Commentary: Pattern of drinking and the Russian heart.

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Abstract
Our knowledge about alcohol consumption levels and drinking patterns in Russia is steadily increasing and the paper by Nilssen and colleagues in this issue of the IJE1 makes a valuable addition to the developing store of literature. As discussed in the paper, a better understanding of the patterns and the trends of alcohol consumption is important for understanding the determinants of trends in cardiovascular disease (CVD); but the significance extends beyond this. Our best gauge of the effects of alcohol on the health of Russians in general is what happened in 1985–1988, during the period of a major anti-alcohol campaign in the former Soviet Union. During that period, the Soviet Union was still intact, and there was little of the massive and complex social and economic changes that make it so difficult to sort out causes of the rise in death rates since 1990. According to the best estimates,2 consumption in 1987 was 25% lower than it had been in 1984, before the anti-alcohol campaign was instituted, even when estimated illicit (and thus unrecorded) alcohol supplies were included. There was a strong effect on ‘circulatory disease’ deaths, which is where CVD would have been classified: in 1987 these deaths were recorded as being 9% lower in men than in 1984, and 6% lower in women.3 The effect was even stronger in other mortality categories: for accidents and violence, a drop of 36% for males and 24% for females; for pneumonia and other respiratory disease, 17% lower for males and 24% lower for females; overall, for mortality from all causes, there was a reduction of 12% for males and 7% for females.3
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