Surprisingly few attempts have been made to quantify the simultaneous contribution of well-established risk factors to CVD mortality differences between countries. We aimed to develop and critically appraise an approach to doing so, applying it to the substantial CVD mortality gap between Russia and Norway using survey data in three cities and mortality risks from the Emerging Risk Factor Collaboration. We estimated the absolute and relative differences in CVD mortality at ages 40–69 years between countries attributable to the risk factors, under the counterfactual that the age- and sex-specific risk factor profile in Russia was as in Norway, and vice-versa. Under the counterfactual that Russia had the Norwegian risk factor profile, the absolute age-standardized CVD mortality gap would decline by 33.3% (95% CI 25.1–40.1) among men and 22.1% (10.4–31.3) among women. In relative terms, the mortality rate ratio (Russia/Norway) would decline from 9–10 to 7–8. Under the counterfactual that Norway had the Russian risk factor profile, the mortality gap reduced less. Well-established CVD risk factors account for a third of the male and around a quarter of the female CVD mortality gap between Russia and Norway. However, these estimates are based on widely held epidemiological assumptions that deserve further scrutiny.

令人惊讶的是，很少有人尝试量化既定风险因素对各国心血管病死亡率差异的同时影响。我们的目的是开发并严格评估一种方法，利用三个城市的调查数据和新兴风险因素合作的死亡风险，将其应用于俄罗斯和挪威之间巨大的心血管疾病死亡率差距。我们估计了各国之间 40-69 岁 CVD 死亡率因危险因素而导致的绝对和相对差异，假设俄罗斯的年龄和性别特定危险因素与挪威相同，反之亦然。在俄罗斯具有挪威危险因素概况的反事实下，男性的绝对年龄标准化CVD死亡率差距将下降33.3%（95% CI 25.1-40.1），女性将下降22.1%（10.4-31.3）。相对而言，死亡率比（俄罗斯/挪威）将从 9-10 下降到 7-8。在挪威具有俄罗斯风险因素概况的反事实下，死亡率差距缩小得较少。俄罗斯和挪威之间的 CVD 死亡率差距，男性 1/3 和女性 1/4 是由明确的 CVD 风险因素造成的。然而，这些估计是基于广泛持有的流行病学假设，值得进一步审查。