Background: Tobacco use remains a major modifiable risk factor for cardiovascular disease (CVD) morbidity and mortality worldwide. In the Russian Federation, tobacco control policy has evolved into a comprehensive regulatory framework addressing both conventional tobacco products and electronic nicotine delivery systems (ENDS). However, evidence linking the extent of policy implementation to population-level cardiovascular mortality remains limited.

Objective: To evaluate the associations between the implementation of tobacco and ENDS regulatory measures, patterns of tobacco and ENDS use, and cardiovascular mortality trends from 2019 to 2023 across 12 regions of the Russian Federation.

Materials and Methods: Associations were examined between the degree of implementation of tobacco control measures across 12 regions of the Russian Federation—assessed using an Integrated Implementation Scale developed within the EPOCH-RF2 study—and the prevalence of tobacco smoking and electronic nicotine delivery system (ENDS) use, derived from Federal statistics microdata of national sample surveys. These measures were further analyzed in relation to mortality rates per 100,000 population from diseases of the circulatory system (CSD), ischemic heart disease (IHD), respiratory diseases (RD), and malignant neoplasms (MN), obtained from official national mortality statistics. Correlation and multivariable regression analyses were conducted using Stata version 11.2.

Results: Regions with more comprehensive implementation of tobacco and ENDS control measures, including advertising bans, demonstrated significantly lower prevalence of tobacco smoking (rsp = –0.577; p = 0.005), ENDS use (rsp = –0.543; p = 0.040), and combined tobacco and/or ENDS use (β = –2.902; p = 0.039). More complete provision of smoking cessation support was associated with a higher proportion of individuals who quit ENDS use (rsp = 0.639; 95% CI 0.264–1.014; p = 0.001) and with a slower increase in ENDS prevalence between 2019 and 2024 (rsp = –0.689; 95% CI –1.017 to –0.361; p < 0.001). Smoking prevalence was strongly associated with cardiovascular mortality, including mortality from diseases of the circulatory system (rsp = 0.762; p < 0.001) and ischemic heart disease (rsp = 0.520; p = 0.017). In contrast, more comprehensive implementation of smoking cessation medical services was inversely associated with IHD mortality in 2023 (rsp = –0.622; 95% CI –1.082 to –0.163; p = 0.008) and with the increase in mortality from RD during 2019–2023 (rsp = –0.672; 95% CI –1.021 to –0.322; p < 0.001). Linear regression analysis demonstrated significant associations between the degree of implementation of the six tobacco control MPOWER measures and favorable relative dynamics of cardiovascular mortality from 2019 to 2023, including mortality from CSD (β = 0.669; p = 0.049) and IHD (β = 1.110; p = 0.040). Price and tax measures showed independent associations with reductions in cardiovascular mortality from CSD (β = 0.777; p = 0.034), IHD (β = 1.244; p = 0.038), and mortality from MN (β = 0.878; p = 0.003). The extent of smoking cessation support services was associated with slower growth in RD mortality (rsp = –0.672; p < 0.001; β = –17.568; p = 0.094), as well as lower IHD mortality (rsp = –0.622; p = 0.008; β = –65.35; p = 0.029).

Conclusions: Comprehensive regulation of tobacco and ENDS use is associated with lower prevalence of nicotine consumption and with favorable trends in cardiovascular mortality at the population level. Strengthening tobacco control policies—particularly price measures and accessible smoking cessation services—represents an effective strategy for NCD prevention and cardiovascular disease prevention in particular. These findings provide population-based evidence supporting tobacco and ENDS regulation as a critical component of NCD, including cardiovascular health policy.

To be updated