ApoBA1 ratio
OR top 20 B-type natriuretic
peptide (BNP)
Abstains 100 [ref] 100 [ref]
Non-hazardous 034 (021 054) 235 (120 458)
Hazardous 031 (016 059) 431 (214 952)
P-value trend lt0001 lt0001
Adjusted for age BMI and waist-hip ratio
Source Leon DA et al EurJ Epidemiol 28 (5)393-404 2013
- The challenge of cardiovascular disease in Russia
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Russia has the highest cardiovascular mortality rate in the world
- Slide Number 6
- Cardiovascular disease mortality in Russia is atypical
- Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010 (age lt65 years)
- Slide Number 9
- Smoking Important but does not explain fluctuations
- Trends of adult smoking rates in Russia 1992ndash2009
- Paradoxical lipid profile relative to other countries
- Hypertension
- Slide Number 14
- Alcohol A key driver of fluctuations
- Slide Number 16
- Slide Number 17
- Individual-level evidence on alcohol
- Hazardous drinking and mortality from varioustypes of circulatory diseaseMen aged 25-54 years Izhevsk 2003 - 5
- Doubts about the diagnosis
- A new international project2014-19
- Cardiovascular disease in Russia strengthening evidence about causes mechanisms prevention and treatment
- Slide Number 23
- Four themes
- Theme B Cross-sectional studies
- Slide Number 26
- Cutting edge scientific approaches
- Serum NMR metabolomics
- The microbiome
- Slide Number 30
- Thank you
- Alcohol control policy developments since 2005
- Tobacco control policy developments since 2005
- Slide Number 34
- Index of CVD risk - 1Ratio of apolipoprotein B to apolipoprotein A1
- Index of CVD risk - 2 B-type natriuretic peptide
- Association of pattern of drinking with cardiovascular risk factorsOR (95 CI)
-
Theme B Cross-sectional studies
bull Two locations ndash Arkhangelsk and Novosibirsk bull Population-based random sample
ndash men and women aged 35-69 years ndash attention given to reducing selection bias ndash N=2750 in each city
bull Additional sample heavy alcohol drinkers from medical facility (N=250 in each city)
bull Main field work starts 2015
25
26
Cardiovascular phenotypes Type Source Biomarkerproxy measure
Atherosclerosis
Questionnaire Previous MI
ECG Evidence previous MI
Carotid ultrasound Carotid IMT plaque
Cardiac remodelling
Blood NT-pro BNP HsTnI hsTnT
Echocardiography Myocardial function and size
Arrhythmia ECG Actiwave Cardio
Baseline rhythm heart rate variability
Vascular dysfunction Vicorder Pulse-wave velocity
Cutting edge scientific approaches
27
Serum NMR metabolomics
bull Highly standardised and reproducible platform for 117 primary and 99 derived measures of specific molecular entities (now gt100000 individuals assayed)
Nature Genetics 44 269 2012
28
bull How are alcohol and CVD phenotypes related to 14
lipoprotein subclasses bull Identifying markers of intermediate metabolism associated
with CVD phenotypes
The microbiome
29 Key expertise Vadim Govorun Moscow
Studies in other countries eg Tromsoslash 7
Endogenous exposures a priori CVD risk biomarkers
(including lipoprotein NMR profile)
Socio-demographic + exogenous exposures
CVD phenotypes
Metabolic profile Microbiome
Associations Analytic framework
Thank you
31
Alcohol control policy developments since 2005
bull 2005 Federal law No171 on production and sale of alcohol
bull 2009 Elaboration of the Russian anti-alcohol policy framework (the Conceptual Framework on anti-alcohol policy implementation)
bull 2009 Strengthening of institutional policy control (Establishment of the Federal Alcohol Service)
bull 2011 Introduction of greater controls and restrictions on production and sale of alcohol (Federal law No218)
Tobacco control policy developments since 2005
bull 2005 the Federal law No87 of 2001 ldquoOn limitations of smoking tobaccordquo is in effect
bull 2008 Ratification of the WHO Framework Convention on Tobacco Control by the Russian Federation
bull 2009 Defining the magnitude of the problem 40 smoking prevalence (GATS report on Russia)
bull 2010 Development of the anti-tobacco policy (the Conceptual framework on anti-tobacco policy for 2010-2015
bull 2013 Introduction of restrictions on tobacco sale and smoking in public (Federal law No 15 on ldquoHealth protection of citizens from exposure to tobacco smoke and consequences from tobacco consumptionrdquo)
34
0
20
40
60
80
100
120
140
160
180
Cancer oesophagus
Cancer stomach
Cancer breast
Ischaemic heartdiseaseInjuries poisoningviolence
Mortality from selected causes Women aged 45-59 Russia 1980 - 2009
Age-
stan
dard
ised
mor
talit
y ra
te p
er 1
000
00
Source WHO HFA database
Index of CVD risk - 1 Ratio of apolipoprotein B
to apolipoprotein A1
ldquoAtherogenicrdquo index
Index of CVD risk - 2 B-type natriuretic peptide
Index of stress on ventricles of heart Marker of non-atherosclerotic cardiac damage
Association of pattern of drinking with cardiovascular risk factors
OR (95 CI)
Pattern of drinking
OR top 20 ApoBA1 ratio
OR top 20 B-type natriuretic
peptide (BNP)
Abstains 100 [ref] 100 [ref]
Non-hazardous 034 (021 054) 235 (120 458)
Hazardous 031 (016 059) 431 (214 952)
P-value trend lt0001 lt0001
Adjusted for age BMI and waist-hip ratio
Source Leon DA et al EurJ Epidemiol 28 (5)393-404 2013
- The challenge of cardiovascular disease in Russia
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Russia has the highest cardiovascular mortality rate in the world
- Slide Number 6
- Cardiovascular disease mortality in Russia is atypical
- Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010 (age lt65 years)
- Slide Number 9
- Smoking Important but does not explain fluctuations
- Trends of adult smoking rates in Russia 1992ndash2009
