HEALTHCARE RESOURCES UTILIZATION AND TEMPORARY DISABILITY IN POPULATION AGED 50-64 ACCORDING TO THE EPIDEMIOLOGICAL ESSE-RF STUDY

Aim. To analyze health care resource utilization and temporary disability in people of pre-retirement age in the Russian population.Material and methods. The analysis was carried out on the basis of the ESSE-RF study materials (13 regions of the RF). Standard epidemiological survey methods and evaluation criteria were used. The analysis included results of a survey of the ESSE-RF study participants about health care resource utilization and temporary disability (TD) during 12 months before the survey. The following characteristics were ascertained: a number and reasons of outpatient visits for medical assistance, hospital admissions (including duration of in-hospital treatment), emergency calls and temporary disability (a number of days and cases), their mean number per one study participant, mean number of cases and days of TD per 100 working participants, associations with social-demographic parameters, risk factors, chronic non-communicable diseases, stress and anxiety levels by the Hospital Anxiety and Depression Scale (HADS).Results. A total of 8334 people aged 50-64 years were examined: men – 2784 (33%) and women – 5550 (67%). A share of the hospitalized (at least one time) was 11% in the age group of 50-54 years, 12% – in the age group of 55-59 years and by the age of 60-64 this indicator increased to 15%. 20% of the participants at least one time were admitted to hospital and/or called an ambulance. A share of people who had utilized health care resources at least one time was increasing with age. Unemployed people were hospitalized more frequently than employed ones. Number of chronic non-communicable diseases correlated with the probability of hospitalization and/or emergency call. Categories 2 and 3 of disability, presence of diabetes mellitus, ischemic heart disease and hypertension were statistically significantly associated with the probability of hospitalization and/or emergency call. Smoking did not increase the probability of hospitalization and/or emergency call in comparison with absence of this risk factor, at that, people who had given up smoking were 1.3 times more likely to be hospitalized than non-smokers. People with low and moderate alcohol consumption were hospitalized and called an ambulance significantly less often than those who abstained from alcohol. Clinically significant anxiety increased the probability of hospital admission and/or emergency call as compared to people without this factor by the HADS. Subclinical and clinically significant anxiety, mean and high levels of stress were associated with the probability of hospitalization and/or emergency call. Number of TD days turned out to be rather low - 0.3 day per 1 working man and 0.4 day - per 1 working woman, this index did not significantly differ with age.Conclusion. So, pre-retirement age (50-64 years) is characterized by increase in health care resource utilization due to health state worsening. At the same time significant share of people of this age (40%) did not seek medical help. These 40% of pre-retirement age people can be possible reserve for health state improvement by means of their active involvement in preventive activity of primary health care system (the study had been conducted before the preventive medical examination program starting)

Survival prognosis in individuals with a high spatial QRS-T angle

Aim. To evaluate medium-term survival without irreversible and fatal cardiovascular events in individuals with a high spatial QRS-T angle (sQRS-Ta) from a regional Russian sample.Material and methods. We analyzed 1394 electrocardiographic records from a random regional sample of men (30%) and women aged 25-64, which were included in the ESSE-RF1 study. Women were on average 5 years older than men, but there was no difference in mean age in the 45-64 groups. The follow-up period lasted 7 year; 26 irreversible events (cardiovascular death, non-fatal myocardial infarction or stroke) and 63 composite endpoints (CEs) (irreversible event or heart failure progression or revascularization) were identified. Irreversible events and composite endpoint in men were noted more often than in women as follows: 3,7% vs 1,1% (p=0,003) and 6,9% vs 3,6% (p=0,01), respectively. sQRS-Ta was estimated as the angle between the integral QRS and T vectors in the orthogonal leads. Survival was assessed by Kaplan-Meier curves using a log-rank test. Differences were considered significant at p≤0,05. Results. Sex groups did not differ in mean sQRS-Ta. sQRS-Ta ≥90o was considered to be increased. The divergence of survival curves by the end of follow-up period in men with increased sQRS-Ta relative to men with sQRS-Ta <900 was greater than in women as follows: 0,88 vs 0,96 for CE (p=0,0026) and 0,93 vs 0,96 for irreversible events (p=0,009); in women — 0,94 vs 0,98 for CE only (p=0,0016). Initial event and CE in men with increased sQRS-Ta occurred earlier than those with normal sQRS-Ta and then in women with increased sQRS-Ta. There were no differences in the frequency of sQRS-Ta increase among 45-64-year-old men and women, but irreversible events in men with increased sQRS-Ta occurred 5 times more often than in women. According to two-stage logistic regression, the probability of irreversible event in men is 4,35 times higher than in women (p=0,0002). After adjusting for sex, in individuals with increased sQRS-Ta, it is 2,75 times higher than in individuals with sQRS-Ta <90o (p=0,015).Conclusion. In men with increased sQRS-Ta (≥90o), survival without irreversible and fatal cardiovascular events was worse, and life expectancy was shorter than in men with normal sQRS-Ta or women with increased sQRS-Ta. The prognosis of irreversible events was significantly affected by male sex and sQRS-Ta increase

