Abstract
Information is limited on the co-existence and prognostic association of the ischemic electrocardiogram (ECG) and blood pressure. Prospectively collected data sets from 28,118 examinations in the Copenhagen City Heart Study were analyzed for cardiac morbidity and mortality for a 5.9-year follow-up. The prognosis of the ECG, independently of blood pressure, was examined. The Cox proportional hazard model was employed to evaluate the prognostic implications of ECG findings and relative risk was adjusted for age and multivariately adjusted for traditional cardiovascular risk factors. End-points were (1) fatal and non-fatal ischemic heart disease (IHD) events and (2) cardiovascular disease (CVD) mortality. During a total follow-up period of 166,471 person years (mean: 5.9 years) 1.481 IHD events were recorded and 1.051 CVD deaths. The relative risk of an ischemic ECG was independent of the blood pressure level. The multivariately adjusted relative risk for fatal and non-fatal IHD for the ischemic ECG was 1.70 (95 CI: 1.39–2.09, p < 0.001) in women, and 1.96 (95 CI: 1.67–2.30, p < 0.001) in men, and for CVD mortality 1.71 (95 CI: 1.34–2.17, p < 0.001) in women and 2.08 (95 CI: 1.74–2.49, p < 0.001) in men. An ECG with left ventricular hypertrophy (LVH) and ST-depression was the finding with the highest risk for future events. LVH by ECG voltage-only was associated with no statistically increased risk, except for men treated for arterial hypertension.
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Abbreviations
- CVD:
-
cardiovascular disease
- ECG:
-
electrocardiogram
- IHD:
-
ischemic heart disease
- LVH:
-
left ventricular hypertrophy
- ST/T:
-
ST depression with negative T-wave
References
AV Chobanian GL Bakris HR Black et al. (2003) ArticleTitleSeventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure Hypertension 42 1206–1252 Occurrence Handle10.1161/01.HYP.0000107251.49515.c2 Occurrence Handle1:CAS:528:DC%2BD3sXpsVGisL4%3D Occurrence Handle14656957
Fisch C. Electrocardiography. In: Braunwald E (ed), Heart Disease. A Textbook of Cardiovascular Medicine. Philadelphia: W.B Saunders Company, 1997: 108–152
BE Kreger LA Cupples WB Kannel (1987) ArticleTitleThe electrocardiogram in prediction of sudden death: Framingham Study experience Am Heart J 113 377–382 Occurrence Handle10.1016/0002-8703(87)90281-X Occurrence Handle1:STN:280:BiiC38vjsVE%3D Occurrence Handle3812193
E Sigurdsson N Sigfusson H Sigvaldason G Thorgeirsson (1996) ArticleTitleSilent ST-T changes in an epidemiologic cohort study – a marker of hypertension or coronary heart disease, or both: the Reykjavik study J Am Coll Cardiol 27 1140–1147 Occurrence Handle10.1016/0735-1097(95)00614-1 Occurrence Handle1:STN:280:BymC1crosVQ%3D Occurrence Handle8609333
D De Bacquer G De Backer M Kornitzer K Myny Z Doyen H Blackburn (1998) ArticleTitlePrognostic value of ischemic electrocardiographic findings for cardiovascular mortality in men and women J Am Coll Cardiol 32 680–685 Occurrence Handle10.1016/S0735-1097(98)00303-9 Occurrence Handle1:STN:280:DyaK1cvht1GnsA%3D%3D Occurrence Handle9741511
CT Larsen J Dahlin H Blackburn et al. (2002) ArticleTitlePrevalence and prognosis of electrocardiographic left ventricular hypertrophy, ST segment depression and negative T-wave; the Copenhagen City Heart Study Eur Heart J 23 315–324 Occurrence Handle10.1053/euhj.2001.2774 Occurrence Handle1:STN:280:DC%2BD387islyhsQ%3D%3D Occurrence Handle11812068