- Paradoxical lipid profile relative to other countries
- Hypertension
- Slide Number 14
- Alcohol A key driver of fluctuations
- Slide Number 16
- Slide Number 17
- Individual-level evidence on alcohol
- Hazardous drinking and mortality from varioustypes of circulatory diseaseMen aged 25-54 years Izhevsk 2003 - 5
- Doubts about the diagnosis
- A new international project2014-19
- Cardiovascular disease in Russia strengthening evidence about causes mechanisms prevention and treatment
- Slide Number 23
- Four themes
- Theme B Cross-sectional studies
- Slide Number 26
- Cutting edge scientific approaches
- Serum NMR metabolomics
- The microbiome
- Slide Number 30
- Thank you
- Alcohol control policy developments since 2005
- Tobacco control policy developments since 2005
- Slide Number 34
- Index of CVD risk - 1Ratio of apolipoprotein B to apolipoprotein A1
- Index of CVD risk - 2 B-type natriuretic peptide
- Association of pattern of drinking with cardiovascular risk factorsOR (95 CI)
-
26
Cardiovascular phenotypes Type Source Biomarkerproxy measure
Atherosclerosis
Questionnaire Previous MI
ECG Evidence previous MI
Carotid ultrasound Carotid IMT plaque
Cardiac remodelling
Blood NT-pro BNP HsTnI hsTnT
Echocardiography Myocardial function and size
Arrhythmia ECG Actiwave Cardio
Baseline rhythm heart rate variability
Vascular dysfunction Vicorder Pulse-wave velocity
Cutting edge scientific approaches
27
Serum NMR metabolomics
bull Highly standardised and reproducible platform for 117 primary and 99 derived measures of specific molecular entities (now gt100000 individuals assayed)
Nature Genetics 44 269 2012
28
bull How are alcohol and CVD phenotypes related to 14
lipoprotein subclasses bull Identifying markers of intermediate metabolism associated
with CVD phenotypes
The microbiome
29 Key expertise Vadim Govorun Moscow
Studies in other countries eg Tromsoslash 7
Endogenous exposures a priori CVD risk biomarkers
(including lipoprotein NMR profile)
Socio-demographic + exogenous exposures
CVD phenotypes
Metabolic profile Microbiome
Associations Analytic framework
Thank you
31
Alcohol control policy developments since 2005
bull 2005 Federal law No171 on production and sale of alcohol
bull 2009 Elaboration of the Russian anti-alcohol policy framework (the Conceptual Framework on anti-alcohol policy implementation)
bull 2009 Strengthening of institutional policy control (Establishment of the Federal Alcohol Service)
bull 2011 Introduction of greater controls and restrictions on production and sale of alcohol (Federal law No218)
Tobacco control policy developments since 2005
bull 2005 the Federal law No87 of 2001 ldquoOn limitations of smoking tobaccordquo is in effect
bull 2008 Ratification of the WHO Framework Convention on Tobacco Control by the Russian Federation
bull 2009 Defining the magnitude of the problem 40 smoking prevalence (GATS report on Russia)
bull 2010 Development of the anti-tobacco policy (the Conceptual framework on anti-tobacco policy for 2010-2015
bull 2013 Introduction of restrictions on tobacco sale and smoking in public (Federal law No 15 on ldquoHealth protection of citizens from exposure to tobacco smoke and consequences from tobacco consumptionrdquo)
34
0
20
40
60
80
100
120
140
160
180
Cancer oesophagus
Cancer stomach
Cancer breast
Ischaemic heartdiseaseInjuries poisoningviolence
Mortality from selected causes Women aged 45-59 Russia 1980 - 2009
Age-
stan
dard
ised
mor
talit
y ra
te p
er 1
000
00
Source WHO HFA database
Index of CVD risk - 1 Ratio of apolipoprotein B
to apolipoprotein A1
ldquoAtherogenicrdquo index
Index of CVD risk - 2 B-type natriuretic peptide
Index of stress on ventricles of heart Marker of non-atherosclerotic cardiac damage
Association of pattern of drinking with cardiovascular risk factors
OR (95 CI)
Pattern of drinking
OR top 20 ApoBA1 ratio
OR top 20 B-type natriuretic
peptide (BNP)
Abstains 100 [ref] 100 [ref]
Non-hazardous 034 (021 054) 235 (120 458)
Hazardous 031 (016 059) 431 (214 952)
P-value trend lt0001 lt0001
Adjusted for age BMI and waist-hip ratio
Source Leon DA et al EurJ Epidemiol 28 (5)393-404 2013
- The challenge of cardiovascular disease in Russia
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Russia has the highest cardiovascular mortality rate in the world
- Slide Number 6
- Cardiovascular disease mortality in Russia is atypical
- Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010 (age lt65 years)
- Slide Number 9
- Smoking Important but does not explain fluctuations
- Trends of adult smoking rates in Russia 1992ndash2009
- Paradoxical lipid profile relative to other countries
- Hypertension
- Slide Number 14
- Alcohol A key driver of fluctuations
- Slide Number 16
- Slide Number 17
- Individual-level evidence on alcohol
- Hazardous drinking and mortality from varioustypes of circulatory diseaseMen aged 25-54 years Izhevsk 2003 - 5
- Doubts about the diagnosis
- A new international project2014-19
- Cardiovascular disease in Russia strengthening evidence about causes mechanisms prevention and treatment
- Slide Number 23
- Four themes
- Theme B Cross-sectional studies
- Slide Number 26
- Cutting edge scientific approaches
- Serum NMR metabolomics
- The microbiome
- Slide Number 30
- Thank you
- Alcohol control policy developments since 2005
- Tobacco control policy developments since 2005
- Slide Number 34
- Index of CVD risk - 1Ratio of apolipoprotein B to apolipoprotein A1
- Index of CVD risk - 2 B-type natriuretic peptide
- Association of pattern of drinking with cardiovascular risk factorsOR (95 CI)
-
Cutting edge scientific approaches
27
Serum NMR metabolomics
