Changes in the prevalence of atrial fibrillation in the Russian population over a 13-year follow-up

AIM: To study the prevalence of atrial fibrillation (AF) in the Russian urban population cohort aged 45-69 years and its changes over 13-year follow-up during aging. MATERIAL AND METHODS: This cross-sectional long-term prospective study included random population sample of men and women 45-69 years (n=9360, HAPIEE project, Novosibirsk), which was examined in 2003-2005 and was re-examined twice and followed up for about 13±1,00 years in men and 13,1±2,17 years in women. The incidence of AF was assessed for individuals without AF or cardiovascular disease (CVD) at the baseline examination. Statistical analysis was performed using the SPSS software package (v.13.0). RESULTS: In a population sample over a 13-year follow-up, AF prevalence increased from 1,6% (1,1% among women and 2,1% among men) at the age of 45-69 years to 4,2% (3,0% among women and 6,1% among men) aged 55-84 years according to screening rest ECG examinations. The prevalence of new AF cases over a 13-year followup in the cohort of 45-69 years old without previous CVD and AF was 5,6%, of which 40% were paroxysmal. The mean age at the time of first registered AF was 69±6,93 years, and was 2 years higher in women (70,0±6,83) than in men (68±6,93). The average period before the AF onset among people aged 45-69 years without baseline CVD and AF was 7,5±3,83 years for men and 8,1±4,02 years for women. The total prevalence of AF in the population sample was 8,3%. The highest AF prevalence was registered at the age of 65-69 years (11,4%) for men and 5 years later for women (12,0%) (p80 years decreased and amounted to 4,1% among men and 5,7% among women. CONCLUSION: In the Russian population sample (Novosibirsk) aged 45-69, the AF prevalence increased from 1,6 to 8,3% over 13 years of follow-up. In addition, 473 new AF cases were identified, ~40% of which were paroxysmal AF. The prevalence of AF in the Siberian population sample for the 45-60 years age group is comparable with the large Russian and North American studies, but higher for persons aged 60-74 years and lower for older age group, for both men and women

The Risk of Type 2 Diabetes Mellitus in a Russian Population Cohort According to Data from the HAPIEE Project

The aim of this study is to investigate the 14-year risk of type 2 diabetes mellitus (T2DM) and develop a risk score for T2DM in the Siberian cohort. A random population sample (males/females, 45–69 years old) was examined at baseline in 2003–2005 (Health, Alcohol, and Psychosocial Factors in Eastern Europe (HAPIEE) project, n = 9360, Novosibirsk) and re-examined in 2006–2008 and 2015–2017. After excluding those with baseline T2DM, the final analysis included 7739 participants. The risk of incident T2DM during a 14-year follow-up was analysed using Cox regression. In age-adjusted models, male and female hazard ratios (HR) of incident T2DM were 5.02 (95% CI 3.62; 6.96) and 5.13 (95% CI 3.56; 7.37) for BMI ≥ 25 kg/m2; 4.38 (3.37; 5.69) and 4.70 (0.27; 6.75) for abdominal obesity (AO); 3.31 (2.65; 4.14) and 3.61 (3.06; 4.27) for fasting hyperglycaemia (FHG); 2.34 (1.58; 3.49) and 3.27 (2.50; 4.26) for high triglyceride (TG); 2.25 (1.74; 2.91) and 2.82 (2.27; 3.49) for hypertension (HT); and 1.57 (1.14; 2.16) and 1.69 (1.38; 2.07) for family history of diabetes mellitus (DM). In addition, secondary education, low physical activity (PA), and history of cardiovascular disease (CVD) were also significantly associated with T2DM in females. A simple T2DM risk calculator was generated based on non-laboratory parameters. A scale with the best quality included waist circumference >95 cm, HT history, and family history of T2DM (area under the curve (AUC) = 0.71). The proposed 10-year risk score of T2DM represents a simple, non-invasive, and reliable tool for identifying individuals at a high risk of future T2DM

