ObjectiveTo study the prevalence of social support (SS) and its influence on the relative risk (RR) of myocardial infarction (MI) and stroke in the female population aged 25–64 in Russia.Materials and methodsUnder the third screening of the WHO “MONICA-psychosocial” programme, a random representative sample of women aged 25–64 (n=870) were surveyed in Novosibirsk. SS was measured according to the methods of the Berkman–Sym test [indices of close contacts (ICC) and index of social network (SNI)]. From 1995 to 2010, women were followed for 16 years to observe the incidence of MI and stroke.ResultsThe prevalence of low levels of ICC and SNI in women aged 25–64 was 57.1 and 77.7%, respectively. Low levels of ICC and SNI were associated with poor self-rated health and awareness about their health, adverse behavioral habits, high job strain and family stress.Rates of MI and stroke development were higher in married women with low ICC and SNI who were being in class “hard manual work”. Over a 16-year study period, the RR of MI in women with low ICC compared to those with high ICC was 4.9 times higher, and the risk of stroke was 4.1 times higher. Low level of SNI increased MI risk in 2.9 times, risk of stroke in 2.7 times.ConclusionMajority of women aged 25–64 years in Russia have low social support which is associated with poor self-rated health, low awareness about the health that increases the risk of MI and stroke in 2.7–4.9 times in groups of “married” and “hard physical work”.

The women are much more susceptible to depression than are the men. The risk of MI with depression is higher in the women than in the men; at the same time, the risk of stroke is higher in the men than in the women. The picture is opposite in the older age group. The risk of CVD in the depressed men is exacerbated by a social gradient; these relationships have not been revealed in the women.

BackgroundRecent studies showed that depression was an independent predictor of mortality from cardio-vascular disease in healthy women.ObjectiveTo explore the effect of depression (D) on relative risk (RR) of myocardial infarction (MI) and stroke for 16 years (1995–2010) in the female population aged 25–64 years from Novosibirsk, Russia.Materials and methodsUnder the third screening of the WHO “MONICA-psychosocial” (MOPSY) programme, a cohort of women aged 25–64 years (N=560) was surveyed. Women were followed for 16 years for the incidence of MI and stroke (1995–2010). D was measured at the baseline examination by means of test “MOPSY”. Participants having stroke, MI, arterial hypertension, coronary artery diseases and diabetes in their medical history at the baseline were excluded from this analysis.ResultsThe prevalence of D in women aged 25–64 years was 55.2%. With the growth of D levels, positive self-rated health reduced and almost 100% of those women have complaints about their health, but considered the care of their health insufficient. Women with major D significantly extended negative behavioral habits: smoking and unsuccessful attempts to give up, low physical activity, and less likely to follow a diet (healthy food). Major D associated with high job strain and family stress. Relative risk (RR) of MI development in women with D during 16 years of study was higher in 2.53 cases (p<0.05) and risk of stroke was higher in 4.63 cases (p<0.05).ConclusionsThe prevalence of D in women aged 25–64 years was >50%. Women with D had a 2.53-fold risk of MI and 4.63-fold risk of stroke during the 16 years of follow-up.