bull Highly standardised and reproducible platform for 117 primary and 99 derived measures of specific molecular entities (now gt100000 individuals assayed)
Nature Genetics 44 269 2012
28
bull How are alcohol and CVD phenotypes related to 14
lipoprotein subclasses bull Identifying markers of intermediate metabolism associated
with CVD phenotypes
The microbiome
29 Key expertise Vadim Govorun Moscow
Studies in other countries eg Tromsoslash 7
Endogenous exposures a priori CVD risk biomarkers
(including lipoprotein NMR profile)
Socio-demographic + exogenous exposures
CVD phenotypes
Metabolic profile Microbiome
Associations Analytic framework
Thank you
31
Alcohol control policy developments since 2005
bull 2005 Federal law No171 on production and sale of alcohol
bull 2009 Elaboration of the Russian anti-alcohol policy framework (the Conceptual Framework on anti-alcohol policy implementation)
bull 2009 Strengthening of institutional policy control (Establishment of the Federal Alcohol Service)
bull 2011 Introduction of greater controls and restrictions on production and sale of alcohol (Federal law No218)
Tobacco control policy developments since 2005
bull 2005 the Federal law No87 of 2001 ldquoOn limitations of smoking tobaccordquo is in effect
bull 2008 Ratification of the WHO Framework Convention on Tobacco Control by the Russian Federation
bull 2009 Defining the magnitude of the problem 40 smoking prevalence (GATS report on Russia)
bull 2010 Development of the anti-tobacco policy (the Conceptual framework on anti-tobacco policy for 2010-2015
bull 2013 Introduction of restrictions on tobacco sale and smoking in public (Federal law No 15 on ldquoHealth protection of citizens from exposure to tobacco smoke and consequences from tobacco consumptionrdquo)
34
0
20
40
60
80
100
120
140
160
180
Cancer oesophagus
Cancer stomach
Cancer breast
Ischaemic heartdiseaseInjuries poisoningviolence
Mortality from selected causes Women aged 45-59 Russia 1980 - 2009
Age-
stan
dard
ised
mor
talit
y ra
te p
er 1
000
00
Source WHO HFA database
Index of CVD risk - 1 Ratio of apolipoprotein B
to apolipoprotein A1
ldquoAtherogenicrdquo index
Index of CVD risk - 2 B-type natriuretic peptide
Index of stress on ventricles of heart Marker of non-atherosclerotic cardiac damage
Association of pattern of drinking with cardiovascular risk factors
OR (95 CI)
Pattern of drinking
OR top 20 ApoBA1 ratio
OR top 20 B-type natriuretic
peptide (BNP)
Abstains 100 [ref] 100 [ref]
Non-hazardous 034 (021 054) 235 (120 458)
Hazardous 031 (016 059) 431 (214 952)
P-value trend lt0001 lt0001
Adjusted for age BMI and waist-hip ratio
Source Leon DA et al EurJ Epidemiol 28 (5)393-404 2013
- The challenge of cardiovascular disease in Russia
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Russia has the highest cardiovascular mortality rate in the world
- Slide Number 6
- Cardiovascular disease mortality in Russia is atypical
- Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010 (age lt65 years)
- Slide Number 9
- Smoking Important but does not explain fluctuations
- Trends of adult smoking rates in Russia 1992ndash2009
- Paradoxical lipid profile relative to other countries
- Hypertension
- Slide Number 14
- Alcohol A key driver of fluctuations
- Slide Number 16
- Slide Number 17
- Individual-level evidence on alcohol
- Hazardous drinking and mortality from varioustypes of circulatory diseaseMen aged 25-54 years Izhevsk 2003 - 5
- Doubts about the diagnosis
- A new international project2014-19
- Cardiovascular disease in Russia strengthening evidence about causes mechanisms prevention and treatment
- Slide Number 23
- Four themes
- Theme B Cross-sectional studies
- Slide Number 26
- Cutting edge scientific approaches
- Serum NMR metabolomics
- The microbiome
- Slide Number 30
- Thank you
- Alcohol control policy developments since 2005
- Tobacco control policy developments since 2005
- Slide Number 34
- Index of CVD risk - 1Ratio of apolipoprotein B to apolipoprotein A1
- Index of CVD risk - 2 B-type natriuretic peptide
- Association of pattern of drinking with cardiovascular risk factorsOR (95 CI)
-
Serum NMR metabolomics
bull Highly standardised and reproducible platform for 117 primary and 99 derived measures of specific molecular entities (now gt100000 individuals assayed)
Nature Genetics 44 269 2012
28
bull How are alcohol and CVD phenotypes related to 14
lipoprotein subclasses bull Identifying markers of intermediate metabolism associated
with CVD phenotypes
The microbiome
29 Key expertise Vadim Govorun Moscow
Studies in other countries eg Tromsoslash 7
Endogenous exposures a priori CVD risk biomarkers
(including lipoprotein NMR profile)
Socio-demographic + exogenous exposures
CVD phenotypes
Metabolic profile Microbiome
Associations Analytic framework
Thank you
31
Alcohol control policy developments since 2005
bull 2005 Federal law No171 on production and sale of alcohol
bull 2009 Elaboration of the Russian anti-alcohol policy framework (the Conceptual Framework on anti-alcohol policy implementation)
bull 2009 Strengthening of institutional policy control (Establishment of the Federal Alcohol Service)
bull 2011 Introduction of greater controls and restrictions on production and sale of alcohol (Federal law No218)
Tobacco control policy developments since 2005
bull 2005 the Federal law No87 of 2001 ldquoOn limitations of smoking tobaccordquo is in effect
bull 2008 Ratification of the WHO Framework Convention on Tobacco Control by the Russian Federation
bull 2009 Defining the magnitude of the problem 40 smoking prevalence (GATS report on Russia)
bull 2010 Development of the anti-tobacco policy (the Conceptual framework on anti-tobacco policy for 2010-2015
