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• Back to the topic: high cardiovascular mortality in Russia
  Sergei V. Jargin
  Published on: 23 September 2020

• Published on: 23 September 2020

  Back to the topic: high cardiovascular mortality in Russia

  • Sergei V. Jargin, pathologist Peoples' Friendship University of Russia

  The question “Why does Russia have such high cardiovascular (CV) mortality rates?”1 can be answered by a pathologist who practiced during the Soviet time.2 Since then, the quality of post mortem examinations has decreased especially during the 1990s: autopsies were sometimes made perfunctorily. The deterioration in anatomic pathology and the health care in general during the 1990s coincided with the increase in the registered CV mortality. A tendency to over-diagnose CV diseases is generally known to exist also for people dying at home and not undergoing autopsy. If a cause of death is not entirely clear, it has been usual to write on a death certificate: “Ischemic heart disease with cardiac insufficiency” or a similar formulation.2 Concerning the relatively high CV mortality in Russia, it should be commented that irregular treatment of hypertension,3 diabetes and other chronic diseases continues to be a problem. Considering the above, the differences between Norwegian and Russian cohorts1 can be better understood. The levels of serum lipids were comparable between Russia and Norway being slightly higher in the latter possibly due to better nutrition. Interestingly, 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 Russia.1 It can be reasonably assumed that average levels of these markers inversely correlate with a nation’s health reflected by the life expecta...

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  The question “Why does Russia have such high cardiovascular (CV) mortality rates?”1 can be answered by a pathologist who practiced during the Soviet time.2 Since then, the quality of post mortem examinations has decreased especially during the 1990s: autopsies were sometimes made perfunctorily. The deterioration in anatomic pathology and the health care in general during the 1990s coincided with the increase in the registered CV mortality. A tendency to over-diagnose CV diseases is generally known to exist also for people dying at home and not undergoing autopsy. If a cause of death is not entirely clear, it has been usual to write on a death certificate: “Ischemic heart disease with cardiac insufficiency” or a similar formulation.2 Concerning the relatively high CV mortality in Russia, it should be commented that irregular treatment of hypertension,3 diabetes and other chronic diseases continues to be a problem. Considering the above, the differences between Norwegian and Russian cohorts1 can be better understood. The levels of serum lipids were comparable between Russia and Norway being slightly higher in the latter possibly due to better nutrition. Interestingly, 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 Russia.1 It can be reasonably assumed that average levels of these markers inversely correlate with a nation’s health reflected by the life expectancy at birth. Indeed, elevated C-reactive protein is known to be associated with various inflammatory conditions. The natriuretic peptide (NP) plays an important role by opposing the vasoconstriction and sodium retention. A plasma NP elevation was found in essential hypertension, decreasing with effective antihypertensive therapy.4 Hs-cTnT is a biomarker for myocardial damage; but other conditions are also associated with its enhanced level: diabetes, COPD, decreased renal function, anaemia etc.5 The insufficient access to modern healthcare,1 higher consumption of alcohol and cigarettes in Russia vs. Norway (the data can be found in Wikipedia), as well as relatively poor quality of alcohol sold in Russia,6 have probably contributed to a higher morbidity. In conclusion, the valuable results by Dr. Iakunchykova and co-workers1 should motivate further search for associations between NT-proBNP, hs-cTnT and other markers with various pathological conditions.
  REFERENCES
  1. Iakunchykova O, Averina M, Wilsgaard T, et al. Why does Russia have such high cardiovascular mortality rates? Comparisons of blood–based biomarkers with Norway implicate non-ischaemic cardiac damage. J Epidemiol Community Health 2020;74:698–704.
  2. Jargin SV. Cardiovascular mortality trends in Russia: possible mechanisms. Nat Rev Cardiol 2015;12:740.
  3. Roberts B, Stickley A, Balabanova D, et al. The persistence of irregular treatment of hypertension in the former Soviet Union. J Epidemiol Community Health 2012;66:1079–82.
  4. Hu W, Zhou PH, Zhang XB, Xu CG, Wang W. Plasma concentrations of adrenomedullin and natriuretic peptides in patients with essential hypertension. Exp Ther Med 2015;9:1901–908.
  5. Wu W, Li DX, Wang Q, et al. Relationship between high-sensitivity cardiac troponin T and the prognosis of elderly inpatients with non-acute coronary syndromes. Clin Interv Aging 2018;13:1091–8.
  6. Jargin SV. Vodka vs. Fortified Wine in Russia: Retrospective View. Alcohol Alcohol 2015;50:624–5.

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  Conflict of Interest:
  None declared.

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