Aim. To assess adherence to a healthy lifestyle depending on the individual and socio-economic characteristics of the Russian population (according to the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation-3 (ESSE-RF3) study), followed by a comparative analysis with ESSE-RF2 (2017).

Material and methods. The analysis was carried out based on research data from ESSE-RF2 in 2017 and ESSE-RF3 in 2020-2022. The healthy lifestyle adherence index included following parameters: no smoking; sufficient consumption of vegetables and fruits; physical activity; no excessive salt intake and alcohol abuse. Three following categories of adherence to a healthy lifestyle were analyzed: high, satisfactory, low. From individual variables, individual socio-economic characteristics with the highest evidence level of influence on healthy lifestyle were taken.

Results. In the ESSE-RF3 sample, 47,2% of respondents had low adherence to a healthy lifestyle, 37,2% — satisfactory, and 15,6% — high. Women are more committed to healthy behavior compared to the male population — 19,6 vs 11,1% (p<0,001). The lowest adherence to a healthy lifestyle was found among men with low incomes who do not have higher education and is typical for younger people. Analysis of changes from 2017 to 2020-2022 revealed that adherence to a healthy lifestyle among the population decreased mainly due to a decrease in the proportion of people with high adherence.

Conclusion. The study made it possible to characterize the current level of healthy lifestyle among the population and demonstrated the most promising strategies aimed at improving adherence to a healthy lifestyle among the Russian population.

Aim. To analyze the prevalence of smoking according to the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation-3 (ESSE-RF3) study, and compare these data with the previous two stages.

Material and methods. Data from following three cross sections of the ESSE-RF study were used: 2013-2014, 2017, 2020-2022. At the first stage, the prevalence and probability of smoking was assessed according to ESSE-RF3 data in 2020-2022 (n=28628, 35-74 years). At the second stage, an analysis was carried out over time using data from all three ESSE-RF sections (n=43804, 35-64 years).

Results. In the overall ESSE-RF3 sample, the prevalence of smoking was 17,0% (men — 27,7%, women — 7,6%). Smoking probability varies significantly by sex, age, education level and income. Over time, the standardized prevalence of smoking increases from 25,0% in 20132014 to 26,2% in 2017, and then decreases to 21,5% in 2020-2022. Women are characterized by the same direction of trends, while men had consistent decrease in prevalence from 41,3 to 37,0 and 34,3%, respectively. The probability of smoking in 2017, relative to 20132014, decreases only in some socio-demographic categories of the population. In 2020-2022, a decrease in the probability of smoking is typical for both the general sample and all subgroups of the population.

Conclusion. The results obtained characterize the current situation and time trends of the last decade and contain important information on smoking epidemiology in Russia.

Aim. To analyze alcohol consumption according to the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation-3 (ESSE-RF3) study and compare these data with the previous two ESSE-RF sections.

Material and methods. Data from following cross-sectional sections of the ESSE-RF study were used: 2013-2014, 2017, 2020-2022. At the first stage, alcohol consumption was assessed according to ESSE-RF3 data in 2020-2022, conducted during the coronavirus disease 2019 (COVID-19) pandemic (n=28685, 35-74 years). At the second stage, a comparison of all three sections of the ESSE-RF study was carried out (n=42043, 35-64 years). Alcohol consumption was divided into those not drinking alcohol, those drinking alcohol little or moderately (<168 g/week of pure ethanol for men, <84 g/week for women), and those drinking alcohol excessively (≥168 g/week for men and ≥84 g/week for women). Differences in qualitative parameters in groups were assessed using the Pearson χ² test, while in quantitative parameters — the Mann-Whitney and Kruskall-Wallis tests. When comparing alcohol consumption in different ESSE-RF sections, direct standardization of samples was carried out according to the socio-demographic structure of the Russian population. Logistic and linear regression models were used to estimate the probability of alcohol consumption.

Results. In the total ESSE-RF3 sample, the proportion of people not drinking alcohol, those with little/moderate and excessive alcohol consumption is 41,0, 55,6 and 3,4%, respectively. The probability of alcohol consumption and the average amount consumed varies significantly by sex, age, education level and income level. The standardized prevalence of any alcohol use (regardless of quantity) and excessive consumption decreases from 75,7 and 5,9% in 2013-2014 to 70,9 and 5,6% in 2017 and to 54,6 and 3,5% in 2020-2022. However, the average amount of ethanol consumed among alcohol drinkers is increasing.