bull 2013 Introduction of restrictions on tobacco sale and smoking in public (Federal law No 15 on ldquoHealth protection of citizens from exposure to tobacco smoke and consequences from tobacco consumptionrdquo)
34
0
20
40
60
80
100
120
140
160
180
Cancer oesophagus
Cancer stomach
Cancer breast
Ischaemic heartdiseaseInjuries poisoningviolence
Mortality from selected causes Women aged 45-59 Russia 1980 - 2009
Age-
stan
dard
ised
mor
talit
y ra
te p
er 1
000
00
Source WHO HFA database
Index of CVD risk - 1 Ratio of apolipoprotein B
to apolipoprotein A1
ldquoAtherogenicrdquo index
Index of CVD risk - 2 B-type natriuretic peptide
Index of stress on ventricles of heart Marker of non-atherosclerotic cardiac damage
Association of pattern of drinking with cardiovascular risk factors
OR (95 CI)
Pattern of drinking
OR top 20 ApoBA1 ratio
OR top 20 B-type natriuretic
peptide (BNP)
Abstains 100 [ref] 100 [ref]
Non-hazardous 034 (021 054) 235 (120 458)
Hazardous 031 (016 059) 431 (214 952)
P-value trend lt0001 lt0001
Adjusted for age BMI and waist-hip ratio
Source Leon DA et al EurJ Epidemiol 28 (5)393-404 2013
- The challenge of cardiovascular disease in Russia
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Russia has the highest cardiovascular mortality rate in the world
- Slide Number 6
- Cardiovascular disease mortality in Russia is atypical
- Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010 (age lt65 years)
- Slide Number 9
- Smoking Important but does not explain fluctuations
- Trends of adult smoking rates in Russia 1992ndash2009
- Paradoxical lipid profile relative to other countries
- Hypertension
- Slide Number 14
- Alcohol A key driver of fluctuations
- Slide Number 16
- Slide Number 17
- Individual-level evidence on alcohol
- Hazardous drinking and mortality from varioustypes of circulatory diseaseMen aged 25-54 years Izhevsk 2003 - 5
- Doubts about the diagnosis
- A new international project2014-19
- Cardiovascular disease in Russia strengthening evidence about causes mechanisms prevention and treatment
- Slide Number 23
- Four themes
- Theme B Cross-sectional studies
- Slide Number 26
- Cutting edge scientific approaches
- Serum NMR metabolomics
- The microbiome
- Slide Number 30
- Thank you
- Alcohol control policy developments since 2005
- Tobacco control policy developments since 2005
- Slide Number 34
- Index of CVD risk - 1Ratio of apolipoprotein B to apolipoprotein A1
- Index of CVD risk - 2 B-type natriuretic peptide
- Association of pattern of drinking with cardiovascular risk factorsOR (95 CI)
-
The microbiome
29 Key expertise Vadim Govorun Moscow
Studies in other countries eg Tromsoslash 7
Endogenous exposures a priori CVD risk biomarkers
(including lipoprotein NMR profile)
Socio-demographic + exogenous exposures
CVD phenotypes
Metabolic profile Microbiome
Associations Analytic framework
Thank you
31
Alcohol control policy developments since 2005
bull 2005 Federal law No171 on production and sale of alcohol
bull 2009 Elaboration of the Russian anti-alcohol policy framework (the Conceptual Framework on anti-alcohol policy implementation)
bull 2009 Strengthening of institutional policy control (Establishment of the Federal Alcohol Service)
bull 2011 Introduction of greater controls and restrictions on production and sale of alcohol (Federal law No218)
Tobacco control policy developments since 2005
bull 2005 the Federal law No87 of 2001 ldquoOn limitations of smoking tobaccordquo is in effect
bull 2008 Ratification of the WHO Framework Convention on Tobacco Control by the Russian Federation
bull 2009 Defining the magnitude of the problem 40 smoking prevalence (GATS report on Russia)
bull 2010 Development of the anti-tobacco policy (the Conceptual framework on anti-tobacco policy for 2010-2015
bull 2013 Introduction of restrictions on tobacco sale and smoking in public (Federal law No 15 on ldquoHealth protection of citizens from exposure to tobacco smoke and consequences from tobacco consumptionrdquo)
34
0
20
40
60
80
100
120
140
160
180
Cancer oesophagus
Cancer stomach
Cancer breast
Ischaemic heartdiseaseInjuries poisoningviolence
Mortality from selected causes Women aged 45-59 Russia 1980 - 2009
Age-
stan
dard
ised
mor
talit
y ra
te p
er 1
000
00
Source WHO HFA database
Index of CVD risk - 1 Ratio of apolipoprotein B
to apolipoprotein A1
ldquoAtherogenicrdquo index
Index of CVD risk - 2 B-type natriuretic peptide
Index of stress on ventricles of heart Marker of non-atherosclerotic cardiac damage
Association of pattern of drinking with cardiovascular risk factors
OR (95 CI)
Pattern of drinking
OR top 20 ApoBA1 ratio
OR top 20 B-type natriuretic
peptide (BNP)
Abstains 100 [ref] 100 [ref]
Non-hazardous 034 (021 054) 235 (120 458)
Hazardous 031 (016 059) 431 (214 952)
P-value trend lt0001 lt0001
Adjusted for age BMI and waist-hip ratio
Source Leon DA et al EurJ Epidemiol 28 (5)393-404 2013
- The challenge of cardiovascular disease in Russia
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Russia has the highest cardiovascular mortality rate in the world
- Slide Number 6
- Cardiovascular disease mortality in Russia is atypical
- Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010 (age lt65 years)
- Slide Number 9
- Smoking Important but does not explain fluctuations
- Trends of adult smoking rates in Russia 1992ndash2009
- Paradoxical lipid profile relative to other countries
- Hypertension
- Slide Number 14
- Alcohol A key driver of fluctuations
- Slide Number 16
- Slide Number 17
- Individual-level evidence on alcohol
- Hazardous drinking and mortality from varioustypes of circulatory diseaseMen aged 25-54 years Izhevsk 2003 - 5
