The Determinants of the 13-Year Risk of Incident Atrial Fibrillation in a Russian Population Cohort of Middle and Elderly Age

Awareness of Hypertension, Hypercholesterolemia, and Diabetes Mellitus and Associated Characteristics in Russian Adults

Russia has higher cardiovascular disease (CVD) mortality compared to other European countries. The major CVD risk factors are age, male sex, and three conditions, namely hypertension, hypercholesterolemia, and diabetes mellitus (DM). This study aimed to assess awareness of these three conditions among Russian adults (N = 3803) and the associated socio-demographic, lifestyle, and health characteristics. We used cross-sectional data from a randomly drawn population-based sample of Russians aged 35-69 years, who participated in the Know Your Heart (KYH) study conducted in Arkhangelsk and Novosibirsk between 2015-2018. Participants' self-reported awareness of hypertension, hypercholesterolemia, and DM was assessed against the measures at the KYH health check (blood pressure, cholesterol, HbA1c and/or use of medication for each condition). Prevalence estimates for the awareness were age- and sex-standardized to the Standard European Population. Socio-demographic, lifestyle, and health-related correlates of the awareness were investigated using logistic regression modelling. Among participants with hypertension (N = 2206), hypercholesterolemia (N = 3171), and DM (N = 329) recorded at a health check, 79%, 45%, and 61% self-reported these conditions, respectively. Higher awareness of hypercholesterolemia and hypertension was associated with older age, female sex, nonsmoking status, obesity, and history of CVD diagnoses. Low household income and history of CVD diagnoses were associated with being aware of DM. The awareness rates of hypertension were relatively high, whereas awareness rates of hypercholesterolemia and DM were relatively low. CVD prevention and early intervention could be improved in Russia through increasing the awareness of the risk factors.

Blood pressure, hypertension and the risk of atrial fibrillation: a systematic review and meta-analysis of cohort studies

Elevated blood pressure and hypertension have been associated with increased risk of atrial fibrillation in a number of epidemiological studies, however, the strength of the association has differed between studies. We conducted a systematic review and meta-analysis of the association between blood pressure and hypertension and atrial fibrillation. PubMed and Embase databases were searched for studies of hypertension and blood pressure and atrial fibrillation up to June 6th 2022. Cohort studies reporting adjusted relative risk (RR) estimates and 95% confidence intervals (CIs) of atrial fibrillation associated with hypertension or blood pressure were included. A random effects model was used to estimate summary RRs. Sixty eight cohort studies were included in the meta-analysis. The summary RR was 1.50 (95% CI: 1.42-1.58, I2 = 98.1%, n = 56 studies) for people with hypertension compared to those without hypertension (1,080,611 cases, 30,539,230 participants), 1.18 (95% CI: 1.16-1.21, I2 = 65.9%, n = 37 studies) per 20 mmHg increase in systolic blood pressure (346,471 cases, 14,569,396 participants), and 1.07 (95% CI: 1.03-1.11, I2 = 91.5%, n = 22 studies) per 10 mmHg increase in diastolic blood pressure (332,867 cases, 14,354,980 participants). There was evidence of a nonlinear association between diastolic blood pressure and atrial fibrillation with a steeper increase in risk at lower levels of diastolic blood pressure, but for systolic blood pressure the association appeared to be linear. For both systolic and diastolic blood pressure, the risk increased even within the normal range of blood pressure and persons at the high end of systolic and diastolic blood pressure around 180/110 mmHg had a 1.8-2.3 fold higher risk of atrial fibrillation compared to those with a blood pressure of 90/60 mmHg. These results suggest that elevated blood pressure and hypertension increases the risk of atrial fibrillation and there is some increase in risk even within the normal range of systolic and diastolic blood pressure.

Decomposition analysis of health inequalities between the urban and rural oldest-old populations in China: Evidence from a national survey

The number of Chinese oldest-old (aged 80+) is growing rapidly and some studies have shown that the health status is unequal among older persons in different regions. However, to the best of our knowledge, no study to date has analyzed health inequalities among the oldest-old in urban and rural areas in China. This study therefore aimed to examine the correlation between health inequalities among the oldest-old in urban and rural areas of China. From the 8th wave of the Chinese Longitudinal Health Longevity Survey (CLHLS), we selected 8124 oldest-old participants who met the requirements of the study. Chi-square tests were used to analyze the distribution characteristics of indicators and a logistic model was performed to determine the factors associated with different self-rated health (SRH). The Fairlie model was adopted to decompose the causes and related contributions to health inequality. Our results found that of the Chinese oldest-old, 46.57% were in good health. Urban residents reported significantly better SRH than rural residents (50.17% vs. 45.13%). Variables associated with good and poor SRH had different distribution characteristics. The logistic model suggested that marital status, alcohol consumption, and annual income were important factors underlying the SRH differences. Our decomposition analysis indicated that 76.64% of the SRH differences were caused by observational factors, and validated that the difference in SRH between urban and rural areas was significantly (P<0.05) associated with exercise status (45.44%), annual income (37.64%), social activity status (3.75%), age (-5.27%), and alcohol consumption (-2.66%). Therefore, socioeconomic status and individual lifestyle status were the main factors underlying the health inequality between urban and rural Chinese oldest-old.