Conclusion. The changes of alcohol consumption over time in Russia are quite favorable, since both involvement in alcohol consumption and its excessive consumption decreases. However, the average amount of alcohol consumed increases, which may be due to changing cultural patterns of alcohol consumption. The COVID-19 pandemic has not altered the direction of changes in alcohol consumption by Russians.

Aim. To study levels and types of physical activity, as well as its individual socio-demographic and seasonal determinants in the Russian population according to the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF) study.

Material and methods. Data from the ESSE-RF2 (2017) and ESSERF3 (2020-2022) was used. The sample included 28731 men and women aged 35-74 from 15 regions. The level of physical activity was assessed using the Global physical activity questionnaire (GPAQ). The following socio-economic and demographic characteristics were taken as covariates: sex, age, place of residence (urban and rural), level of education, marital status, work characteristics, income level, season of the year. Statistical analysis was performed using SPSS version 22 (IBM Corp. USA).

Results. The study showed that 27,4% of the sample have insufficient physical activity. Among the low physical activity category, there are more women than men (28,12 vs 26,7%, p<0,001); among men, high physical activity was more often identified (24,1 vs 18,3%, p<0,001). Compared to the urban population, rural residents have higher physical activity rates (23,9 vs 20,3%, p<0,001). The proportion of people with high physical activity is also higher among people with higher income levels (p<0,001). General physical activity in men is higher compared to women, due to work and recreational activity, but transport-related physical activity is significantly higher in women. From 2017 to 20202022, the population level of physical activity decreased.

Conclusion. This study provides the most complete description of Russian patterns of physical activity and shows the areas of necessary intervention for the development of measures and programs aimed at increasing physical activity of Russian population.

Aim. To assess the prevalence of psychological stress (PS) using the Perceived Stress Scale-10 (PSS-10) in various Russian regions and to analyze PS associations with socio-demographic characteristics and behavioral risk factors and some non-communicable diseases (NCDs).

Material and methods. We studied representative samples of the population aged 35-74 years in the Russian regions, examined as part of the Epidemiology of Cardiovascular Diseases in Regions of Russian Federation-3 (ESSE-RF3) study. The subjects were interviewed using a questionnaire containing a section on the psychological stress — PSS-10. For men, PS levels are ranked as follows: "Low" — 0-11, "Medium" — 12-17, "High" — 18-40. For women, PS levels are ranked as follows: "Low" — 0-13, "Medium" — 14-19, "High" — 20-40. Statistical analysis was carried out using the open-source R 3.6.1 environment.

Results. The average PS level was 12,0±7,3 (men: 10,7±7,0; women: 13,1±7,4). Every fifth person (20,3%) in the Russian population has a high PS level, with higher PS rates among women compared to men (high PS level — 21,6 vs 18,9%, respectively). A high PS level was associated with the income level (average or low), no marriage, unemployment, low level of physical activity, depression, anxiety, NCDs (type 2 diabetes, myocardial infarction, stroke), additionally for women — hypertension.

Conclusion. The Russian population is characterized by a high PS prevalence, while PS rates are higher among women, which must be taken into account when predicting the NCD risks.

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 study the problem of obesity at the national level.

Material and methods. The ESSE-RF3 study examined a representative sample of the population of 15 Russian regions aged 35-74 years with a response >70% (n=28731). Modular design questionnaire was used. The study received approval from the Independent Ethics Committee of the National Medical Research Center for Therapy and Preventive Medicine. Signed informed consent was obtained from each participant. Body mass (BM) was measured once with an accuracy of 100 g. The height was measured with an accuracy of 0,5 cm once in a standing position without shoes. Waist circumference was measured with a standard measuring tape with an accuracy of 0,5 cm. There were following BM categories: insufficient (BM index (BMI) <18,5), normal (18,5≲ BMI ≲24,9), overweight (25,0≲ BMI ≲29,9), class I obesity (30,0≲ BMI ≲34,9), class II obesity (35,0≲ BMI ≲39,9) and class III obesity (BMI >40). Abdominal obesity (AO) was assessed using the following criteria: waist circumference ≥102 cm and ≥88 cm for men and women, respectively. The changes of obesity were studied with the inclusion of materials from the ESSE-RF (2012-14) and ESSE-RF2 (2017) studies, carried out using the same methodology with ESSE-RF3 in the same age range of 35-64 years. Statistical analysis was carried out using the open-source R 3.6.1 environment. Analysis of associations between factors and a binary variable was carried out using the logistic regression method. The significance level for all tested hypotheses was 0,05.