- Doubts about the diagnosis
- A new international project2014-19
- Cardiovascular disease in Russia strengthening evidence about causes mechanisms prevention and treatment
- Slide Number 23
- Four themes
- Theme B Cross-sectional studies
- Slide Number 26
- Cutting edge scientific approaches
- Serum NMR metabolomics
- The microbiome
- Slide Number 30
- Thank you
- Alcohol control policy developments since 2005
- Tobacco control policy developments since 2005
- Slide Number 34
- Index of CVD risk - 1Ratio of apolipoprotein B to apolipoprotein A1
- Index of CVD risk - 2 B-type natriuretic peptide
- Association of pattern of drinking with cardiovascular risk factorsOR (95 CI)
-
Studies in other countries eg Tromsoslash 7
Endogenous exposures a priori CVD risk biomarkers
(including lipoprotein NMR profile)
Socio-demographic + exogenous exposures
CVD phenotypes
Metabolic profile Microbiome
Associations Analytic framework
Thank you
31
Alcohol control policy developments since 2005
bull 2005 Federal law No171 on production and sale of alcohol
bull 2009 Elaboration of the Russian anti-alcohol policy framework (the Conceptual Framework on anti-alcohol policy implementation)
bull 2009 Strengthening of institutional policy control (Establishment of the Federal Alcohol Service)
bull 2011 Introduction of greater controls and restrictions on production and sale of alcohol (Federal law No218)
Tobacco control policy developments since 2005
bull 2005 the Federal law No87 of 2001 ldquoOn limitations of smoking tobaccordquo is in effect
bull 2008 Ratification of the WHO Framework Convention on Tobacco Control by the Russian Federation
bull 2009 Defining the magnitude of the problem 40 smoking prevalence (GATS report on Russia)
bull 2010 Development of the anti-tobacco policy (the Conceptual framework on anti-tobacco policy for 2010-2015
bull 2013 Introduction of restrictions on tobacco sale and smoking in public (Federal law No 15 on ldquoHealth protection of citizens from exposure to tobacco smoke and consequences from tobacco consumptionrdquo)
34
0
20
40
60
80
100
120
140
160
180
Cancer oesophagus
Cancer stomach
Cancer breast
Ischaemic heartdiseaseInjuries poisoningviolence
Mortality from selected causes Women aged 45-59 Russia 1980 - 2009
Age-
stan
dard
ised
mor
talit
y ra
te p
er 1
000
00
Source WHO HFA database
Index of CVD risk - 1 Ratio of apolipoprotein B
to apolipoprotein A1
ldquoAtherogenicrdquo index
Index of CVD risk - 2 B-type natriuretic peptide
Index of stress on ventricles of heart Marker of non-atherosclerotic cardiac damage
Association of pattern of drinking with cardiovascular risk factors
OR (95 CI)
Pattern of drinking
OR top 20 ApoBA1 ratio
OR top 20 B-type natriuretic
peptide (BNP)
Abstains 100 [ref] 100 [ref]
Non-hazardous 034 (021 054) 235 (120 458)
Hazardous 031 (016 059) 431 (214 952)
P-value trend lt0001 lt0001
Adjusted for age BMI and waist-hip ratio
Source Leon DA et al EurJ Epidemiol 28 (5)393-404 2013
- The challenge of cardiovascular disease in Russia
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Russia has the highest cardiovascular mortality rate in the world
- Slide Number 6
- Cardiovascular disease mortality in Russia is atypical
- Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010 (age lt65 years)
- Slide Number 9
- Smoking Important but does not explain fluctuations
- Trends of adult smoking rates in Russia 1992ndash2009
- Paradoxical lipid profile relative to other countries
- Hypertension
- Slide Number 14
- Alcohol A key driver of fluctuations
- Slide Number 16
- Slide Number 17
- Individual-level evidence on alcohol
- Hazardous drinking and mortality from varioustypes of circulatory diseaseMen aged 25-54 years Izhevsk 2003 - 5
- Doubts about the diagnosis
- A new international project2014-19
- Cardiovascular disease in Russia strengthening evidence about causes mechanisms prevention and treatment
- Slide Number 23
- Four themes
- Theme B Cross-sectional studies
- Slide Number 26
- Cutting edge scientific approaches
- Serum NMR metabolomics
- The microbiome
- Slide Number 30
- Thank you
- Alcohol control policy developments since 2005
- Tobacco control policy developments since 2005
- Slide Number 34
- Index of CVD risk - 1Ratio of apolipoprotein B to apolipoprotein A1
- Index of CVD risk - 2 B-type natriuretic peptide
- Association of pattern of drinking with cardiovascular risk factorsOR (95 CI)
-
Thank you
31
Alcohol control policy developments since 2005
bull 2005 Federal law No171 on production and sale of alcohol
bull 2009 Elaboration of the Russian anti-alcohol policy framework (the Conceptual Framework on anti-alcohol policy implementation)
bull 2009 Strengthening of institutional policy control (Establishment of the Federal Alcohol Service)
bull 2011 Introduction of greater controls and restrictions on production and sale of alcohol (Federal law No218)
Tobacco control policy developments since 2005
bull 2005 the Federal law No87 of 2001 ldquoOn limitations of smoking tobaccordquo is in effect
bull 2008 Ratification of the WHO Framework Convention on Tobacco Control by the Russian Federation
bull 2009 Defining the magnitude of the problem 40 smoking prevalence (GATS report on Russia)
bull 2010 Development of the anti-tobacco policy (the Conceptual framework on anti-tobacco policy for 2010-2015
bull 2013 Introduction of restrictions on tobacco sale and smoking in public (Federal law No 15 on ldquoHealth protection of citizens from exposure to tobacco smoke and consequences from tobacco consumptionrdquo)
34
0
20
40
60
80
100
120
140
160
180
Cancer oesophagus
Cancer stomach
Cancer breast