Association of Heart Rate Variability with the Psychosocial Stress Level in Men 41-44 Years Old Living in Moscow

Aim. Research of the association of heart rate variability (HRV) with the level of psychosocial stress (PS) and other indicators of the risk of cardiovascular diseases in a sample of 41-44-year-old men living in Moscow.Material and methods. A total of 299 men aged 41-44 years were examined. The study included a clinical examination and a survey using a standard questionnaire. The categorization of risk factors (RF) for cardiovascular diseases (CVD) was carried out in accordance with generally accepted criteria The psychosocial stress was assessed using the Reeder scale. Depending on the psychosocial stress level, all surveyed men were divided into 3 groups by terciles: group 1 (3,28-4,0 points) – mild stress, group 2 (2,71-3,14) – moderate stress, group 3 (1,28-2,57) – severe stress. The analysis of HRV was performed on the basis of a short recording of an electrocardiogram using the original software package.Results. Nonparametric ANOVA showed that the mean [M (95% CI)] values of the HRV time domain (SDNN, rMSSD and the state of regulatory reserves) were lower in the group of men with high PS compared with the group with low PS [25.3 ms (20.9-29.7) versus 40.5 ms (30.7-50.3), p=0.007; 29.5 ms (24.6-34.3) versus 49.5 ms (36.7-62.3), p=0.030; and 46.7 (44.7-48.6) versus 49.7 (48.1-51.4), p=0.019; respectively]. On the contrary, the mean values [M (95% CI)] of the integral indicators of HRV (SI and IVR) were higher in the group of men with high PS [635.8 c.u. (556.2-715.4) versus 488.9 (423.8-554.1), p=0.005; 1172.6 (1045.1-1300.1) versus 904.7 (790.0-1019.4), p=0.003; respectively]. The results of correlation and multiple regression analysis confirmed that these HRV indicators are statistically significantly associated not only with PS, but also with other indicators (age, waist / hip ratio, diastolic blood pressure). However, their predictive value turned out to be low, and the proportion of the explained variance of HRV indices ranged from 2.5 to 13.1%.Conclusion. The weakening of the autonomous regulation of the heart rate with a decrease in the activity of the parasympathetic link, the activation of the central circuit of regulation with the prevalence of sympathetic influences, a decrease in the functional reserves of the heart rate regulation system are associated with an increase in the level of PS and other indicators of the risk of cardiovascular diseases

A new bivalve fauna from the Permian-Triassic boundary section of southwestern China

A new marine bivalve fauna from the continuous Upper Permian Longtan Formation to Lower Triassic Yelang Formation of the Zhongzai section in southwestern China is documented. Four bivalve assemblages spanning the Permian–Triassic boundary are recognized and regionally correlated in South China. The bivalve assemblages changed from elements dominated by Palaeozoic types to those dominated by Mesozoic types. Three new species, Claraia zhongzaiensis sp. nov., Claraia sp. nov. 1 and Claraia sp. nov. 2, are described

Non-High Density Lipoprotein Cholesterol: A Modern Benchmark for Assessing Lipid Metabolism Disorders

