The long-term prognostic value of a standard 12-lead electrocardiogram (ECG) for predicting cardiac events in apparently healthy middle-aged subjects is not well defined.
A total of 9511 middle-aged subjects (mean age 43?±?8.2 years, 52% males) without a known cardiac disease and with a follow-up 40 years were included in the study. Fatal and non-fatal cardiac events were collected from the national registries. The predictive value of ECG was separately analyzed for 10 and 30 years. Major ECG abnormalities were classified according to the Minnesota code.
Subjects with major ECG abnormalities (N?=?1131) had an increased risk of cardiac death after 10-years (adjusted hazard ratio [HR] 1.7; 95% confidence interval [95% CI], 1.1-2.5, p?=?0.009) and 30-years of follow-up (HR 1.3, 95% CI, 1.1-1.5, p?
The optimal blood pressure (BP) in persons with type-2 diabetes is debated. We investigated shapes of the associations of SBP and DBP levels with risk of cardiovascular events and mortality in a large primary care-based sample of diabetic patients.
We investigated all 34?009 consecutive cardiovascular disease-free type-2 diabetes patients aged 35 years or older (mean age 64 years) at 84 primary care centers in central Sweden between 1999 and 2008. We followed this cohort until the end of 2009 in national registries for the incidence of major cardiovascular events (a composite endpoint of myocardial infarction, stroke, heart failure, or cardiovascular mortality) or total mortality.
During up to 11 years of follow-up, 6344 patients (18.7%) had a first cardiovascular event, and 6235 died (18.3%). The associations of annually updated SBP and DBP with risk of major cardiovascular events were U-shaped. The lowest risk of cardiovascular events was observed at a SBP of 135-139?mmHg and a DBP of 74-76?mmHg, and the lowest mortality risk at a SBP of 142-150?mmHg and a DBP of 78-79?mmHg, in both antihypertensive drug-untreated and drug-treated persons.
In a large primary care-based sample of patients with type-2 diabetes, associations of SBP and DBP with risk of major cardiovascular events and mortality were U-shaped. This may have implications for risk stratification of persons with diabetes.
Distribution of body fat is more important than the amount of fat as a prognostic factor for life expectancy. Despite that, body mass index (BMI) still holds its status as the most used indicator of obesity in clinical work.
We assessed the association of five different anthropometric measures with mortality in general and cardiovascular disease (CVD) mortality in particular using Cox proportional hazards models. Predictive properties were compared by computing integrated discrimination improvement and net reclassification improvement for two different prediction models. The measures studied were BMI, waist circumference, hip circumference, waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR). The study population was a prospective cohort of 62,223 Norwegians, age 20-79, followed up for mortality from 1995-1997 to the end of 2008 (mean follow-up 12.0 years) in the Nord-Tr?ndelag Health Study (HUNT 2).
After adjusting for age, smoking and physical activity WHR and WHtR were found to be the strongest predictors of death. Hazard ratios (HRs) for CVD mortality per increase in WHR of one standard deviation were 1.23 for men and 1.27 for women. For WHtR, these HRs were 1.24 for men and 1.23 for women. WHR offered the greatest integrated discrimination improvement to the prediction models studied, followed by WHtR and waist circumference. Hip circumference was in strong inverse association with mortality when adjusting for waist circumference. In all analyses, BMI had weaker association with mortality than three of the other four measures studied.
Our study adds further knowledge to the evidence that BMI is not the most appropriate measure of obesity in everyday clinical practice. WHR can reliably be measured and is as easy to calculate as BMI and is currently better documented than WHtR. It appears reasonable to recommend WHR as the primary measure of body composition and obesity.
OBJECTIVES: It is well known that pulmonary function is associated with all-cause and cardiovascular (CV) death. Less is known about the association between respiratory symptoms and mortality and whether such an association is independent of physical fitness. In this study, we assessed the association of breathlessness and productive cough with CV and all-cause mortality over 26 years. DESIGN: Prospective occupational cohort study. SETTING AND SUBJECTS: In 1972-75, 1999 apparently healthy men aged 40-59 years were recruited to the study from five companies in Oslo, Norway. At study entry clinical, physiological and biochemical parameters including respiratory symptoms, spirometry, and an objective assessment of physical fitness were measured in all subjects, of whom 1,623 had acceptable spirometry. The data was analysed using Cox proportional hazards analysis, adjusting for age, lung function, physical fitness, and other possible confounders, with mortality until 2000. RESULTS: After 26 years (range 25-27), 615 men (38%) had died, of whom 308 (50%) from CV deaths. In multivariable proportional hazards models, 'having phlegm winter mornings' [hazard ratio (HR) 1.30, P = 0.01], 'breathlessness when hurrying/walking uphill' (HR 1.43, P = 0.005) and combinations of the two symptoms remained significant predictors of all-cause mortality. None of six respiratory symptoms were significant predictors of CV mortality in multivariable models. CONCLUSIONS: Phlegm, breathlessness and combinations of them were associated with all-cause mortality, even after adjusting for physical fitness, known CV and other risk factors such as smoking, and lung function. The finding of an association also after adjustment for physical fitness is new. In contrast, none of the six respiratory symptoms individually or in combination were associated with CV mortality in multivariable analysis.
little is known about demographic and clinical characteristics associated with sleep-disordered breathing (SDB) and obstructive sleep apnoea (OSA) or central sleep apnoea (CSA) in community-dwelling elderly. We also examined these (OSA and CSA) associations to all-cause and cardiovascular (CV) mortality.
a total of 331 community-dwelling elderly aged 71-87 years underwent a clinical examination and one-night polygraphic recordings in their homes. Mortality data were collected after seven years.
a total of 55% had SDB, 38% had OSA and 17% had CSA. Compared with those with no SDB and OSA, more participants with CSA had a left ventricular ejection fraction 75 years does not appear to be associated with cardiovascular disease (CVD) disease or mortality, whereas CSA might be a pathological marker of CVD and impaired systolic function associated with higher mortality.
