**Abstract**

Introduction: The study aimed to determine gender differences in the prevalence and dynamics of affective states over a long period, i.e., 23 years, and to establish their effect on the risk of cardiovascular diseases (CVD), i.e., arterial hypertension (AH), myocardial infarction (MI), and stroke among the population aged 25–64 in Russia / Siberia. Methods: Between 1994 and 2017, we conducted 4 screening surveys of representative samples (totalling 4,815 people) under the international programs MONICA and HAPIEE in Russia / Siberia. To determine the sex differences in cardiovascular risk from 1994 to 2010, we observed cohorts formed from the screened individuals without CVD and diabetes mellitus (DM). Results: High levels of affective states in the period from 1994 to 2003, especially in women, were replaced by a downward trend in 2013. At the same time, there was a reduction in the gender gap in terms of frequency of depression lower 1%, and men in the younger age groups reported higher levels of personal anxiety (49.3% vs 46.1% in adults aged 35-44y) and vital exhaustion (16.9% vs 15.6%) than women in 2017. We found that men with unfavourable levels of affective states have a 3–5 fold higher risk of hypertension and stroke, while women have a higher risk of myocardial infarction (p for all < 0.05). Hostility in men is associated with a negative risk of myocardial infarction and stroke (HR=0.3 and HR=0.29, respectively; p for all < 0.05). However, this was levelled out by unfavourable social characteristics. Conclusions: The downward trends in prevalence of psychosocial factors were unstable and associated with reduced gender gap for affective states. It had a significant impact on the gender magnitude of cardiovascular risk.

**Keywords:** anxiety, depression, vital exhaustion, hostility, social support, population, risk, sex differences, arterial hypertension, myocardial infarction, stroke, marital status, education, occupational status
