A study from the ESSE-RF-2 project across four Russian regions found that only about one in five people maintain a healthy lifestyle. The survey highlights widespread dietary and lifestyle gaps that threaten heart health.
Among the most common issues identified in more than half of participants was high salt intake. Excess salt can raise blood pressure over time, increasing the risk of stroke or heart attack. The World Health Organization recommends keeping salt consumption to 5–6 grams per day, while global averages run between 9 and 12 grams daily. Reducing salt intake is regarded as one of the most cost-effective strategies to lower premature deaths worldwide by millions each year (World Health Organization data and statements).
Nevertheless, a strict reduction in salt can pose risks for older adults. Sharp salt withdrawal may cause drops in blood sodium, which can lead to hospitalizations, disorientation, falls, and even sudden death in vulnerable individuals. Sodium is essential for kidney function, nerve signaling and immune response; deficiency can trigger inflammatory changes in the blood. For patients with heart failure, compensatory adjustments may be needed. This complex balance requires careful medical guidance and gradual dietary improvements, ideally starting in childhood, as noted by medical experts and researchers involved in geriatric health studies in Russia.
Second on the list of risk factors is insufficient intake of fruits and vegetables, observed in about 37.5% of participants, followed by smoking, which affects roughly 22.7% of Russians. Inadequate physical activity appears in about 19.6%, and excessive alcohol consumption in 4.9% of the population.
Experts emphasize that a daily intake of vegetables should reach at least 400 grams, with 500 grams or more being ideal. Vegetables and fruits can be eaten fresh or cooked, but fresh produce tends to preserve more vitamins and minerals, especially vitamin C. A nutritionist from a major online healthcare service explains that variety matters: a diverse vegetable plate supports better health, so including zucchini, eggplant, sauerkraut, carrots and beets is beneficial. She also points to fish and dairy as commonly neglected but important components of a heart-healthy diet, noting the omega-3 fatty acids in oily fish help reduce cardiovascular risk and that calcium-rich foods support bone health and osteoporosis prevention. Typical daily calcium needs come from 2–3 servings of dairy, such as a glass of milk, 125 grams of yogurt, and about 30 grams of cheese (nutrition guidelines cited by the same medical expert).
Regular physical activity plays a crucial role in overall health. Different activities affect the body in distinct ways, so a mix is optimal. The guidance suggests about 150 minutes of moderate activity weekly to maintain health. There is no single perfect sport; a combination of endurance, resistance and flexibility exercises tends to yield the best cardio and musculoskeletal benefits. The key is choosing activities people enjoy, ensuring consistency and long-term adherence, according to the nutritionist cited in the medical service article.
Even so, stopping smoking far outpaces other measures in reducing risk. Experts highlight that quitting can dramatically improve life expectancy, with benefits extending even into older age. For seniors, quitting can add years of life, while middle-aged individuals may gain a decade or more. Nicotine replacement therapies and gradual reduction methods, including switching to electronic nicotine delivery systems, are discussed as part of a comprehensive cessation plan.
Public health campaigns in Russia, such as the national project Strengthening Public Health, have contributed to declines in smoking prevalence—from about 41% in 2013 to around 33% in 2022. Still, personal responsibility remains essential, and gradual lifestyle changes are encouraged rather than rushed.
Experts note that the major risk factors for most noncommunicable diseases include physical inactivity, unhealthy eating patterns, overweight, smoking and alcohol use. They advise forming a personalized recovery plan with a physician to tackle these factors step by step, rather than trying to overhaul everything at once.