To examine whether elevated resting heart rate (RHR) is an independent risk factor for mortality or a mere marker of physical fitness (VO2Max).
This was a prospective cohort study: the Copenhagen Male Study, a longitudinal study of healthy middle-aged employed men. Subjects with sinus rhythm and without known cardiovascular disease or diabetes were included. RHR was assessed from a resting ECG at study visit in 1985-1986. VO2Max was determined by the Ã?strand bicycle ergometer test in 1970-1971. Subjects were classified into categories according to level of RHR. Associations with mortality were studied in multivariate Cox models adjusted for physical fitness, leisure-time physical activity and conventional cardiovascular risk factors.
2798 subjects were followed for 16 years. 1082 deaths occurred. RHR was inversely related to physical fitness (p 90 had an HR (95% CI) of 3.06 (1.97 to 4.75). With RHR as a continuous variable, risk of mortality increased with 16% (10-22) per 10 beats per minute (bpm). There was a borderline interaction with smoking (p = 0.07); risk per 10 bpm increase in RHR was 20% (12-27) in smokers, and 14% (4-24) in non-smokers.
Elevated RHR is a risk factor for mortality independent of physical fitness, leisure-time physical activity and other major cardiovascular risk factors.
Cites: Am Heart J. 1986 May;111(5):932-403706114
Cites: Science. 1984 Oct 12;226(4671):180-26484569
Cites: Am J Epidemiol. 1980 Dec;112(6):736-497457467
Cites: Med Lab (Stuttg). 1977 Feb;30(2):29-37834159
Cites: Dan Med Bull. 1975 Feb;22(2):81-41132257
Cites: N Engl J Med. 1993 Feb 25;328(8):533-78426620
Cites: Eur Heart J. 2013 Mar;34(12):932-4123178644
AIM: To study the relationship between heart rate and (a) all deaths and (b) cardiovascular deaths in a large cohort of middle-aged Norwegian men and women. METHODS AND RESULTS: A prospective study of participants in cardiovascular surveys that were carried out in 1985-1999 and covered men and women aged 40-45 years in all counties except the capital, Oslo. In total, 180,353 men and 199,490 women aged 40-45 years without cardiovascular history or diabetes accrued 4 775 683 years of follow-up. There was a positive and graded association between heart rate and mortality from all causes, as well as between heart rate and deaths from cardiovascular disease (CVD), ischaemic heart disease, and stroke. However, these associations were greatly reduced when we adjusted for the main risk factors of disease. The hazard ratios for any death were reduced from 3.14 to 1.82 for men (95% CI, 1.62-2.04) and from 2.14 to 1.37 for women (95% CI, 1.19-1.59), when we compared > or =95 b.p.m. with
BACKGROUND: Resting heart rate is directly associated and maximal exercise-induced heart rate inversely associated with cardiovascular mortality, and therefore their difference might contain prognostic information from both variables. The comparative long-term prognostic values of maximal exercise-induced heart rate and of the difference between it and resting heart rate were studied in apparently healthy middle-aged men. METHODS: Resting heart rate and maximal exercise-induced heart rate were measured, and their difference calculated, in 1960 apparently healthy men aged 40-59 years, and mortality was recorded over a period of 16 years. Conventional coronary risk factors were assessed at baseline. RESULTS: Both the difference between the two heart rates and the maximal exercise-induced heart rate were strongly, independently and inversely associated with cardiovascular mortality after adjustment for age, smoking, systolic blood pressure, lung function, glucose tolerance, serum cholesterol level, serum triglycerides level, physical fitness and exercise ECG findings. The adjusted relative risk of cardiovascular death in heart-rate difference quartiles 3 and 4 compared with that in quartile 1 (the lowest heart-rate difference quartile) was 0.54 (95% confidence interval 0.33-0.86; P = 0.009). The corresponding value for maximal exercise-induced heart rate was 0.56 (95% confidence interval 0.34-0.89; P = 0.018). Within the lowest heart-rate difference quartile, but not within the lowest maximal exercise-induced heart rate quartile, a further, strong, negative gradient in cardiovascular mortality was observed. In the high working capacity range, low heart-rate difference but not low maximal exercise-induced heart rate predicted very high cardiovascular disease mortality. Heart-rate difference and maximal exercise-induced heart rate were also inversely associated with non-cardiovascular disease mortality. CONCLUSIONS: Both heart-rate difference and maximal exercise-induced heart rate were strong, graded, long-term predictors of cardiovascular mortality among apparently healthy middle-aged men, independent of age, physical fitness and conventional coronary risk factors. However, low heart-rate difference was a better predictor than low maximal exercise-induced heart rate for recognizing individuals who were at particularly high risk of dying prematurely from cardiovascular diseases.