Premature cardiovascular mortality and alcohol consumption before death in Arkhangelsk, Russia: an analysis of a consecutive series of forensic autopsies

BACKGROUND: High cardiovascular diseases (CVD) mortality among the middle aged is a major cause of reduced life expectancy in Russia, especially among men. Hazardous alcohol consumption is suspected to be a powerful contributing factor. METHODS: All men (1099) and women (519) aged 30-70 years who died between 1 January 2008 and 31 August 2009 from CVD in the city of Arkhangelsk, north-west Russia, were included. CVD mortality was stratified by age, gender and diagnosis. For the cases diagnosed by forensic pathologists, the blood alcohol concentration (BAC) was determined. The forensic autopsy rate was 72% for men and 62% for women. RESULTS: Age-standardized CVD mortality rate (all age groups) in men was higher than in women. The largest male-female ratio (4.3) was observed in the age group of 50-59 years. Alcoholic and unspecified cardiomyopathies were the most dominant of CVD mortalities in women, and second in men aged <50 years; they accounted for 50 and 25% of deaths, respectively. About one-third of men and women who died from CVD aged <60 years had consumed alcohol shortly before death. This occurred most frequently among the diagnostic groups 'other acute or subacute cardiac ischaemia', 'atherosclerotic heart disease' and 'cardiomyopathies'. Alcohol was more likely to be found at autopsy in men than in women (odds ratio 1.55; 95% confidence interval 1.14-2.10). No difference was found for those who died from myocardial infarction, cerebrovascular diseases and cardiomyopathies. Of the deceased, <1% had a BAC of ≥ 4 g/l. CONCLUSIONS: A high proportion of subjects who died from CVD in Arkhangelsk consumed alcohol shortly before death. It was highest among males aged 50-59 years. The largest gender difference in mortality, highest absolute number of premature CVD deaths, and the highest proportion of alcohol-positive autopsies occurred among them. Since associations with alcohol consumption varied considerably between the types of CVD diagnoses, this observation should be taken into account when planning future research. Our study does not provide evidence that cardiovascular deaths are misclassified cases of acute alcohol poisoning.