Aim. To study the epidemiological characteristics and changes of hypertension (HTN), as well as factors associated with HTN in the Russian population aged 35-74 years.Material and methods. The Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation-3 (ESSE-RF3) study examined a representative sample of the population aged 35-74 years of 15 Russian regions with a response >70% (n=28611). Modular design questionnaire was used. Blood pressure (BP) was measured twice after a 5-minute rest in a sitting position on the right arm with an Omron blood pressure monitor. There were following criteria for hypertension: systolic blood pressure (SBP) ≥140 mm Hg and/or diastolic blood pressure (DBP) ≥90 mm Hg, and/or antihypertensive therapy. The effectiveness of treatment was considered the proportion (%) of people who achieved target blood pressure values among those being treated, while the control was considered the proportion (%) of patients with a BP <140/90 mm Hg of the total number of hypertensive patients. HTN changes were studied in a single age range of 35-64 years with the inclusion of materials from the ESSE-RF (2012-14) and ESSE-RF2 (2017) studies, carried out using the same methodology as ESSE-RF3. Statistical analysis was carried out using the open-source R 3.6.1 environment. Analysis of the association between factors and a binary variable was performed using logistic regression. The significance level for all tested hypotheses was 0,05.Results. According to ESSE-RF3, the average levels of SBP and DBP in the population were 131,9±18,7 and 84,4±10,9 mm Hg, respectively, while the proportion of those with BP ≥140/90 mm Hg — 38,8% (men: 44,8%, women: 33,9%). Prevalence of hypertension was 53,9% (men: 56,0%, women: 52,1%), awareness — 77,7% (men: 71,5%, women: 82,3%), while the treatment received 63,4%, significantly higher among women than among men: 72,3 vs 53,3%. The effectiveness of treatment was 44,0%, higher among women compared to men (48,2 vs 37,4%). In addition, 27,9% of patients have controlled HTN.Conclusion. The problem of controlled HTN in Russia remains unresolved in the 21st century. The following significant sex differences remain: the prevalence of HTN is higher among men, but awareness of the disease, treatment rate and its effectiveness are lower compared to women.

Aim. To study the prevalence of dyslipidemias and their association with various risk factors in the Russian population of men and women aged 35-74 years in 2020-2022.Material and methods. This work was carried out as part of the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation-3 (ESSE-RF3) study. The sample included 28731 men and women aged 35-74 years living in 15 Russian regions. Hypercholesterolemia (HC) was diagnosed with total cholesterol (TC) ≥5,0 mmol/l, while elevated low-density lipoprotein cholesterol (LDL-C) was considered ≥3,0 mmol/l, hypertriglyceridemia — with triglyceride levels ≥1,7 mmol/l, reduced high-density lipoprotein cholesterol (HDL-C) <1,0 mmol/l in men and <1,2 mmol/l in women. Associations were assessed using logistic regression after adjustment for socio-demographic characteristics, drinking status, presence of hypertension (HTN) and stroke.Results. The prevalence of hypertriglyceridemia in the Russian Federation in 2020-2022 was 58,8%, hypertriglyceridemia — 32,2%. The incidence of lipid-lowering therapy increased with age from 1% in the group of 35-44 years to 16% in the group of 65-74 years. On average, only 7,6% of study participants received lipid-lowering therapy. Significant associations of HC with HTN, obesity and alcohol abuse were identified. Similar results were obtained for elevated LDL-C levels, with the exception of alcohol abuse. In turn, a reduced HDL-C level was significantly associated with the lack of higher education, marriage, physical activity, smoking and the presence of diseases.Conclusion. The prevalence of lipid disorders in the Russian Federation in 2020-2022 remained at a high level. These disorders occurred more often in women, and they were better informed about their cholesterol levels and more often received lipid-lowering therapy. HTN, obesity, and some behavioral and social risk factors were associated with dyslipidemia.

Aim. To assess the prevalence of non-alcoholic fatty liver disease (NAFLD) using the liver obesity index — FLI (Fatty Liver Index), and to study its associations with socio-demographic indicators and behavioral risk factors for NAFLD.Material and methods. The data from the multicenter ESSE-RF study (Epidemiology of cardiovascular diseases in the regions of the Russian Federation) — samples from the unorganized male and female population aged 25-64 years were used. 5,161 respondents were included, of which 2,275 (44,1%) were men. To assess the prevalence of NAFLD, the liver obesity index FLI was used, calculated according to the formula by Bedogni G, et al. (2006). A high FLI index ≥60 was considered a predictor of liver steatosis.Results. High FLI ≥60 was detected in 38,5% of men and 26,6% of women. Multivariate analysis of associations of high FLI index in men and women showed a strong relationship with age: men — odds ratio (OR) 5,01, 95% confidence interval (CI): 3,82-6,59 (p<0,0001) and women — OR 8,58, 95% CI: 6,39-11,64 (p<0,0001), living in rural areas: men — OR 1,32, 95% CI: 1,06-1,63 (p=0,011) and women — OR 1,4, 95% CI: 1,15-1,71 (p=0,001). The FLI index ≥60 was significantly associated with low physical activity (p=0,001) in men and current smoking in women (p=0,013).Conclusion. A high FLI index ≥60 is most common among men, significantly associated with age, living in rural areas, currently smoking women, and low physical activity men. Higher education, in relation to FLI ≥60, had a protective effect on women.

