Cardiovascular disease (CVD) mortality in Russia is among the highest in the world. CVD mortality rate among Russian middle-aged (30-59) men and women is more than ten times higher than in Norway. Comparative studies however show that abnormally high levels of the conventional (atherosclerotic) cardiovascular risk factors such as serum cholesterol, obesity, diabetes and hypertension are equally as frequent in Norway, Sweden and Finland as in Russia. The study was partly based on data collected in a population-based cohort study in Arkhangelsk and partly on autopsy reports for 1.618 men and women who died from cardiovascular disease at age 30-70 in the city of Arkhangelsk in 2008-09. The results have shown that the CVD risk profile in Russia may be appreciably different to that in the US and Western Europe. Therefore the preventive measures directed against the high CVD rates should also be aimed at reducing hazardous drinking through judicious anti-alcohol policy.