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俄罗斯联邦的心血管负担与经皮介入治疗:系统的流行病学最新情况

Cardiovascular burden and percutaneous interventions in Russian Federation: systematic epidemiological update.

作者信息

Kharlamov Alexander N

机构信息

De Haar Research Foundation, Rotterdam, The Netherlands, New York, NY, USA.

出版信息

Cardiovasc Diagn Ther. 2017 Feb;7(1):60-84. doi: 10.21037/cdt.2016.08.10.

Abstract

The situation with cardiovascular (CV) burden in Russian population is alerting, and becomes of interest due to high CV mortality, and shorter lifespan if compare with the Western society amid the absence of the established monitoring or screening system for major CV risk factors. The purpose of this systematic epidemiological update was to explore CV burden in Russia. The study represents pooled results with a systematic epidemiological review of the national mass screening, selected randomized clinical trials and statistical datasets of the national public health CV institutions exploring the trends of the CV burden in all 83 regions of Russia. We overviewed data from a number of the available Russian-speaking national data sources of 2001-2014, and NANOM-FIM trial (NCT01270139) as the only available real-world population study. The CV diseases in Russia accounted for 54.9% of all deaths in 2011-2014. The death rate was 13.3 per 1,000 citizens with CV mortality of 653.9 per 100,000. The life expectancy achieves 64.3 years for male and 76.1 years for female. The mean age of pts in trial was 51.6 years (77.2% males). A total of 175 Russian PCI centers implemented 205,902 angio a year, and 75,378 PCI achieving 531 PCI per 1,000,000 with placement of 101,451 stents (1.37 stents per PCI; 48,057 DES). The smoking (17.3% of screened with a 2,786 cigarettes a year; 70.6% in trial), excessive alcohol consumption (1.8% of screened with a 11.6 L per year; 50.6% in trial), unhealthy Russian diet (abundance of carbohydrates/sugar, saturated and trans fats in 24.3% of screened), psychosocial factors (20%) and physical inactivity (19.6% of screened) remain the major modifiable risk factors. They, in turn, affect such risk factors as dyslipidemia (86.7% in trial), obesity (16.7% of screened; BMI in trial was 28.4), and hypertension (40.8% suffered; 86.1% in trial). CV mortality was not directly associated with a level of poverty (r=0.26, P=0.02) or socio-economic development (P>0.05) in regions. The documented 27% 10-year decline of CV mortality was interpreted as a success of the national policy. Mortality statistics show the stark reality of a high CV burden in Russia. New national program and aggressive emerging efforts are required to tackle CV diseases in Russia.

摘要

俄罗斯人群中心血管(CV)负担的情况令人担忧,由于心血管疾病死亡率高,且与西方社会相比寿命较短,同时缺乏针对主要心血管危险因素的既定监测或筛查系统,这一情况备受关注。本次系统流行病学更新的目的是探究俄罗斯的心血管负担。该研究汇总了对全国大规模筛查、选定的随机临床试验以及国家公共卫生心血管机构的统计数据集进行系统流行病学回顾的结果,以探究俄罗斯所有83个地区心血管负担的趋势。我们概述了2001 - 2014年一些可用的俄语国家数据源的数据,以及NANOM - FIM试验(NCT01270139)这一唯一可用的真实世界人群研究。俄罗斯的心血管疾病在2011 - 2014年占所有死亡人数的54.9%。死亡率为每1000名公民中有13.3人死亡,心血管疾病死亡率为每10万人中有653.9人死亡。男性预期寿命为64.3岁,女性为76.1岁。试验中患者的平均年龄为51.6岁(77.2%为男性)。俄罗斯共有175个PCI中心,每年实施205,902例血管造影术,75,378例PCI手术,每100万人中有531例PCI手术,植入101,451枚支架(每例PCI手术植入1.37枚支架;48,057枚药物洗脱支架)。吸烟(筛查人群中17.3%的人每年吸烟2786支;试验人群中70.6%的人吸烟)、过量饮酒(筛查人群中1.8%的人每年饮酒11.6升;试验人群中50.6%的人饮酒)、不健康的俄罗斯饮食(筛查人群中24.3%的人碳水化合物/糖、饱和脂肪和反式脂肪含量高)、社会心理因素(20%)和身体不活动(筛查人群中19.6%的人身体不活动)仍然是主要的可改变危险因素。这些因素进而影响血脂异常(试验人群中86.7%的人血脂异常)、肥胖(筛查人群中16.7%的人肥胖;试验人群中的BMI为28.4)和高血压(40.8%的人患有高血压;试验人群中86.1%的人患有高血压)等危险因素。心血管疾病死亡率与各地区的贫困水平(r = 0.26,P = 0.02)或社会经济发展水平(P>0.05)没有直接关联。记录在案的心血管疾病死亡率10年下降27%被视为国家政策的成功。死亡率统计显示了俄罗斯心血管负担沉重的严峻现实。需要新的国家计划和积极的新举措来应对俄罗斯的心血管疾病。

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