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Persistent ischemic ECG abnormalities on repeated ECG examination have important prognostic value for cardiovascular disease beyond established risk factors: A population-based study in middle-aged men with up to 32 years of follow-up
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. (Geriatrics)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. (Geriatrics)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. (Geriatrics)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
2007 (English)In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 93, no 9, 1104-1110 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To determine the effect of new, persistent or reverted ischaemic ECG abnormalities at ages 50 and 70 years on the risk of subsequent cardiovascular disease. Design, setting and participants: A prospective community-based observational cohort of 50-year-old men in Sweden, followed for 32 years. 2322 men of age 50 years participated in 1970-3, and 1221 subjects were re-examined at the age of 70 years. Main outcome measures: Myocardial infarction (MI), cardiovascular mortality and overall mortality. Results: At 50 years of age, after adjusting for established conventional risk factors, T wave abnormalities, ST segment depression, major Q/QS pattern and ECG-left ventricular hypertrophy were all found to be independent risk factors for the main outcome measures during the 32 years of follow-up. When ECG variables were re-measured at 70 years of age, they were still found to be independent risk factors for the mortality outcomes, but lost in significance for prediction of Ml. Regarding mortality, it was twice as dangerous to have persistent T wave abnormalities (HR 4.63; 95% Cl 2.18 to 9.83) or ST segment depression (HR 5.66; 95% Cl 1.77 to 18.1), as with new T wave abnormalities (HR 2.20; 95% Cl 1.48 to 3.29) or ST segment depression (HR 2.55; 95% Cl 1.74 to 3.75), developing between ages 50 and 70 years. The addition of "ECG indicating ischaemia" significantly increased the predictive power of the Framingham score (p<0.001). Conclusions: It is worthwhile to obtain serial ECGs for proper risk assessment, since persistent ST-T abnormalities carried twice as high a risk for future mortality compared with new or reverted abnormalities.

Place, publisher, year, edition, pages
2007. Vol. 93, no 9, 1104-1110 p.
Keyword [en]
Vascular disease, Electrodiagnosis, Cardiovascular risk, Phlebology, Cardiology, Circulatory system, Follow up study, Male, Middle age, Population, Public health, Risk factor, Predictive value, Anomaly, Human, Electrocardiography, Atherosclerosis, Cardiovascular disease, Ischemia
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-95035DOI: 10.1136/hrt.2006.109116ISI: 000248747500021PubMedID: 17483125OAI: oai:DiVA.org:uu-95035DiVA: diva2:169094
Available from: 2006-11-10 Created: 2006-11-10 Last updated: 2011-01-27Bibliographically approved
In thesis
1. The Resting Electrocardiogram and Risk for Cardiovascular Disease: A Population-Based Study in Middle-Aged Men with up to 32 Years of Follow-Up
Open this publication in new window or tab >>The Resting Electrocardiogram and Risk for Cardiovascular Disease: A Population-Based Study in Middle-Aged Men with up to 32 Years of Follow-Up
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim was to contribute to the optimal use of the resting ECG by exploring, in middle-aged and elderly men, the development and regression of ECG abnormalities; the prognostic value of the ECG for cardiovascular disease compared to conventional risk factors; and the impact of age at baseline and follow-up time for prediction of cardiovascular disease.

It was based on the Uppsala Study of Adult Men cohort that was started in 1970. Participants were examined at ages 50, 70, 77, and 82, with annual updates on mortality and in-hospital morbidity using national registries.

The studies indicated that the prevalence of silent MI and frequency of regression of major Q/QS patterns may be higher than previously believed. Considering that persistent T wave abnormalities and ST segment depression carried twice as high a risk for future cardiovascular disease (CVD) mortality as new or reverted abnormalities, the results suggested that serial electrocardiograms (ECG) would contribute to proper risk assessment. Also, the inclusion of ischemic ECG findings significantly increased the predictive power of the Framingham score at age 70 for CVD.

While hypertension and dyslipidemia were consistent long-term risk factors for myocardial infarction at ages 50 and 70, the length of follow-up period and age at baseline affected the predictive power of ECG abnormalities, fasting insulin, BMI, and smoking.

For stroke, midlife values for blood pressure and ECG abnormalities retained prognostic value over long follow-up periods, even though they improved when re-measured in elderly participants. ApoB/apoA1 ratio, driven by apoA1, was associated with stroke in elderly but not middle-aged men. Hyperinsulinemia and diabetes mellitus were more specifically associated with ischemic stroke than with any-cause stroke.

In summary, the resting ECG carried prognostic information beyond conventional risk factors. Even though the low prevalence of ECG abnormalities at the age of 50 calls into question the role of the ECG as a screening tool, the additional risk information it carries with it justifies its regular and repeated registration above the age of 50.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2006. 77 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 190
Keyword
Medical sciences, electrocardiogram, risk factors, epidemiology, population-based studies, cardiovascular mortality, apolipoproteins, MEDICIN OCH VÅRD
Identifiers
urn:nbn:se:uu:diva-7210 (URN)91-554-6694-X (ISBN)
Public defence
2006-12-08, Auditorium Minus, Museum Gustavianum, Akademigatan 3, 75310 Uppsala, 09:15
Opponent
Supervisors
Available from: 2006-11-10 Created: 2006-11-10 Last updated: 2013-07-24Bibliographically approved

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