Aim. To perform a population analysis of Non-High Density Lipoprotein Cholesterol level (non-HDL-c) in Russian population and to evaluate its association with cardiovascular events.Material and Methods. The material consisted of results obtained from 11 regions of the ESSE-RF1 Study and from 4 regions of the ESSE-RF2 Study. Study protocols were identical. The studies were performed in 2012-2014 and 2017, respectively. Endpoints were assessed in 19041 people aged 35-64 years. The median follow-up was 6.5 years in ESSE RF (1) and 3.8 years in ESSE RF(2). Analysis was performed for three lipid variables: total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and non-HDLC in two samples: the general population sample and the same sample without individuals with coronary heart disease (CHD), myocardial infarction (MI) and/or stroke history and not taking statins (the population sample of "without a history of cardiovascular diseases [CVD]". The analysis of nonlinear associations was performed using the generalized additive Cox model. The combined cardiovascular endpoint was represented by cardiovascular death and nonfatal MI and stroke. Traditional and laboratory FRs, socio-demographic parameters were analyzed. The significance level for all tested hypotheses was set to be 0.05.Results. The prevalence of elevated non-HDL-C level (>3.7 mmol/l) was found to be 74.6%. No gender differences were found: there was 74.6% for men and 74.5% for women. Both mean values and prevalence of elevated non-HDL-C were increased with age in women, and its level was slightly decreased in men after 55 years old. Almost all analyzed RFs were significantly associated with elevated non-HDL-C in these two population samples. In both samples elevated total CH and elevated LDL-C were associated with all-cause mortality after correction for all RFs. On the contrary, the non-HDL-C was associated with CVD combined end pints. It has been shown that the risk of these end points increases uniformly with increase in levels of non HDL cholesterol, no nonlinear associations were found.Conclusion. The results of a population-based analysis of non-HDL-C performed in the Russian population for the first time confirmed that elevated non-HDL-C levels contribute significantly to determining the risk of cardiovascular events in the medium term. It can be assumed that the new risk scales (SCORE2 and SCORE OP) proposed by the European Society of Cardiology and the European Society of Preventive Cardiology, which include non-HDL C instead of TC, will allow adequate assessment of 10-year cardiovascular risk for Russians. However, continued monitoring of endpoints in order to obtain stable associations is required

Myocardial infarction in the population of some Russian regions and its prognostic value

Aim. To study the prevalence of myocardial infarction (MI) in the population of Russian regions and its contribution to cardiovascular events.Material and methods. The analysis material was representative samples of the population aged 35-64 years from 11 Russian regions,  examined within the multicenter study “Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions  of Russian Federation”. The response rate was about 80%. The study used a community-based  systematic stratified multiply random sample. During the study, information on prior MI was obtained using a standard questionnaire. Anthropometry and measurement of blood pressure (BP) and heart rate (HR) with an automatic BP monitor were performed. Resting electrocardiography (ECG) was performed, followed by Minnesota coding. Major and minor QQS waves and STT segments were considered as ischemic  ECG abnormalities. Biochemical parameters were determined using an Arkhitect 000 Clinical Chemistry Analyzer. The median prospective  follow-up was 6,21 [5,25; 6,75] years. A composite endpoint (CE) was analyzed, including cardiovascular death and non-fatal MI. During the follow-up period, 363 all-cause deaths were detected,  of which 134 were from cardiovascular diseases, while 196 — CEs. Statistical analysis was carried out in R 3.6.1 environment.Results. The MI prevalence among the Russian population was 2,9%; 5,2% for men and 1,5% for women,  increasing  with age. Men with prior MI were  more likely to take statins and beta-blockers  than women as follows: 39,0% vs 25,6% and 29,3% vs 27,1%, respectively. MI newly diagnosed within the follow-up  period was associated with the following risk factors (RFs): smoking, increased BP, HR, triglycerides and glucose.  For individuals with prior MI, a significant relationship was found only with smoking.  Multiple comparison  of the contribution of RFs, ECG abnormalities,  and prior MI showed  that the inclusion of ischemic ECG abnormalities in the analysis significantly increases  the risk of cardiovascular events in individuals without prior MI compared with individuals without both MI and ECG changes.  A high CE risk was noted in patients with prior MI: relative risk (RR), 4,73 (2,92-7,65); the addition of ischemic ECG abnormalities increased the RR to 5,75 (3,76-8,8).Conclusion. The RR of CEs in patients  with prior MI without or with ischemic ECG changes  is 4,73 and 5,75 times higher than in patients without MI and ECG abnormalities. The risk factors  identified  in this case cannot explain such an increase  in CEs. It is obvious  that people  with prior MI need  rehabilitation. The presence of RFs in patients with newly diagnosed  MI indicates insufficient primary prevention, which suggests  that strengthening preventive measures to eliminate conventional risk factors in patients with newly diagnosed  MI will help reduce the risk of recurrent MI or cardiovascular  mortality

