In explaining recent trends in Russian mortality, alcohol drinking has often been put forward as a major factor. However, cardiovascular disease remains the major cause of death in Russia and alcohol is currently viewed as having a protective effect on heart disease. This study explores this apparent paradox by examining daily trends in deaths from cardiovascular disease in Moscow.
Those dying in Moscow in the years 1993-1995.
Analysis of daily variation in deaths based on data from Moscow City death certificates.
There is a significant increase in deaths from alcohol poisoning, accidents, and violence and cardiovascular diseases on Saturdays, Sundays, and Mondays. This is especially marked for sudden deaths. This pattern is consistent with the known pattern of drinking in Russia, which is more likely to take place in binges than is the case in other countries.
A possible causative role for alcohol in sudden cardiovascular death is suggested as there are no other obvious explanations for this pattern, which cannot be accounted for by daily variations in traditional risk factors such as smoking or lipids. Although this is inconsistent with the prevailing view in the West that alcohol is seen as cardioprotective, there is considerable supporting evidence from a necropsy study and from studies in other places with a similar pattern of drinking. In countries such as Russia, where patterns of drinking differ considerably from that in the West, binge drinking can be an important cause of sudden cardiac death. This has important implications for estimates of the amount of mortality worldwide attributable to specific risk factors and thus for national and international policy.
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To study the pattern of lethal outcomes due to rheumatic diseases (RD) in Moscow.
Annual reports of 38 pathological departments of Moscow have been analysed for 1999 and 2000.
RD accounted for 1.8% diagnosis at autopsies (n = 784). RD as the main diagnosis was in 668 cases (1.53%). Diseases of the bone-muscle system caused death 3.5 times less often than rheumatism. As concommitent diseases RD were encountered in 118 cases (0.27%), diseases of the bone-muscle system were registered 2 times less frequently than rheumatism. Chronic rheumatic diseases of the heart were diagnosed in 590 cases (98.5%), rheumatic fever was detected in 9 (1.5%) patients. The main diagnosis of RA, seronegative arthritides, systemic vasculitides, SLE, osteoarthrosis was made in 49, 10 9.3, 12.7, 1.3%, respectively. Such nosological entities as osteoporosis, gout and other microcrystalline arthritides were referred to the group "other rheumatic diseases" and made up 12.7%. As concomitant pathology RA, OA, seronegative spondyloarthritides, SLE, other RD occurred in 54, 8.1, 27, 2.7, 2.7%, respectively.
The share of RD in autopsy diagnosis accounts for 1.8% of the total number of necropsies. These figures seem to underestimate the real situation and may be explained by poor registration of RD at autopsy and a fall in the total number of autopsies for the last 10 years. For Moscow and Russia as a whole there is a prevalence of rheumatism mortality (76%), primarily deaths of chronic rheumatic cardiac diseases, over mortality due to diseases of the bone-muscular system (24%).
A trial period of one year in which the ambulance service for patients with acute cardiac disease was improved is described. This trial took pace in the County of Vestsjaelland in a mixed urban and rural district with five general practices and with more than fifteen kilometres (9.4 miles) to the county hospital. Two ambulance stations were equipped with defibrillators and the staff were trained in their use. The recommendations made by a subcommittee appointed by the Danish Board of Health were thus fulfilled, but, in addition, the general practitioners/doctors-on-duty were connected with the arrangement. They were equipped with radios by which they could communicate with the ambulance stations. If the leader of the ambulance station considered, on the basis of the alarm, that a patient with acute cardiac disease was involved, the doctor-on-duty in the district concerned was contact so that he could come and participate in the treatment unless prevented by other work. An attempt was made to assess the effect of an arrangement such as this on survival of patients, the extent to which medical assistance can be obtained and the extent of the actual medical assistance. During the trial period, 158 turn-outs occurred to the approximately 30,000 population in the district concerned. The total number of emergency ambulance turn-outs was 1,200, 41 of these were patients with clinical cardiac arrest and 56 to patients with other forms of acute cardiac disease. Sixty-one patients were found to have conditions other than cardiac diseases. It proved possible to provide medical assistance in 79% of the cases.(ABSTRACT TRUNCATED AT 250 WORDS)
All available information recorded on the death certificates of 12973 Finnish persons who, according to the official Finnish mortality statistics, died in 1968 from arteriosclerotic and other degenerative heart diseases (ADHD, rubrics 420-422 in ICD) comprised the material of the present study. The mortality of males from ADHD analysed by age and place of residence was very high when compared with various national rates of international WHO statistics. The degree of urbanization of the domicile did not have any statistically significant effect on the mortality from ADHD. Significant differences between various provinces were found in the mortality of males from ADHD. The male population living in the eastern provinces of Finland showed a highly significantly higher mortality from degenerative heart diseases than the male population living on the west coast. A highly significant difference was found in mortality between various subgroups of the Finnish male and female populations analysed by age, place of residence, and type of community. The uniform difference between the mortality of various male and female subgroups of the Finnish population, which was obtained using the present statistical survey of death certificates, and the fairly uniform distribution of high rate of mortality of males from degenerative heart diseases in most regions of the country lend further support to the reliability of cause-of-death statistics, since certification of deaths can then be regarded to occur uniformly and with about the same accuracy in different parts of the country.
