@article {lakunchykova698, author = {Olena lakunchykova and Maria Averina and Tom Wilsgaard and Hugh Watkins and Sofia Malyutina and Yulia Ragino and Ruth H Keogh and Alexander V Kudryavtsev and Vadim Govorun and Sarah Cook and Henrik Schirmer and Anne Elise Eggen and Laila Arnesdatter Hopstock and David A Leon}, title = {Why does Russia have such high cardiovascular mortality rates? Comparisons of blood-based biomarkers with Norway implicate non-ischaemic cardiac damage}, volume = {74}, number = {9}, pages = {698--704}, year = {2020}, doi = {10.1136/jech-2020-213885}, publisher = {BMJ Publishing Group Ltd}, abstract = {Background Russia has one of the highest rates of mortality from cardiovascular disease (CVD). At age 35{\textendash}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{\textendash}69~years measured in two cross-sectional population-based studies: Know Your Heart (KYH) (Russia, 2015{\textendash}2018; n=4046) and the seventh wave of the Troms{\o} Study (Troms{\o} 7) (Norway, 2015{\textendash}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 Troms{\o} 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 Troms{\o} 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{\textemdash}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{\textemdash}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.}, issn = {0143-005X}, URL = {https://jech.bmj.com/content/74/9/698}, eprint = {https://jech.bmj.com/content/74/9/698.full.pdf}, journal = {Journal of Epidemiology \& Community Health} }