The prevalence of traditional risk factors for cardiovascular disease in the Omsk region: data of the ESSE-RF2 study

Aim. To study the prevalence of some traditional risk factors for cardiovascular disease (CVD) in the Omsk region.Material and methods. The prevalence of traditional risk factors for CVD in a representative sample of the Omsk region population aged 25-64 years (n=1,648) was estimated as a part of the ESSE-RF2 study in 2017.Results. It was established that the mean age of CVD detection in the Omsk region is 46,3 years, the prevalence of overweight is 35,0%, obesity — 30,3%. Abdominal obesity was detected in 56,8% of subjects. Smoking was reveled in 21,2% of the population, former smoking — 20,0%. Alcohol consumption more than 2 times a month was observed in one third of respondents (30,5%). In the group of healthy people, compared with CVD patients, the percentage of smokers and alcohol consumers was detected significantly more often: smoking — 25,2±1,26% vs 17,1±0,86% and 32,9±1,6% vs 28,1±1,4%, respectively. Perhaps it was the diseases the reason for smoking cessation and alcohol abstinence among people with CVD. It should be noted that among 70% of alcohol consumers, both with/ without CVD, strong drinks were the preferred type of alcohol. Hypertension (HTN) was observed in 47,9% of subjects, and in 43,1% the diagnosis was verified. In 4,8% of HTN individuals, blood pressure increase was detected for the first time in this study. The prevalence of diabetes of both types in the Omsk region was 6,7%, and in group A (with CVD) it was much higher than in group B (without CVD): 10,7% vs 2,8%. Type 2 diabetes prevailed in people with CVD (p=0,000005). This was not characteristic of type 1 diabetes.Conclusion. The most common risk factors for CVD in the Omsk region population were HTN (47,9%), abdominal obesity (56,8%), a positive family history of early CVD (62,0%), alcohol consumption over the past 12 months (71,7%) and strong alcohol drinking (72,0%). However, a significant portion of the subjects (41,3%) consumed alcohol no more than 1 time per month

Eating habits among the Omsk Oblast population and poor nutrition in association with cardiovascular diseases according to the ESSE-RF2 study

Aim. To assess the prevalence of eating habits among the Omsk Oblast population and their association with cardiovascular diseases (CVDs) according to the ESSERF2 study.Material and methods. In the ESSE-RF2 study with persons aged 25-64 years (random sample, n=1648), the dietary habits of 21 food groups were assessed using the questionnaire method. Results. Insufficient consumption of vegetables and fruits was revealed in 60,0% and 68,7% of the region’s population, which is 1,5-2,2 times higher than amongRussians. The daily intake of cereals is 2,3 times higher than that of pasta, especially in those with CVDs. In the region, poultry is preferred. Poultry at least once a week is consumed by 91,7% of Omsk residents, red meat — 74,8%, and fish — only 35,2% (vs 84,7%, 83,1% and 65,1% in Russians, respectively). The daily intake of liquid dairy products is low. Cheese and cottage cheese is consumed significantly lower than the national average, while legumes — 4 times lower. The presence of confectionery in the daily diet of 40,3% of Omsk residents looks more favorable than the average among Russians. In addition, 50% of the population eat pickles only 1-2 times a month (significantly less than in Russia). On the contrary, 60,9% of Omsk residents regularly (daily-weekly) consume meat and sausages (56,0% in Russia, p=0,000). Omsk residents with CVDs refrain from excessive consumption of sugar, other sweets, meat and sausages, pickles and marinades. They are almost 2 times more likely to exclude red meat from the diet or reduce its daily consumption than people without CVDs. Salting of cooked food, consumption of vegetables and fruits, fish, seafood and dairy products practically did not depend on CVDs.Conclusion. The food habits of Omsk residents differs from the national one in many products. People with CVDs have unfavorable eating habits: reduced consumption of fresh vegetables, fruits, fish, seafood, legumes and nuts. Patients do not change their diet in favor of cardioprotective products and decrease in adding more salt. Although, they more often refuse meat and sausages, pickles, marinades, sweets, and pasta, and increase the consumption of cereals

