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Why does Russia have such high cardiovascular mortality rates? Comparisons of blood-based biomarkers with Norway implicate non-ischaemic cardiac damage
  1. Olena lakunchykova1,
  2. Maria Averina1,2,
  3. Tom Wilsgaard1,
  4. Hugh Watkins3,4,
  5. Sofia Malyutina5,6,
  6. Yulia Ragino6,
  7. Ruth H Keogh7,
  8. Alexander V Kudryavtsev1,8,
  9. Vadim Govorun9,
  10. Sarah Cook1,
  11. Henrik Schirmer1,10,11,
  12. Anne Elise Eggen1,
  13. Laila Arnesdatter Hopstock1,
  14. David A Leon1,12
  1. 1 Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
  2. 2 Department of Laboratory Medicine, University Hospital of North Norway, Tromsø, Norway
  3. 3 Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
  4. 4 Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
  5. 5 Novosibirsk State Medical University, Russian Ministry of Health, Novosibirsk, Russian Federation
  6. 6 Research Institute of Internal and Preventive Medicine, Branch of Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russian Federation
  7. 7 Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
  8. 8 Department of Innovative Programs, Northern State Medical University, Arkhangelsk, Russian Federation
  9. 9 Federal Research and Clinical Center of Physical-Chemical Medicine of the Federal Medical Biological Agency of Russia, Moskva, Russian Federation
  10. 10 Department of Cardiology, Akershus University Hospital, Lorenskog, Norway
  11. 11 Institute of Clinical Medicine, University of Oslo, Oslo, Norway
  12. 12 Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
  1. Correspondence to Olena Lakunchykova, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø 9019, Norway; oia000{at}


Background Russia has one of the highest rates of mortality from cardiovascular disease (CVD). At age 35–69 years, they are eight times higher than in neighbouring Norway. Comparing profiles of blood-based CVD biomarkers between these two populations can help identify reasons for this substantial difference in risk.

Methods We compared age-standardised mean levels of CVD biomarkers for men and women aged 40–69 years measured in two cross-sectional population-based studies: Know Your Heart (KYH) (Russia, 2015–2018; n=4046) and the seventh wave of the Tromsø Study (Tromsø 7) (Norway, 2015–2018; n=17 646). A laboratory calibration study was performed to account for inter-laboratory differences.

Results Levels of total, low-density lipoprotein-, high-density lipoprotein-cholesterol and triglycerides were comparable in KYH and Tromsø 7 studies. N-terminal pro-b-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT) and high-sensitivity C-reactive protein (hsCRP) were higher in KYH compared with Tromsø 7 (NT-proBNP was higher by 54.1% (95% CI 41.5% to 67.8%) in men and by 30.8% (95% CI 22.9% to 39.2%) in women; hs-cTnT—by 42.4% (95% CI 36.1% to 49.0%) in men and by 68.1% (95% CI 62.4% to 73.9%) in women; hsCRP—by 33.3% (95% CI 26.1% to 40.8%) in men and by 35.6% (95% CI 29.0% to 42.6%) in women). Exclusion of participants with pre-existing coronary heart disease (279 men and 282 women) had no substantive effect.

Conclusions Differences in cholesterol fractions cannot explain the difference in CVD mortality rate between Russia and Norway. A non-ischemic pathway to the cardiac damage reflected by raised NT-proBNP and hs-cTnT is likely to contribute to high CVD mortality in Russia.

  • Cardiovascular disease
  • Epidemiology of cardiovascular disease
  • Biostatistics
  • Cohort studies
  • Epidemiology
  • Statistics
  • Epidemiological methods
  • Pharmacoepidemiology
  • Health inequalities
  • Prescribing
  • Gender
  • Seasonal
  • CHD/Coronary heart

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  • Correction notice This article has been corrected since it first published online. The first author's last name has been corrected to 'Iakunchykova'.

  • Contributors Study design: OL, MA, HS, LH, AEE, DAL. Data analysis: OL, TW, RK, DAL. Data interpretation: OL, MA, HW, SM, YR, AK, VG, SC, HS, AEE, LH, DAL. Drafting manuscript: OL and DAL. Revising manuscript content: OL, MA, HW, SM, RK, YR, AK, VG, SC, HS, AEE, LH, DAL. Approving final version of manuscript: All authors.

  • Funding The KYH study is a component of the International Project on Cardiovascular Disease in Russia (IPCDR). IPCDR was funded by the Wellcome Trust Strategic Award [100217] supported by funds from UiT The Arctic University of Norway; Norwegian Institute of Public Health; the Norwegian Ministry of Health and Social Affairs. The seventh wave of the Tromsø study was funded by UiT The Arctic University of Norway, Northern Norway Regional Health Authority, Norwegian Ministry of Health and Social Services, and Troms Country. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethical approval Ethical approval for the study was received from the ethics committees of the London School of Hygiene & Tropical Medicine (approval number 8808, 24/02/2015), Novosibirsk State Medical University (approval number 75, 21/05/2015), the Institute of Preventative Medicine (no approval number; 26/12/2014), Novosibirsk and the Northern State Medical University, Arkhangelsk (approval number 01/01-15, 27/01/2015). The Regional Committee for Research Ethics approved Tromsø 7 (REC North ref. 2014/940), and The Norwegian Data Inspectorate licensed the data. Study has conformed to the principles embodied in the Declaration of Helsinki.

  • Data sharing statement Data are available upon reasonable request.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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