Ассоциации сердечно-сосудистых заболеваний и сахарного диабета 2 типа с офтальмологическими заболеваниями в популяционной выборке старше 55 лет = Associations of cardiovascular diseases and type 2 diabetes with ophthalmic diseases in a population sample over 55 years old

Цель. Изучение ассоциаций сердечно-сосудистых заболеваний и сахарного диабета 2 типа (СД-2) с офтальмологическими заболеваниями в популяционной выборке мужчин и женщин от среднего до старческого возраста (Новосибирск). / Материал и методы. Популяционная когорта исходно обследована в 2003-2005гг (n=9360, 45-69 лет, Новосибирск, проект HAPIEE (Health, Alcohol and Psychosocial factors in Eastern Europe). При повторном обследовании (2015-2017гг) в случайной подвыборке (n=1011) идентифицировали офтальмологические заболевания (ОЗ) — гипертоническую ретинопатию (ГР), диабетическую ретинопатию (ДР), катаракту, глаукому, возрастную макулярную дистрофию (ВМД), патологию оптического диска и другие ОЗ. / Результаты. Распространенность признаков ГР у лиц с артериальной гипертензии (АГ) и без АГ составила 81 и 46%, соответственно (p<0,001), ассоциация сохранялась независимо от других факторов, отношение шансов =2,27 (95% доверительный интервал: 1,78-4,17). Связи ВМД, катаракты и ДР с АГ в многофакторных моделях нивелировались и преимущественно объяснялись метаболическими факторами. У лиц с СД-2 чаще, чем без СД-2, встречались признаки ДР (9,3 vs 0,4%, p<0,001), ВМД (22 vs 17%, p=0,042) и глаукома (14 vs 7%, p=0,001); ассоциации СД-2 с ДР и глаукомой сохранялись независимо от других факторов. Шанс иметь признаки ГР у лиц с каротидным атеросклерозом (АСА) был выше в 1,6 раз, чем у лиц без АСА при поправке на пол, возраст и курение (p=0,013). / Заключение. В обследованной популяционной выборке преимущественно пожилого возраста выявили ряд ассоциаций между кардиометаболическими и распространенными ОЗ. Идентифицированные варианты коморбидности могут иметь важное лечебно-профилактическое применение в стареющей популяции. // Aim. To study associations of cardiovascular diseases and type 2 diabetes (T2D) with ophthalmic diseases in a population sample of men and women from middle to old age (Novosibirsk). / Material and methods. The population cohort was initially studied in 2003-2005 (n=9360, 45-69 years old, Novosibirsk, the Health, Alcohol and Psychosocial factors in Eastern Europe (HAPIEE) project). At the second survey (2015-2017) in a random subsample (n=1011), the following ophthalmic diseases were identified: hypertensive retinopathy (HR), diabetic retinopathy (DR), cataract, glaucoma, age-related macular degeneration (AMD), optic disc abnormalities, etc. / Results. The prevalence of HR signs in persons with and without hypertension (HTN) was 81 and 46%, respectively (p<0,001). This association persisted regardless of other factors (odds ratio, 2,27 (95% confidence interval: 1,78-4,17). The prevalence of AMD, cataract and DR increased in HTN, but associations were largely explained by metabolic factors in multivariate models. People with T2D more often than without T2D had signs of DR (9,3 vs 0,4%, p<0,001), AMD (22 vs 17%, p=0,042) and glaucoma (14 vs 7%, p=0,001). Associations of T2D with DR and glaucoma persisted regardless of other factors. Individuals with carotid atherosclerosis (CA) were 1,6 times more likely to have HR than those without CA when adjusted for sex, age, and smoking (p=0,013). / Conclusion. In the surveyed population sample of mainly elderly people, a number of associations between cardiometabolic and common ophthalmic diseases were revealed. The identified comorbidities may have important therapeutic and prophylactic applications in an aging population

