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CVD deaths often occur at a younger age than in western countries and are much more likely to be sudden. While much of the cardiovascular disease in Russia is likely to be attributable to the traditional risk factors, such as a poor diet and smoking, there is now considerable evidence that many of the excess deaths especially among younger men are attributable to heavy alcohol consumption, with this factor explaining the large fluctuations in  cardiovascular deaths since the mid 1980s. (18).
The second most important cause of death involves external causes of injury and poisoning (which includes homicide, suicide, alcohol poisonings, etc.). As with cardiovascular diseases, these deaths peaked in 1994. The importance of this category of causes of death is unusual by the standards of most industrialized countries, where external causes tend to be superseded by cancer. A reduction in deaths from external causes after 1994 was reversed in 1998 and the Russian rate continues to be the highest in the European Region (2). The male mortality rate in this category is 4.4 times greater than that of women, accounting for about half the deaths of working-age men, and there is considerable evidence to link it to alcohol abuse.
External causes are followed in importance by cancer, which rose until 1995 and then began to fall (19). This fall will, however, be transient as it is due to a temporary decline in deaths from lung cancer reflecting reduced smoking rates in the immediate postwar period (20). While the incidence of cancer is low for ages 65 and above compared to western European countries, it is very high in the below-65 age group. In addition, the rapid increase in smoking among young women means that their rates of lung cancer will rise considerably in the next few decades (21).