Hypotension and survival: diagnostic criteria in Russian and United States population

Aim. Based on Russian and United States population studies, to determine the criterion for distinguishing between normal and low blood pressure (BP), which is the most significant for predicting all-cause mortality.Material and methods. We used data from prospective Russian studies of 14730 men aged 19-82 years (9307 deaths per 342309 person-years of followup) and 6141 women aged 18-72 years (2101 deaths per 158727 person-years of follow-up), and two United States population studies: the First National Health and Nutrition Examination Survey (NHANES I) in conjunction with the NHANES I Epidemiologic Followup Study, and the Second National Health and Nutrition Examination Survey (NHANES II) in conjunction with the NHANES II Mortality Study. The total American cohort included only white subjects: 8618 men aged 25-75 years (3130 deaths per 121794 person-years of follow-up) and 11135 women 25-75 years (2465 deaths per 176676 person-years of follow-up). Primary examinations were carried out in 1971-1982, while the latest information on the subjects’ survival status was obtained in 2017 (Russia) and 1992 (USA). KaplanMeier curves and Cox proportional hazards models were created; all-cause death was taken into account as an outcome.Results. Survival analysis using Cox models, in which, in addition to BP levels, sex, age and risk factors were taken into account, showed that in persons with a pronounced BP decrease, survival is worse in comparison with those with normal BP. Mean dynamic BP, unfavorable for all-cause mortality, was below 70 and 68 mm Hg and 76 and 72 mm Hg in men and women in the Russian and US cohorts, respectively.Conclusion. Not only hypertension, but also severe hypotension is associated with increased all-cause mortality compared to normal BP. Survival decrease is manifested in severe hypotension, subject to sex and adjustment for age and risk factors

Prevalence of arterial hypotension with a poor prognosis in populations of the Russian Federation and the United States of America

Aim. To study the prevalence of hypotension (HoTN) with an unfavorable prognosis in populations of the Russian Federation and the United States of America in a thirty-year perspective.Material and methods. We used data from Russian population-based studies performed in 1975-1982 at the now-familiar National Medical Research Center for Therapy and Preventive Medicine, and the study Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF) in 2012-2014. A comparison was made with data from studies of US population of the National Health and Nutrition Examination Survey (NHANES): NHANES II (1976-1980) and Continuous NHANES (2007-2012). Age, sex, systolic and diastolic blood pressure were analyzed. The proportion of persons with HoTN (prevalence) was calculated in men and women of five age groups using the original HoTN criterion. Results. We used the previously developed criterion of HoTN with an unfavorable prognosis: for Russian populations, the mean dynamic pressure is <76 and <72 mm Hg, respectively. The prevalence of HoTN in modern populations was 0,1±0,5% in Russia and 6,0±8,7% in the USA (confidence interval for significance level P=0,95). For 30 years, the prevalence of HoTN in Russia according to this criterion has not changed, while in the USA it has increased both in men (on average 3 times) and in women (2,5 times).Conclusion. The prevalence of unfavorable HoTN in the US adult population is many times higher than in Russia over the entire analyzed period of time, while over 30 years in the US it has increased by 2,5-3 times