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Impact of follow-up time and re-measurement of the electrocardiogram and conventional risk factors on their predicitve value for myocardial infarction.
Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Public Health and Caring Sciences.
2006 In: Journal of Internal Medicin, Vol. 260, no 1, 22-30 p.Article in journal (Refereed) Published
Place, publisher, year, edition, pages
2006. Vol. 260, no 1, 22-30 p.
URN: urn:nbn:se:uu:diva-95036OAI: oai:DiVA.org:uu-95036DiVA: diva2:169095
Available from: 2006-11-10 Created: 2006-11-10Bibliographically 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.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 190
Medical sciences, electrocardiogram, risk factors, epidemiology, population-based studies, cardiovascular mortality, apolipoproteins, MEDICIN OCH VÅRD
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
Available from: 2006-11-10 Created: 2006-11-10 Last updated: 2013-07-24Bibliographically approved

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