Ventricular Arrhythmias and Cardiovascular Mortality in Elderly Men and Women in Russia: Results from the Population-Based Study

Aims. Russia is a country with high all-cause and CVD mortality and significant differences in the life expectancy of men and women. Pathways underlying these phenomena are an important research priority. Methods and results. We use data from the population-based study "Stress, Aging and Health in Russia", fielded in 2007-2009 in Moscow. It included 1,800 subjects aged 55+ (47% men). Interviews, conventional risk factors, inflammation markers, stress hormones, ECG, and 24-hour Holter monitoring (HM) were conducted. Patterns of ventricular arrhythmia (VA): frequent VPCs(≥10/hr), couplets, runs, and multiform VPCs, were assessed by HM. The mean length of the mortality follow up is 7.4 years (416 deaths). The relationship between VA and all-cause and CVD mortality with control for other risk factors was estimated by proportional hazard models. The same models were used for estimating contributions of VA to the male-female mortality gap. Multiform VPC are present in 46.6% men and 26.9% women. VPC couplets and runs are found in 27.3% and 12.7% of men and in 9.5% and 3.5% of women, respectively. Significant links between VA and the risk of CVD and all-cause mortality were found. The highest hazard ratio (HR) for the CVD death is observed for VPC runs 2.4 (CI 1.6, 3.7) for men and 2.8 (CI 1.5,5.1) for women. Both in men and women, couplets are also associated with significantly elevated HR. The CVD mortality impact of the frequent VPCs is greater for women: 2.39 (CI 1.42, 4.03) vs. 1.40 (1.01, 1.95). Mortality impacts of the multiform VPCs are significant in men only. The mortality effects of VA were independent of conventional CVD risks, history of MI and stroke. The VA accounts for 12.6% and 10% of the male-female mortality gap for CVD and for all-causes, respectively. The study supports the predictive potential of VA for CVD and all-cause mortality. VA may underlie a non-trivial part of the mortality difference between the sexes.