Dynamics of cognitive functions in ageing and their relationship to education level = Динамика когнитивных функций при старении и их связь с уровнем образования

Age-related cognitive changes in the Russian population have not been sufficiently studied. Objective: to assess the time course of changes in cognitive functions (CF) in two serial measurements 9 years apart in the urban population of middle, elder, and senile age and their relationship to education level. Patients and methods. A random male and female sample of 45-69-year-old Novosibirsk residents (n=9360; HAPIEE project) was surveyed. CF was tested by standard methods. Resurvey was conducted in a random subsample (n=1663) included in this analysis. The mean follow-up period was 8.8 years (SD 1.1). Results and discussion. The test for semantic verbal fluency revealed its dynamic decline in all age groups, which was steeper in women than in men (p<0.001). Persons aged 70 years and older showed negative changes in memory, verbal fluency, and attention (p<0.001). Persons with primary (6%) and vocational (26%) education had steeper rates of decline in delayed recall (p=0.011; 0.038) than those with university education (35%). Conclusion. It is established that a dynamic decrease in CF begins at the age of 55–59 years; it is steeper among those aged 70 years and older. An age-related decline in memory function is accelerated in persons with lower educational levels

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30–79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30–79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306–359) million women and 317 (292–344) million men in 1990 to 626 (584–668) million women and 652 (604–698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55–62) of women and 49% (46–52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43–51) of women and 38% (35–41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20–27) for women and 18% (16–21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. Funding WHO

Worldwide trends in diabetes prevalence and treatment from 1990 to 2022: a pooled analysis of 1108 population-representative studies with 141 million participants

Background Diabetes can be detected at the primary health-care level, and effective treatments lower the risk of complications. There are insufficient data on the coverage of treatment for diabetes and how it has changed. We estimated trends from 1990 to 2022 in diabetes prevalence and treatment for 200 countries and territories. Methods We used data from 1108 population-representative studies with 141 million participants aged 18 years and older with measurements of fasting glucose and glycated haemoglobin (HbA1c), and information on diabetes treatment. We defined diabetes as having a fasting plasma glucose (FPG) of 7·0 mmol/L or higher, having an HbA1c of 6·5% or higher, or taking medication for diabetes. We defined diabetes treatment as the proportion of people with diabetes who were taking medication for diabetes. We analysed the data in a Bayesian hierarchical meta-regression model to estimate diabetes prevalence and treatment. Findings In 2022, an estimated 828 million (95% credible interval [CrI] 757–908) adults (those aged 18 years and older) had diabetes, an increase of 630 million (554–713) from 1990. From 1990 to 2022, the age-standardised prevalence of diabetes increased in 131 countries for women and in 155 countries for men with a posterior probability of more than 0·80. The largest increases were in low-income and middle-income countries in southeast Asia (eg, Malaysia), south Asia (eg, Pakistan), the Middle East and north Africa (eg, Egypt), and Latin America and the Caribbean (eg, Jamaica, Trinidad and Tobago, and Costa Rica). Age-standardised prevalence neither increased nor decreased with a posterior probability of more than 0·80 in some countries in western and central Europe, sub-Saharan Africa, east Asia and the Pacific, Canada, and some Pacific island nations where prevalence was already high in 1990; it decreased with a posterior probability of more than 0·80 in women in Japan, Spain, and France, and in men in Nauru. The lowest prevalence in the world in 2022 was in western Europe and east Africa for both sexes, and in Japan and Canada for women, and the highest prevalence in the world in 2022 was in countries in Polynesia and Micronesia, some countries in the Caribbean and the Middle East and north Africa, as well as Pakistan and Malaysia. In 2022, 445 million (95% CrI 401–496) adults aged 30 years or older with diabetes did not receive treatment (59% of adults aged 30 years or older with diabetes), 3·5 times the number in 1990. From 1990 to 2022, diabetes treatment coverage increased in 118 countries for women and 98 countries for men with a posterior probability of more than 0·80. The largest improvement in treatment coverage was in some countries from central and western Europe and Latin America (Mexico, Colombia, Chile, and Costa Rica), Canada, South Korea, Russia, Seychelles, and Jordan. There was no increase in treatment coverage in most countries in sub-Saharan Africa; the Caribbean; Pacific island nations; and south, southeast, and central Asia. In 2022, age-standardised treatment coverage was lowest in countries in sub-Saharan Africa and south Asia, and treatment coverage was less than 10% in some African countries. Treatment coverage was 55% or higher in South Korea, many high-income western countries, and some countries in central and eastern Europe (eg, Poland, Czechia, and Russia), Latin America (eg, Costa Rica, Chile, and Mexico), and the Middle East and north Africa (eg, Jordan, Qatar, and Kuwait). Interpretation In most countries, especially in low-income and middle-income countries, diabetes treatment has not increased at all or has not increased sufficiently in comparison with the rise in prevalence. The burden of diabetes and untreated diabetes is increasingly borne by low-income and middle-income countries. The expansion of health insurance and primary health care should be accompanied with diabetes programmes that realign and resource health services to enhance the early detection and effective treatment of diabetes. Funding UK Medical Research Council, UK Research and Innovation (Research England), and US Centers for Disease Control and Prevention