Results. Mean BMI values is 28,2±4,6 kg/m² among men and 28,9±5,9 kg/m² among women. The prevalence of overweight is 44,0 and 33,7%, obesity — 30,0 and 39,5%, AO — 30,9 and 55,1% among men and women, respectively. In addition, 30,3% have a combination of obesity and AO; obesity and/or AO — 49,1%. Obesity statistics did not significantly change, but in each section the rates are higher among women. The closest associations were found between obesity and hypertension (men: odds ratio (OR) (95% confidence interval) 2,88 (2,66-3,12), women: OR 3,03 (2,81-3,27) (p<0,001) and hyperuricemia for women (OR 4,21 (3,74-4,75) (p<0,001).

Conclusion. A third of the Russian population is obese, and half has obesity and/or AO. This severity of the problem requires the development and adoption of a strategy to monitor obesity at the national level.

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 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 establish reference values of handgrip test for a middle-aged and elderly population (35-74 years), as well as study the association of health characteristics and muscle strength.

Material and methods. For the analysis, we used data from the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation-3 (ESSE-RF3) study, conducted in 2020-2022. The sample was selected similarly to the previous ESSE-RF stages. The sample included 27689 men and women aged 35-74 years from 14 Russian regions. Of the individual variables, the characteristics with the highest evidence level of influence on muscle strength were taken as covariates. Muscle strength was assessed by a handgrip test using a MEGEON 34090 device with an accuracy of 0,1 kg. Three measurements were taken for each arm in a standing position, and the maximum value was used in the analysis. Normative sex-specific handgrip test values were established regardless of age: a participant's handgrip value was considered reduced if it was 2 standard deviations below the average value of participants at the age with the best/highest scores.

Results. The average handgrip test values for the entire male sample were 43,4±11,1 kg, while for the female sample — 27,6±6,1 kg. In men under 53 years of age, muscle strength decreases at a rate of 0,12 kg/year, then the decline accelerates to 0,48 kg/year. In women under 45,5 years of age, a slight and insignificant increase in muscle strength was detected by 0,02 kg/year, and after 45,5 years, handgrip value falls at a rate of 0,2 kg/year. Therefore, both men and women lose 1,3% of muscle strength per year to year and the decline rate do not differ. The peak age can be considered 35 years old, since at this age, the average muscle strength in men and women is 47,6±11,5 and 29,2±5,7 kg, respectively, and the calculated norm (M–2SD) for men was 47,6–2´11,5≈24 kg using rounding down, and for women it was 29,2– 2´5,7≈17 kg. With age, as expected, the proportion of people of both sexes with a metabolic syndrome level below the threshold increases, reaching 7,5% after 65 years. Multivariate regression analysis showed that, taking into account adjustments for covariates, for every 10 years, muscle strength decreases by an average of 3,1 kg in men and by 1,7 kg in women. Negative associations of metabolic syndrome with inflammation markers (fibrinogen and C-reactive protein) and noncommunicable diseases are also significant, but only men have significantly lower rates of metabolic syndrome in the presence of anxiety and depression, low income and urban residence.

Conclusion. The use of handgrip test in any age range during medical examinations or preventive examinations of the adult population and informing primary care specialists about the results obtained can help improve the general health of the population.

Aim. To assess the associations of social and behavioral risk factors with cognitive impairment in the Russian population aged 55-74 years.

Material and methods. This study was conducted as part of the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation-3 (ESSE-RF3) study. A total of 13736 participants living in 14 Russian regions were examined. Cognition was assessed using the Mini-Mental State Examination (MMSE) score as follows: cognitive impairment was recorded in the total score<24, based on 30 points. Associations were assessed using logistic regression after adjusting for sociodemographic characteristics, drinking status, and the presence of hypertension and stroke.

Results. According to the multivariate analysis, no higher education (odds ratio (OR) 2,5 (95% confidence interval (CI): 1,98-3,27), p=0,001), no marriage (OR 1,6 (95% CI: 1,29-2,00), p=0,001), unemployment (OR 2,2 (95% CI: 1,71-2,86), p=0,001), and low income (OR 2,04 (95% CI: 1,60-2,57), p=0,001) are significantly associated with cognitive impairment. Of the 4 behavioral risk factors studied, only insufficient consumption of vegetables and fruits was significantly associated with cognitive impairment (OR 1,52 (95% CI: 1,18-1,99), p=0,001)

Conclusion. The study results indicate an association between cognitive impairment and education, marital status, income, employment, professional activity, as well as insufficient consumption of vegetables and fruits.