Ischaemic heartdiseaseInjuries poisoningviolence
Mortality from selected causes Women aged 45-59 Russia 1980 - 2009
Age-
stan
dard
ised
mor
talit
y ra
te p
er 1
000
00
Source WHO HFA database
Index of CVD risk - 1 Ratio of apolipoprotein B
to apolipoprotein A1
ldquoAtherogenicrdquo index
Index of CVD risk - 2 B-type natriuretic peptide
Index of stress on ventricles of heart Marker of non-atherosclerotic cardiac damage
Association of pattern of drinking with cardiovascular risk factors
OR (95 CI)
Pattern of drinking
OR top 20 ApoBA1 ratio
OR top 20 B-type natriuretic
peptide (BNP)
Abstains 100 [ref] 100 [ref]
Non-hazardous 034 (021 054) 235 (120 458)
Hazardous 031 (016 059) 431 (214 952)
P-value trend lt0001 lt0001
Adjusted for age BMI and waist-hip ratio
Source Leon DA et al EurJ Epidemiol 28 (5)393-404 2013
- The challenge of cardiovascular disease in Russia
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Russia has the highest cardiovascular mortality rate in the world
- Slide Number 6
- Cardiovascular disease mortality in Russia is atypical
- Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010 (age lt65 years)
- Slide Number 9
- Smoking Important but does not explain fluctuations
- Trends of adult smoking rates in Russia 1992ndash2009
- Paradoxical lipid profile relative to other countries
- Hypertension
- Slide Number 14
- Alcohol A key driver of fluctuations
- Slide Number 16
- Slide Number 17
- Individual-level evidence on alcohol
- Hazardous drinking and mortality from varioustypes of circulatory diseaseMen aged 25-54 years Izhevsk 2003 - 5
- Doubts about the diagnosis
- A new international project2014-19
- Cardiovascular disease in Russia strengthening evidence about causes mechanisms prevention and treatment
- Slide Number 23
- Four themes
- Theme B Cross-sectional studies
- Slide Number 26
- Cutting edge scientific approaches
- Serum NMR metabolomics
- The microbiome
- Slide Number 30
- Thank you
- Alcohol control policy developments since 2005
- Tobacco control policy developments since 2005
- Slide Number 34
- Index of CVD risk - 1Ratio of apolipoprotein B to apolipoprotein A1
- Index of CVD risk - 2 B-type natriuretic peptide
- Association of pattern of drinking with cardiovascular risk factorsOR (95 CI)
-
Alcohol control policy developments since 2005
bull 2005 Federal law No171 on production and sale of alcohol
bull 2009 Elaboration of the Russian anti-alcohol policy framework (the Conceptual Framework on anti-alcohol policy implementation)
bull 2009 Strengthening of institutional policy control (Establishment of the Federal Alcohol Service)
bull 2011 Introduction of greater controls and restrictions on production and sale of alcohol (Federal law No218)
Tobacco control policy developments since 2005
bull 2005 the Federal law No87 of 2001 ldquoOn limitations of smoking tobaccordquo is in effect
bull 2008 Ratification of the WHO Framework Convention on Tobacco Control by the Russian Federation
bull 2009 Defining the magnitude of the problem 40 smoking prevalence (GATS report on Russia)
bull 2010 Development of the anti-tobacco policy (the Conceptual framework on anti-tobacco policy for 2010-2015
bull 2013 Introduction of restrictions on tobacco sale and smoking in public (Federal law No 15 on ldquoHealth protection of citizens from exposure to tobacco smoke and consequences from tobacco consumptionrdquo)
34
0
20
40
60
80
100
120
140
160
180
Cancer oesophagus
Cancer stomach
Cancer breast
Ischaemic heartdiseaseInjuries poisoningviolence
Mortality from selected causes Women aged 45-59 Russia 1980 - 2009
Age-
stan
dard
ised
mor
talit
y ra
te p
er 1
000
00
Source WHO HFA database
Index of CVD risk - 1 Ratio of apolipoprotein B
to apolipoprotein A1
ldquoAtherogenicrdquo index
Index of CVD risk - 2 B-type natriuretic peptide
Index of stress on ventricles of heart Marker of non-atherosclerotic cardiac damage
Association of pattern of drinking with cardiovascular risk factors
OR (95 CI)
Pattern of drinking
OR top 20 ApoBA1 ratio
OR top 20 B-type natriuretic
peptide (BNP)
Abstains 100 [ref] 100 [ref]
Non-hazardous 034 (021 054) 235 (120 458)
Hazardous 031 (016 059) 431 (214 952)
P-value trend lt0001 lt0001
Adjusted for age BMI and waist-hip ratio
Source Leon DA et al EurJ Epidemiol 28 (5)393-404 2013
- The challenge of cardiovascular disease in Russia
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Russia has the highest cardiovascular mortality rate in the world
- Slide Number 6
- Cardiovascular disease mortality in Russia is atypical
- Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010 (age lt65 years)
- Slide Number 9
- Smoking Important but does not explain fluctuations
- Trends of adult smoking rates in Russia 1992ndash2009
- Paradoxical lipid profile relative to other countries
- Hypertension
- Slide Number 14
- Alcohol A key driver of fluctuations
- Slide Number 16
- Slide Number 17
- Individual-level evidence on alcohol
- Hazardous drinking and mortality from varioustypes of circulatory diseaseMen aged 25-54 years Izhevsk 2003 - 5
- Doubts about the diagnosis
- A new international project2014-19
- Cardiovascular disease in Russia strengthening evidence about causes mechanisms prevention and treatment
- Slide Number 23
- Four themes
- Theme B Cross-sectional studies
- Slide Number 26
- Cutting edge scientific approaches
- Serum NMR metabolomics
- The microbiome
- Slide Number 30
- Thank you
- Alcohol control policy developments since 2005
- Tobacco control policy developments since 2005
- Slide Number 34
- Index of CVD risk - 1Ratio of apolipoprotein B to apolipoprotein A1
- Index of CVD risk - 2 B-type natriuretic peptide
