Why does Russia have such high cardiovascular mortality rates? Comparisons of blood-based biomarkers with Norway implicate non-ischaemic cardiac damage

• Published in: Journal of Epidemiology and Community Health
• Main Authors: lakunchykova, Olena, Averina, Maria, Wilsgaard, Tom, Watkins, Hugh, Malyutina, Sofia, Ragino, Yulia, Keogh, Ruth H, Kudryavtsev, Alexander V, Govorun, Vadim, Cook, Sarah, Schirmer, Henrik, Eggen, Anne Elise, Hopstock, Laila Arnesdatter, Leon, David A
• Format: Text
• Language: English
• Published: BMJ Publishing Group 2020
• Subjects: Original Research; Norway; Tromsø
• Online Access: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7577103/; http://www.ncbi.nlm.nih.gov/pubmed/32414935; https://doi.org/10.1136/jech-2020-213885

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.