At the present time, there is a growing trend of vegetarian diets, even in countries with a traditional Nordic diet.

Aim. To study the prevalence and characteristics of vegetarian diets in the Russian population at the present stage.

Material and methods. The analysis included data from representative samples of the adult population 25-74 years old, examined within three sections of the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF) study in 20132014, 2017 and 2020-2022. A total of 57351 participants (24862 men and 32489 women) were analyzed. Nutrition assessment was carried out using the frequency method. Restrictive diets include semi-vegetarian, vegetarian and vegan diets. Data are presented as frequencies and odds ratios (OR) with 95% confidence intervals (CI).

Results. The prevalence of restrictive diets in the Russian population according to three sections of the ESSE-RF study was 3,1%. There is an increase in the prevalence of these diets from 2,7% in 2013, to 3,6% in 2017 and 3,3% in 2020-2022. Men are less likely than women to exclude red meat from their diet (OR 0,55 [0,49-0,61], p<0,05), as are married individuals (0,58 [0,52-0,64], p<0,05). Persons with higher education more often follow a semi-vegetarian diet (OR 1,15 [1,04-1,27], p<0,05). With age, the refusal to consume red meat in the population increases (p<0,001). A semi-vegetarian diet is associated with a lower likelihood of general (OR 0,84 [0,71-0,99], p=0,037) and abdominal obesity (0,78 [0,52-0,64], p<0,001), hypertriglyceridemia (0,82 [0,73-0,92], p=0,001) and hyperglycemia (0,81 [0,67-0,97], p=0,021). The probability of hypertension is lower among people who limit the consumption of animal products (semi-vegetarians (OR 0,85 [0,76-0,95], p=0,004) and vegetarians (0,62 [0,42-0,92], p=0,018), as well as hypercholesterolemia: in semi-vegetarians (0,90 [0,81-0,99], p=0,041), in vegetarians (0,68 [0,47-0,97], p=0,035) and in vegans (0,37 [0,15-0,91], p=0,030).

Conclusion. In the Russian population, individuals following vegetarian diets (3,1% of the population) have a healthier profile of nutritional risk factors.

Aim. To study the proportion of coronavirus disease 2019 (COVID-19) survivors and hospitalization cases of the Russian population for the period 2020-2022, depending on socio-demographic characteristics.

Material and methods. The work was performed on random samples of the population aged 35-74 years from 15 regions participating in the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation-3 (ESSE-RF3) study. The examination was carried out from February 2020 to March-April 2022 (n=28718, 47% men).

Results. According to a survey of sample participants, the proportion of respondents who had COVID-19 by the spring of 2022 among all surveyed was 26,0%. Among 45-54-year-old respondents, this parameter was maximum (28,0%), while among those aged 65-74-year-old — minimal (22,3%). The following categories of people were more likely to have COVID-19: women (27,9 vs 23,9% of men, p<0,001), persons with higher education (30 vs 22,6% persons without higher education, p<0,001), persons with high income (30,0 vs 24,3% low-income, p=0,002), persons with family (26,6 vs 24,8% single, p<0,001), employed persons (28,4 vs 21,7% non-employed, p<0,001), as well as those living in urban areas (26,5 vs 24,5% country people, p=0,003). But those less likely to have COVID-19 (men, people without higher education, low-income, single, unemployed or rural residents) had more severe disease course. The following categories of people had higher hospitalization rates: men (26,0 vs 20,9% women, p<0,001), patients without higher education (27,1 vs 19,6% those with higher education, p<0,001), non-employed (34,3 vs 18,4% workers), p<0,001) and rural residents (27,2 vs 22,0% of city residents, p<0,001). Hospitalization rate was not associated with the level of income and marital status. However, low-income and single people were more likely to require mechanical ventilation.

Conclusion. The results obtained by survey reflect the following population data: the proportion of patients after COVID-19, hospitalization rate and the development of severe acute respiratory failure requiring mechanical ventilation among Russians for the period 2020-2022. This can complement the population data demonstrated by state statistics. Special attention from the healthcare system, both during treatment and prevention of COVID-19, requires males, people aged ≥65 years, low-income people, single people (widowers, divorced), unemployed people (pensioners, disabled people, nonemployed), rural residents and people without higher education.