- Association of pattern of drinking with cardiovascular risk factorsOR (95 CI)
-
Tobacco control policy developments since 2005
bull 2005 the Federal law No87 of 2001 ldquoOn limitations of smoking tobaccordquo is in effect
bull 2008 Ratification of the WHO Framework Convention on Tobacco Control by the Russian Federation
bull 2009 Defining the magnitude of the problem 40 smoking prevalence (GATS report on Russia)
bull 2010 Development of the anti-tobacco policy (the Conceptual framework on anti-tobacco policy for 2010-2015
bull 2013 Introduction of restrictions on tobacco sale and smoking in public (Federal law No 15 on ldquoHealth protection of citizens from exposure to tobacco smoke and consequences from tobacco consumptionrdquo)
34
0
20
40
60
80
100
120
140
160
180
Cancer oesophagus
Cancer stomach
Cancer breast
Ischaemic heartdiseaseInjuries poisoningviolence
Mortality from selected causes Women aged 45-59 Russia 1980 - 2009
Age-
stan
dard
ised
mor
talit
y ra
te p
er 1
000
00
Source WHO HFA database
Index of CVD risk - 1 Ratio of apolipoprotein B
to apolipoprotein A1
ldquoAtherogenicrdquo index
Index of CVD risk - 2 B-type natriuretic peptide
Index of stress on ventricles of heart Marker of non-atherosclerotic cardiac damage
Association of pattern of drinking with cardiovascular risk factors
OR (95 CI)
Pattern of drinking
OR top 20 ApoBA1 ratio
OR top 20 B-type natriuretic
peptide (BNP)
Abstains 100 [ref] 100 [ref]
Non-hazardous 034 (021 054) 235 (120 458)
Hazardous 031 (016 059) 431 (214 952)
P-value trend lt0001 lt0001
Adjusted for age BMI and waist-hip ratio
Source Leon DA et al EurJ Epidemiol 28 (5)393-404 2013
- The challenge of cardiovascular disease in Russia
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Russia has the highest cardiovascular mortality rate in the world
- Slide Number 6
- Cardiovascular disease mortality in Russia is atypical
- Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010 (age lt65 years)
- Slide Number 9
- Smoking Important but does not explain fluctuations
- Trends of adult smoking rates in Russia 1992ndash2009
- Paradoxical lipid profile relative to other countries
- Hypertension
- Slide Number 14
- Alcohol A key driver of fluctuations
- Slide Number 16
- Slide Number 17
- Individual-level evidence on alcohol
- Hazardous drinking and mortality from varioustypes of circulatory diseaseMen aged 25-54 years Izhevsk 2003 - 5
- Doubts about the diagnosis
- A new international project2014-19
- Cardiovascular disease in Russia strengthening evidence about causes mechanisms prevention and treatment
- Slide Number 23
- Four themes
- Theme B Cross-sectional studies
- Slide Number 26
- Cutting edge scientific approaches
- Serum NMR metabolomics
- The microbiome
- Slide Number 30
- Thank you
- Alcohol control policy developments since 2005
- Tobacco control policy developments since 2005
- Slide Number 34
- Index of CVD risk - 1Ratio of apolipoprotein B to apolipoprotein A1
- Index of CVD risk - 2 B-type natriuretic peptide
- Association of pattern of drinking with cardiovascular risk factorsOR (95 CI)
-
34
0
20
40
60
80
100
120
140
160
180
Cancer oesophagus
Cancer stomach
Cancer breast
Ischaemic heartdiseaseInjuries poisoningviolence
Mortality from selected causes Women aged 45-59 Russia 1980 - 2009
Age-
stan
dard
ised
mor
talit
y ra
te p
er 1
000
00
Source WHO HFA database
Index of CVD risk - 1 Ratio of apolipoprotein B
to apolipoprotein A1
ldquoAtherogenicrdquo index
Index of CVD risk - 2 B-type natriuretic peptide
Index of stress on ventricles of heart Marker of non-atherosclerotic cardiac damage
Association of pattern of drinking with cardiovascular risk factors
OR (95 CI)
Pattern of drinking
OR top 20 ApoBA1 ratio
OR top 20 B-type natriuretic
peptide (BNP)
Abstains 100 [ref] 100 [ref]
Non-hazardous 034 (021 054) 235 (120 458)
Hazardous 031 (016 059) 431 (214 952)
P-value trend lt0001 lt0001
Adjusted for age BMI and waist-hip ratio
Source Leon DA et al EurJ Epidemiol 28 (5)393-404 2013
- The challenge of cardiovascular disease in Russia
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Russia has the highest cardiovascular mortality rate in the world
- Slide Number 6
- Cardiovascular disease mortality in Russia is atypical
- Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010 (age lt65 years)
- Slide Number 9
- Smoking Important but does not explain fluctuations
- Trends of adult smoking rates in Russia 1992ndash2009
- Paradoxical lipid profile relative to other countries
- Hypertension
- Slide Number 14
- Alcohol A key driver of fluctuations
- Slide Number 16
- Slide Number 17
- Individual-level evidence on alcohol
- Hazardous drinking and mortality from varioustypes of circulatory diseaseMen aged 25-54 years Izhevsk 2003 - 5
- Doubts about the diagnosis
- A new international project2014-19
- Cardiovascular disease in Russia strengthening evidence about causes mechanisms prevention and treatment
- Slide Number 23
- Four themes
- Theme B Cross-sectional studies
- Slide Number 26
- Cutting edge scientific approaches
- Serum NMR metabolomics
- The microbiome
- Slide Number 30
- Thank you
- Alcohol control policy developments since 2005
- Tobacco control policy developments since 2005
- Slide Number 34
- Index of CVD risk - 1Ratio of apolipoprotein B to apolipoprotein A1
- Index of CVD risk - 2 B-type natriuretic peptide
- Association of pattern of drinking with cardiovascular risk factorsOR (95 CI)
-
Index of CVD risk - 1 Ratio of apolipoprotein B
to apolipoprotein A1
ldquoAtherogenicrdquo index
Index of CVD risk - 2 B-type natriuretic peptide
Index of stress on ventricles of heart Marker of non-atherosclerotic cardiac damage