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background: Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories.Methods: We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age.Findings: The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran.Interpretation: Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings.Copyright (C) 2021 World Health Organization; licensee Elsevier.</p

General and abdominal adiposity and hypertension in eight world regions: a pooled analysis of 837 population-based studies with 7•5 million participants

Background Adiposity can be measured using BMI (which is based on weight and height) as well as indices of abdominal adiposity. We examined the association between BMI and waist-to-height ratio (WHtR) within and across populations of different world regions and quantified how well these two metrics discriminate between people with and without hypertension. Methods We used data from studies carried out from 1990 to 2023 on BMI, WHtR and hypertension in people aged 20–64 years in representative samples of the general population in eight world regions. We graphically compared the regional distributions of BMI and WHtR, and calculated Pearson's correlation coefficients between BMI and WHtR within each region. We used mixed-effects linear regression to estimate the extent to which WHtR varies across regions at the same BMI. We graphically examined the prevalence of hypertension and the distribution of people who have hypertension both in relation to BMI and WHtR, and we assessed how closely BMI and WHtR discriminate between participants with and without hypertension using C-statistic and net reclassification improvement (NRI). Findings The correlation between BMI and WHtR ranged from 0·76 to 0·89 within different regions. After adjusting for age and BMI, mean WHtR was highest in south Asia for both sexes, followed by Latin America and the Caribbean and the region of central Asia, Middle East and north Africa. Mean WHtR was lowest in central and eastern Europe for both sexes, in the high-income western region for women, and in Oceania for men. Conversely, to achieve an equivalent WHtR, the BMI of the population of south Asia would need to be, on average, 2·79 kg/m2 (95% CI 2·31–3·28) lower for women and 1·28 kg/m2 (1·02–1·54) lower for men than in the high-income western region. In every region, hypertension prevalence increased with both BMI and WHtR. Models with either of these two adiposity metrics had virtually identical C-statistics and NRIs for every region and sex, with C-statistics ranging from 0·72 to 0·81 and NRIs ranging from 0·34 to 0·57 in different region and sex combinations. When both BMI and WHtR were used, performance improved only slightly compared with using either adiposity measure alone. Interpretation BMI can distinguish young and middle-aged adults with higher versus lower amounts of abdominal adiposity with moderate-to-high accuracy, and both BMI and WHtR distinguish people with or without hypertension. However, at the same BMI level, people in south Asia, Latin America and the Caribbean, and the region of central Asia, Middle East and north Africa, have higher WHtR than in the other regions. Funding UK Medical Research Council and UK Research and Innovation (Innovate UK)

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI 2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity. Funding UK Medical Research Council, UK Research and Innovation (Research England), UK Research and Innovation (Innovate UK), and European Union