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Age and follow-up time affect the prognostic value of the ECG and conventional cardiovascular risk factors for stroke in adult men
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.
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2007 (English)In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 61, no 8, 704-712 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To explore whether the predictive power of mid-life ECG abnormalities and conventional cardiovascular risk factors for future stroke change over a 30-year follow-up period, and whether a repeated examination improves their predictive power. DESIGN AND SETTING: Longitudinal population-based study. PARTICIPANTS: 2,322 men aged 50 years, with a follow-up period of 30 years. 1,221 subjects were re-examined at age 70 years MAIN OUTCOME MEASURE: Risk for fatal and non-fatal stroke during three decades of follow-up. Investigations included resting ECG and traditional cardiovascular risk factors. RESULTS: When measured at age 50 years, ST segment depression and T wave abnormalities, together with ECG-left ventricular hypertrophy, were of importance only during the first 20 years, but regained importance when re-measured at age 70 years. Blood pressure was a significant predictor for stroke over all three decades of follow-up. In elderly people only, there is evidence that apolipoprotein A1 may protect from future stroke. CONCLUSION: Mid-life values for blood pressure and ECG abnormalities retain their predictive value over long follow-up periods even though they improved in predictive power when re-measured in elderly people. Despite lower prevalence, ECG abnormalities had greater impact at age 50 years than at age 70 years. By contrast, apolipoprotein A1 was protective for future stroke only at age 70 years.

Place, publisher, year, edition, pages
2007. Vol. 61, no 8, 704-712 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-17246DOI: 10.1136/jech.2006.048074ISI: 000248036300010PubMedID: 17630370OAI: oai:DiVA.org:uu-17246DiVA: diva2:45017
Available from: 2008-06-18 Created: 2008-06-18 Last updated: 2017-12-08Bibliographically 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
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Available from: 2006-11-10 Created: 2006-11-10 Last updated: 2013-07-24Bibliographically approved

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