A statistical survey of death certificates was made to analyse the ante-mortem and post-mortem medical and medico-legal examinations used in the determination of the cause of death of 12973 decedents who were recorded officially to have died of arteriosclerotic and other degenerative heart diseases in Finland in 1968. The relationship between the regional autopsy rate and the rate of mortality from degenerative heart diseases was studied in particular. The survey indicated that there was no systematic relationship between the type of ante-mortem and post-mortem cause-of-death examinations, including medical and medico-legal autopsies, and the rate of mortality from arteriosclerotic and other degenerative heart diseases in various groups of the Finnish population analysed by age, sex and domicile. This was concluded to be an indication of the reliability of Finnish cause-of-death statistics of degenerative heart diseases which show a generally high rate of mortality and prominent regional differences in the rate of deaths from those diseases among the Finnish male population.
The role of ambient levels of carbon monoxide (CO) in the exacerbation of heart problems in individuals with both cardiac and other diseases was examined by comparing daily variations in CO levels and daily fluctuations in nonaccidental mortality in metropolitan Toronto for the 15-year period 1980-1994. After adjusting the mortality time series for day-of-the-week effects, nonparametic smoothed functions of day of study and weather variables, statistically significant positive associations were observed between daily fluctuations in mortality and ambient levels of carbon monoxide, nitrogen dioxide, sulfur dioxide, coefficient of haze, total suspended particulate matter, sulfates, and estimated PM2.5 and PM10. However, the effects of this complex mixture of air pollutants could be almost completely explained by the levels of CO and total suspended particulates (TSP). Of the 40 daily nonaccidental deaths in metropolitan Toronto, 4.7% (95% confidence interval of 3.4%-6.1%) could be attributable to CO while TSP contributed an additional 1.0% (95% confidence interval of 0.2-1.9%), based on changes in CO and TSP equivalent to their average concentrations. Statistically significant positive associations were observed between CO and mortality in all seasons, age, and disease groupings examined. Carbon monoxide should be considered as a potential public health risk to urban populations at current ambient exposure levels.
Previous reports from the Russian Lipid Research Clinics (LRC) study showed no association between the level of high-density-lipoprotein (HDL) cholesterol and mortality from coronary heart disease (CHD), while US LRC data indicated a strong negative association between HDL cholesterol and CHD mortality. This report investigated the association of HDL cholesterol and mortality in these same population samples with follow-up extended to 12 years. The association between HDL cholesterol and mortality remained inverse and significant in the US sample. In the Russian sample, high levels of HDL cholesterol were associated with higher risk of all-cause and cancer mortality, although adjustment for known risk factors reduced the strength of the association. The association between HDL cholesterol and CHD mortality was negative in the Russian sample, although the strength of the association was less than that for the US sample. Extended follow-up reduced the difference in the association between HDL cholesterol and mortality between the two countries; however, important differences remained. Further research will be required to clearly determine the cause for their differences.
Surgery for atrial fibrillation (AF) has been demonstrated as an effective treatment to restore and maintain sinus rhythm in patients for whom a rhythm control strategy is desired. It is usually offered to patients undergoing other types of cardiac surgery (eg, mitral valve repair or replacement, coronary artery bypass grafting, aortic valve surgery, intracardiac defects, ascending aortic surgery). It is also feasible as a stand-alone procedure, bearing a high success rate. In the past few years, less-invasive procedures have been described. AF is a triggered arrhythmia, resulting from ectopic activity most commonly located in and around the pulmonary veins of the left atrium. Therefore, electrical isolation of the pulmonary veins from the rest of the left atrium in order to prevent AF from being triggered is the rationale common to all surgical techniques. Further substrate modification may be required in patients with more persistent AF. This is done by adding ablation of the posterior left atrium with connecting lines of block between pulmonary veins, to the mitral valve annulus, as well as in specific sites in the right atrium. The left atrial appendage is resected or occluded at the same time. Despite patients' high rate of freedom from AF after surgery (70%-85% at 1 year), surgical ablation of AF has never been clearly shown to alter long-term mortality. The available literature supports the recommendation to stop oral anticoagulation therapy 6 months after surgery when sinus rhythm can be documented, because a very low rate of thromboembolic events is reported. However, there is no evidence-based data to support the safety of omitting long-term oral anticoagulation. Thus, surgery should be used primarily as a concomitant procedure during cardiac surgery for other diseased states or as a stand-alone procedure after failure of prior attempts of catheter ablation and antiarrhythmic drugs.