ImportanceMost epidemiological studies of heart failure (HF) have been conducted in high-income countries with limited comparable data from middle- or low-income countries.ObjectiveTo examine differences in HF etiology, treatment, and outcomes between groups of countries at different levels of economic development.Design, Setting, and ParticipantsMultinational HF registry of 23 341 participants in 40 high-income, upper–middle-income, lower–middle-income, and low-income countries, followed up for a median period of 2.0 years.Main Outcomes and MeasuresHF cause, HF medication use, hospitalization, and death.ResultsMean (SD) age of participants was 63.1 (14.9) years, and 9119 (39.1%) were female. The most common cause of HF was ischemic heart disease (38.1%) followed by hypertension (20.2%). The proportion of participants with HF with reduced ejection fraction taking the combination of a β-blocker, renin-angiotensin system inhibitor, and mineralocorticoid receptor antagonist was highest in upper–middle-income (61.9%) and high-income countries (51.1%), and it was lowest in low-income (45.7%) and lower–middle-income countries (39.5%) (P &amp;lt; .001). The age- and sex- standardized mortality rate per 100 person-years was lowest in high-income countries (7.8 [95% CI, 7.5-8.2]), 9.3 (95% CI, 8.8-9.9) in upper–middle-income countries, 15.7 (95% CI, 15.0-16.4) in lower–middle-income countries, and it was highest in low-income countries (19.1 [95% CI, 17.6-20.7]). Hospitalization rates were more frequent than death rates in high-income countries (ratio = 3.8) and in upper–middle-income countries (ratio = 2.4), similar in lower–middle-income countries (ratio = 1.1), and less frequent in low-income countries (ratio = 0.6). The 30-day case-fatality rate after first hospital admission was lowest in high-income countries (6.7%), followed by upper–middle-income countries (9.7%), then lower–middle-income countries (21.1%), and highest in low-income countries (31.6%). The proportional risk of death within 30 days of a first hospital admission was 3- to 5-fold higher in lower–middle-income countries and low-income countries compared with high-income countries after adjusting for patient characteristics and use of long-term HF therapies.Conclusions and RelevanceThis study of HF patients from 40 different countries and derived from 4 different economic levels demonstrated differences in HF etiologies, management, and outcomes. These data may be useful in planning approaches to improve HF prevention and treatment globally.

РезюмеЦель исследования. Определить влияние стресса на рабочем месте на отношение риска (ОР; HR) развития инфаркта миокарда (ИМ) и инсульта в открытой популяции женщин 25-64 лет в течение 16 лет в России/Сибири (Новосибирск). Материалы и методы. В рамках программы ВОЗ «MONICA-психосоциальная» в 1994 г. обследована случайная репрезентативная выборка 870 женщин в возрасте 25-64 лет -жительниц одного из района Новосибирска. Стресс на рабочем месте изучен с использованием шкалы Карасека; отношение к работе и профилактическим проверкам своего здоровья исследовано при помощи шкалы «Знание и отношение к своему здоровью» программы ВОЗ «MONICA-психосоциальная». В течение 16 лет (с 1994 по 2010 г.) в когорте исследовали все впервые возникшие случаи ИМ и инсульта с использованием программы ВОЗ «Регистр острого ИМ», всей возможной медицинской документации. Регрессионную модель Кокса использовали для определения ОР развития ИМ и инсульта в открытой популяции женщин 25-64 лет в течение 16 лет. Результаты. Распространенность высокого уровня стресса в открытой популяции женщин 25-64 лет составила 31,6%. Высокий уровень стресса на работе ассоциировался с высокой ответственностью, невозможностью отдохнуть в конце рабочего дня, частой профессиональной неудовлетворенностью и снижением трудоспособности. В течение 16 лет ОР развития ИМ был в 3,22 раза (p<0,05), инсульта -в 1,96 раза (p<0,05) выше у женщин с высоким уровнем стресса на работе. Частота возникновения ИМ и инсульта выше у замужних женщин, испытывающих стресс на работе, в категории «руководитель» и «физический труд» с высоким и низким уровнем образования. Заключение. Распространенность высокого уровня стресса на рабочем месте в открытой популяции России/Сибири (Новосибирск) у женщин 25-64 лет значительна. При нем ОР развития ИМ, инсульта в 3-2 раза выше, чем без высокого уровня стресса. На ОР развития ИМ, инсульта влияет социальный градиент. Results. The prevalence of high-level stress in the open female population aged 25-64 years was 31.6%. The high level of job stress was associated with a high responsibility, impossibility to have a rest at the end of a working day, frequent professional dissatisfaction, and a reduced work capacity. During 16 years, the women having high-level job stress showed a 3.22-and 1.96-fold increases in the HR of MI (p<0.05) and stroke (p<0.05), respectively. The incidence of MI and stroke was higher in married women expressing job stress as managers or manual laborers and having high and low educational attainment. Conclusion. The prevalence of high-level workplace stress was substantial in the open population of 25-64-year-old women in Russia/Siberia (Novosibirsk). The stress-related HR of MI and stroke was 3-2 times higher than in those without high-level stress. The HR of MI and stroke is affected by a social gradient.