Association of pattern of drinking with cardiovascular risk factors
OR (95 CI)
Pattern of drinking
OR top 20 ApoBA1 ratio
OR top 20 B-type natriuretic
peptide (BNP)
Abstains 100 [ref] 100 [ref]
Non-hazardous 034 (021 054) 235 (120 458)
Hazardous 031 (016 059) 431 (214 952)
P-value trend lt0001 lt0001
Adjusted for age BMI and waist-hip ratio
Source Leon DA et al EurJ Epidemiol 28 (5)393-404 2013
- The challenge of cardiovascular disease in Russia
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Russia has the highest cardiovascular mortality rate in the world
- Slide Number 6
- Cardiovascular disease mortality in Russia is atypical
- Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010 (age lt65 years)
- Slide Number 9
- Smoking Important but does not explain fluctuations
- Trends of adult smoking rates in Russia 1992ndash2009
- Paradoxical lipid profile relative to other countries
- Hypertension
- Slide Number 14
- Alcohol A key driver of fluctuations
- Slide Number 16
- Slide Number 17
- Individual-level evidence on alcohol
- Hazardous drinking and mortality from varioustypes of circulatory diseaseMen aged 25-54 years Izhevsk 2003 - 5
- Doubts about the diagnosis
- A new international project2014-19
- Cardiovascular disease in Russia strengthening evidence about causes mechanisms prevention and treatment
- Slide Number 23
- Four themes
- Theme B Cross-sectional studies
- Slide Number 26
- Cutting edge scientific approaches
- Serum NMR metabolomics
- The microbiome
- Slide Number 30
- Thank you
- Alcohol control policy developments since 2005
- Tobacco control policy developments since 2005
- Slide Number 34
- Index of CVD risk - 1Ratio of apolipoprotein B to apolipoprotein A1
- Index of CVD risk - 2 B-type natriuretic peptide
- Association of pattern of drinking with cardiovascular risk factorsOR (95 CI)
-
Index of CVD risk - 2 B-type natriuretic peptide
Index of stress on ventricles of heart Marker of non-atherosclerotic cardiac damage
Association of pattern of drinking with cardiovascular risk factors
OR (95 CI)
Pattern of drinking
OR top 20 ApoBA1 ratio
OR top 20 B-type natriuretic
peptide (BNP)
Abstains 100 [ref] 100 [ref]
Non-hazardous 034 (021 054) 235 (120 458)
Hazardous 031 (016 059) 431 (214 952)
P-value trend lt0001 lt0001
Adjusted for age BMI and waist-hip ratio
Source Leon DA et al EurJ Epidemiol 28 (5)393-404 2013
- The challenge of cardiovascular disease in Russia
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Russia has the highest cardiovascular mortality rate in the world
- Slide Number 6
- Cardiovascular disease mortality in Russia is atypical
- Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010 (age lt65 years)
- Slide Number 9
- Smoking Important but does not explain fluctuations
- Trends of adult smoking rates in Russia 1992ndash2009
- Paradoxical lipid profile relative to other countries
- Hypertension
- Slide Number 14
- Alcohol A key driver of fluctuations
- Slide Number 16
- Slide Number 17
- Individual-level evidence on alcohol
- Hazardous drinking and mortality from varioustypes of circulatory diseaseMen aged 25-54 years Izhevsk 2003 - 5
- Doubts about the diagnosis
- A new international project2014-19
- Cardiovascular disease in Russia strengthening evidence about causes mechanisms prevention and treatment
- Slide Number 23
- Four themes
- Theme B Cross-sectional studies
- Slide Number 26
- Cutting edge scientific approaches
- Serum NMR metabolomics
- The microbiome
- Slide Number 30
- Thank you
- Alcohol control policy developments since 2005
- Tobacco control policy developments since 2005
- Slide Number 34
- Index of CVD risk - 1Ratio of apolipoprotein B to apolipoprotein A1
- Index of CVD risk - 2 B-type natriuretic peptide
- Association of pattern of drinking with cardiovascular risk factorsOR (95 CI)
-
Association of pattern of drinking with cardiovascular risk factors
OR (95 CI)
Pattern of drinking
OR top 20 ApoBA1 ratio
OR top 20 B-type natriuretic
peptide (BNP)
Abstains 100 [ref] 100 [ref]
Non-hazardous 034 (021 054) 235 (120 458)
Hazardous 031 (016 059) 431 (214 952)
P-value trend lt0001 lt0001
Adjusted for age BMI and waist-hip ratio
Source Leon DA et al EurJ Epidemiol 28 (5)393-404 2013
- The challenge of cardiovascular disease in Russia
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Russia has the highest cardiovascular mortality rate in the world
- Slide Number 6
- Cardiovascular disease mortality in Russia is atypical
- Massive fluctuations over time in ischaemic heart disease 1970 ndash 2010 (age lt65 years)
- Slide Number 9
- Smoking Important but does not explain fluctuations
- Trends of adult smoking rates in Russia 1992ndash2009
- Paradoxical lipid profile relative to other countries
- Hypertension
- Slide Number 14
- Alcohol A key driver of fluctuations
- Slide Number 16
- Slide Number 17
- Individual-level evidence on alcohol
- Hazardous drinking and mortality from varioustypes of circulatory diseaseMen aged 25-54 years Izhevsk 2003 - 5
- Doubts about the diagnosis
- A new international project2014-19
- Cardiovascular disease in Russia strengthening evidence about causes mechanisms prevention and treatment
- Slide Number 23
- Four themes
- Theme B Cross-sectional studies
- Slide Number 26
- Cutting edge scientific approaches
- Serum NMR metabolomics
- The microbiome
- Slide Number 30
- Thank you
- Alcohol control policy developments since 2005
- Tobacco control policy developments since 2005
- Slide Number 34
- Index of CVD risk - 1Ratio of apolipoprotein B to apolipoprotein A1
- Index of CVD risk - 2 B-type natriuretic peptide
- Association of pattern of drinking with cardiovascular risk factorsOR (95 CI)
-