Consumption of alcohol and mortality in Russia.

Abstract

The study by David Leon and colleagues1Leon DA Chenet L Shkolnikov VM et al.Huge variation in Russian mortality rates 1984–94: artefact, alcohol, or what?.Lancet. 1997; 350: 383-388Summary Full Text Full Text PDF PubMed Scopus (625) Google Scholar suggests that alcohol intake is largely responsible for the sharp fall and subsequent rise in Russian mortality between 1984 and 1994.1Leon DA Chenet L Shkolnikov VM et al.Huge variation in Russian mortality rates 1984–94: artefact, alcohol, or what?.Lancet. 1997; 350: 383-388Summary Full Text Full Text PDF PubMed Scopus (625) Google Scholar However, as Dean Kromhout and colleagues' accompanying commentary2Kromhout D Bloemberg B Doornbos G Reversibility of rise in Russian mortality rates.Lancet. 1997; 350: 379-380Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar points out, other factors may have been important. One factor not mentioned in either report is psychological nature. In 1984, 2 years after Brezhnev's death, Glasnost and Perestroika were announced and Russians were optimistic about the future. By contrast, the early 1990s were characterised by economic uncertainty and political instability.Psychological disorders, especially depression, are important determinants of mortality, particularly cardiac death. Patients with myocardial infarction who are depressed have a six-fold risk of reinfarction and sudden death compared with individuals who are not depressed.3Cleophas TJM Depression and myocardial infarction, implications for medical prognosis and options for treatment.Drugs Aging. 1997; 11: 111-118Crossref PubMed Scopus (12) Google Scholar Specific independent psychological risk factors for coronary artery disease have been identified.4Cleophas TJM de Jong J Niemeyer MG Zwinderman AH Changes in life-style in men under sixty years of age before and after myocardial infarction: a case-control study.Angiology. 1993; 44: 761-770Crossref PubMed Scopus (8) Google Scholar Cleophas and colleagues' case-control study5Cleophas TJM Tuinenberg E van der Meulen J Niemeyer MG Zwinderman AH Wine consumption and other dietary characteristics in males under 60 before and after myocardial infarction.Angiology. 1996; 47: 789-796Crossref PubMed Scopus (20) Google Scholar showed that after adjustment for these factors, the beneficial effect of alcohol on coronary artery disease was lost, suggesting that psychological factors rather than alcohol consumption were responsible for the beneficial effects observed. A final point, many other countries, particularly European Mediterranean countries, consume similar or even greater quantities of alcohol without the increased mortality reported in Russia. The study by David Leon and colleagues1Leon DA Chenet L Shkolnikov VM et al.Huge variation in Russian mortality rates 1984–94: artefact, alcohol, or what?.Lancet. 1997; 350: 383-388Summary Full Text Full Text PDF PubMed Scopus (625) Google Scholar suggests that alcohol intake is largely responsible for the sharp fall and subsequent rise in Russian mortality between 1984 and 1994.1Leon DA Chenet L Shkolnikov VM et al.Huge variation in Russian mortality rates 1984–94: artefact, alcohol, or what?.Lancet. 1997; 350: 383-388Summary Full Text Full Text PDF PubMed Scopus (625) Google Scholar However, as Dean Kromhout and colleagues' accompanying commentary2Kromhout D Bloemberg B Doornbos G Reversibility of rise in Russian mortality rates.Lancet. 1997; 350: 379-380Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar points out, other factors may have been important. One factor not mentioned in either report is psychological nature. In 1984, 2 years after Brezhnev's death, Glasnost and Perestroika were announced and Russians were optimistic about the future. By contrast, the early 1990s were characterised by economic uncertainty and political instability. Psychological disorders, especially depression, are important determinants of mortality, particularly cardiac death. Patients with myocardial infarction who are depressed have a six-fold risk of reinfarction and sudden death compared with individuals who are not depressed.3Cleophas TJM Depression and myocardial infarction, implications for medical prognosis and options for treatment.Drugs Aging. 1997; 11: 111-118Crossref PubMed Scopus (12) Google Scholar Specific independent psychological risk factors for coronary artery disease have been identified.4Cleophas TJM de Jong J Niemeyer MG Zwinderman AH Changes in life-style in men under sixty years of age before and after myocardial infarction: a case-control study.Angiology. 1993; 44: 761-770Crossref PubMed Scopus (8) Google Scholar Cleophas and colleagues' case-control study5Cleophas TJM Tuinenberg E van der Meulen J Niemeyer MG Zwinderman AH Wine consumption and other dietary characteristics in males under 60 before and after myocardial infarction.Angiology. 1996; 47: 789-796Crossref PubMed Scopus (20) Google Scholar showed that after adjustment for these factors, the beneficial effect of alcohol on coronary artery disease was lost, suggesting that psychological factors rather than alcohol consumption were responsible for the beneficial effects observed. A final point, many other countries, particularly European Mediterranean countries, consume similar or even greater quantities of alcohol without the increased mortality reported in Russia.