Aim.  To study the prevalence of non-alcoholic fatty liver disease (NAFLD) and its association with cardiovascular risk factors (RFs). Material and methods.  The database from the ESSE-RF2 and ESSE-RF3 epidemiological studies was used, including data from surveys of population aged 35-64 years in 18 Russian regions (n=21204). To assess the prevalence of NAFLD, the fatty liver index (FLI) was used. Statistical analysis was performed using the statistical programming language and the R environment (version 3.6.1) with open-source code. The significance level for all tested hypotheses was p≤0,05. Results.  Standardized prevalence rates of FLI ≥60 in the ESSE-RF3 study are slightly higher than in the ESSE-RF2 study (39,2% vs 42,3%, respectively). Multivariate analysis adjusted for sex, age, region, settlement type, and education showed significant associations of FLI ≥60 with hypertension, type 2 diabetes, hyperuricemia, lipid metabolism disorders, elevated high-sensitivity C-reactive protein levels, and cerebrovascular accident in men and women. Conclusion.  Multivariate analysis confirmed the closest association of NAFLD with hypertension, type 2 diabetes mellitus, metabolic disorders, nonspecific inflammation, dyslipidemia, and cerebrovascular accident in men and women.

Aim. To analyze the prevalence of anxiety and depression in Russians using the Hospital Anxiety and Depression Scale (HADS) during the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF) study. To study the associations of increased levels of anxiety and depression (HADS-A/ HADS-D ≥8+) with demographic and socio-economic characteristics according to the ESSE-RF3 study.Material and methods. In the ESSE-RF3 study, a representative sample of the population of 15 Russian regions aged 35-74 years was examined with a response >70%. After removing respondents with missing data from the analysis, the final sample was 28716 people. The level of anxiety/depression was assessed by the sum of points <8 — "normal", ≥8 <11 — subclinical, ≥8+ — increased, ≥11 — clinical (high level). The changes in HADS-A/HADS-D over time were studied in a single age range of 35-64 years with the inclusion of materials from the ESSE-RF (2012-2014) and ESSE-RF2 (2017) studies. Statistical analysis was performed using the open-source R environment (version 4.1). Analysis of the association between factors and a binary variable was carried out using the logistic regression method. The significance level for all tested hypotheses was p≲0,05.Results. In the Russian cohort (ESSE-RF3), the average level of anxiety/depression was 4,3±3,7/3,9±3,4, respectively, while the prevalence of subclinical/clinical anxiety and depression was 19,3/6,8% and 15,9/4,5%, respectively. The prevalence rates of HADS-A/HADS-D ≥8 <11 and HADS-A ≥11 in the ESSE-RF and ESSE-RF2 studies were significantly higher (p<0,001) compared with data from the ESSE-RF3 study. Regression analysis of HADS-D ≥8+ in men and women in models (M1 and M2) showed a significant (p<0,001) association with age 55-74 years, with secondary and less than secondary education and income, as well with diseases (men ≥2 and women ≥1) and women living in rural areas (p=0,019).Conclusion. Data analysis showed significant (p<0,001) lower values of the standardized prevalence of anxiety and depression in men and women in ESSE-RF3 compared with the ESSE-RF and ESSE-RF2 studies. The exception were women with HADS-D ≥11, among which its prevalence in ESSE-RF3 did not differ significantly from that in ESSERF2. Regression analysis showed different associations of anxiety and depression with socioeconomic and demographic indicators in men and women.

Aim. To assess the significance of troponin I (hs-cTnI) for cardio­vascular risk stratification in a population of Russian working-age men and women of.Material and methods. The data of 13976 men and women aged 25-64 from the ESSE-RF1 and ESSE-RF2 multicenter studies were analyzed. The examination included following points: standard questionnaire, measurements of height, weight, waist circumference, body mass index, blood pressure, pulse rate, biochemical tests. The level of hs-cTnI in blood serum samples stored at -70^оC in the Biobank of the National Medical Research Center for Therapy and Preventive Medicine was determined by chemiluminescent immunoassay analysis. Individual cardiovascular risk was calculated using the SCORE scale: values <1% — low risk; 1-4% — moderate, 5-9% — high and ≥10% very high. Similar to the BiomarCaRE study, participants were divided into 3 sex-adjusted cTnI levels: men 12 pg/ml; women 10 pg/ml. We analyzed following hard endpoints: cardiovascular death or non-fatal myocardial infarction, and composite endpoint: the same and stroke.Results. The prospective analysis of the relationship between troponin levels and endpoints and composite endpoints showed that in participants without prior CVD, hs-cTnI levels >12 pg/ml in men and >10 pg/ml in women are associated with an increased risk of endpoints and composite endpoints by 3,39 (1,91-6,03) and 2,69 (1,6-4,52) times (p<0,001), respectively. Similarly to BiomarCaRE, the SCORE-calculated risk reclassification was validated by adding the hs-cTnI value. The net reclassification improvement index (NRI) for endpoints and composite endpoints was 13% and 11% (p<0,001), respectively. Among men, the reclassification for NRI composite endpoints was more accurate than among women: 19% and 11%, respectively.Conclusion. The hs-cTnI level is an independent predictor of myo­cardial infarction, stroke, and death from CVD in people aged 35-64 years without prior CVD. Adding the hs-cTnI level to the SCORE model makes the risk prediction more accurate.