Epidemiology of coronary heart disease in Eastern Siberia (Yakutia)

Abstract

Cardiovascular disease (CVD) is the main reason of death among the population of Eastern Siberia (Yakutia). Monitoring of epidemiological situation of coronary heart disease (CHD) and other CVD allows to make goal-directed preventive programs in region of extreme conditions. Methods: Two casual representative cohorts of men at the ages of 20-54 years during 1985-87 and 1997-99 (n=2666 and n=831, approximately) was examined. The study was carried out according to WHO standard methods. The men formerly examined in 1985-87 were objects of follow-up observation for registration of "end points". Results: The prevalence of high blood pressure was 26.7%, obesity - 23.2 %, smoking - 43.7 %. At the analysis of the lipid spectrum of blood serum was established, that the prevalence of hypercholesterolemia, hypertriglyceridemia and hypoHDLcholesterolemia was 21.5 %, 6.8 % and 3.9 % approximately. The prevalence of CHD was 18.7 %, myocardial infarction - 2.6 %, angina - 7.1 %. Authors established the middle levels of total cholesterol (228.3 mg/dL), tryglicerides (119.1 mg/dL) and HDL cholesterol (55.8 mg/dL). During a 10-year follow-up interval 133 men have died. Age-adjusted rate of total mortality was 4.9 per 1000 person-years, including CVD mortality - 1.9 per 1000 person-years. At an estimation of mortality in quintiles of systolic blood pressure (SBP) direct relation between SBP level and total mortality incidence is detected. Curves of CHD mortality and CVD mortality by their characters reminded "J"-shaped relation. Curves of total mortality and CVD mortality in quintiles of body mass index reminded "U"-shaped relation. CHD, CVD and total mortality were associated with the status of smoking. Relative risk (RR) of CHD, CVD and total mortality sharply grew in 2-3 times at smoking up to 20 cigarettes/day (p<0.01). RR of CHD mortality was 4.7 times higher in those who smoked more than 20 cigarettes/day, then in never smokers (p<0.01). Multivariate (Cox regression model) estimation of relative risk total mortality showed, that the essential contribution to risk of death is made by such variables as raised SBP [OR 1.02, 95%CI (1.01-1.03)], smoking [OR 2.81, 95%CI (1.58-5.00)], age [OR 1.05, 95%CI (1.02-1.08)], presence of angina [OR 2.28, 95%CI (1.14-4.55)]. Conclusion: For last 10 years in Eastern Siberia the epidemiological situation of CHD has worsened. In republic Sakha (Yakutia) the concept of reorganization of public health with a priority of prevention of the basic not infectious diseases is introduced.