D De Bacquer G De Backer M Kornitzer H Blackburn (1998) ArticleTitlePrognostic value of ECG findings for total, cardiovascular disease, and coronary heart disease death in men and women Heart 80 570–577 Occurrence Handle1:STN:280:DyaK1M7msVCiuw%3D%3D Occurrence Handle10065025
P Greenland X Xie K Liu et al. (2003) ArticleTitleImpact of minor electrocardiographic ST-segment and/or T-wave abnormalities on cardiovascular mortality during long-term follow-up Am J Cardiol 91 1068–1074 Occurrence Handle10.1016/S0002-9149(03)00150-4 Occurrence Handle12714148
WB Kannel T Gordon D Offutt (1969) ArticleTitleLeft ventricular hypertrophy by electrocardiogram. Prevalence, incidence, and mortality in the Framingham study Ann Intern Med 71 89–105 Occurrence Handle1:STN:280:CCaB38jhtFE%3D Occurrence Handle4239887
WB Kannel T Gordon WP Castelli JR Margolis (1970) ArticleTitleElectrocardiographic left ventricular hypertrophy and risk of coronary heart disease. The Framingham study Ann Intern Med 72 813–822 Occurrence Handle1:STN:280:CS%2BB2Mjmtlw%3D Occurrence Handle4247338
P Schnohr GB Jensen P Lange H Scharling C Apstein (2001) ArticleTitleThe Copenhagen City Heart Study. Østerbroundersøgelsen. Tables with data from the third examination 1991–1994 Eur Heart J 3 H H1–H83
GA Rose H Blackburn RF Gillum RJ Prineas (1982) Cardiovascular Survey Methods EditionNumber2 World Health Organization Geneva
G Rose PJ Baxter DD Reid P McCartney (1978) ArticleTitlePrevalence and prognosis of electrocardiographic findings in middle- aged men Br Heart J 40 636–643 Occurrence Handle1:STN:280:CSeC1cnpvVM%3D Occurrence Handle656238
WB Kannel K Anderson DL McGee LS Degatano MJ Stampfer (1987) ArticleTitleNonspecific electrocardiographic abnormality as a predictor of coronary heart disease: The Framingham Study Am Heart J 113 370–376 Occurrence Handle10.1016/0002-8703(87)90280-8 Occurrence Handle1:STN:280:BiiC38vjsVA%3D Occurrence Handle3812192
Y Liao K Liu A Dyer et al. (1987) ArticleTitleSex differential in the relationship of electrocardiographic ST-T abnormalities to risk of coronary death: 11.5 Year follow-up findings of the Chicago Heart Association Detection Project in Industry Circulation 75 347–352 Occurrence Handle1:STN:280:BiiC3czltVA%3D Occurrence Handle3492312
WB Kannel AL Dannenberg D Levy (1987) ArticleTitlePopulation implications of electrocardiographic left ventricular hypertrophy Am J Cardiol 60 851–931 Occurrence Handle10.1016/0002-9149(87)90466-8
D Levy M Salomon RB D’Agostino AJ Belanger WB Kannel (1994) ArticleTitlePrognostic implications of baseline electrocardiographic features and their serial changes in subjects with left ventricular hypertrophy Circulation 90 1786–1793 Occurrence Handle1:STN:280:ByqD3cfhtVc%3D Occurrence Handle7923663
H Blackburn HL Taylor A Keys (1970) ArticleTitleCoronary heart disease in seven countries. XVI. The electrocardiogram in prediction of five-year coronary heart disease incidence among men aged 40 through 59 Circulation 41 I154–I161 Occurrence Handle1:STN:280:CS%2BC2sbivFw%3D Occurrence Handle5442779
WB Kannel P Sorlie (1981) Left ventricular hypertrophy in hypertension, prognostic and pathogenetic implications: The Framingham Study BE Strauer (Eds) The Heart in Hypertension Springer-Verlag Berlin 223–242
PM Okin RB Devereux S Jern et al. (2003) ArticleTitleRegression of electrocardiographic left ventricular hypertrophy by losartan versus atenolol: The Losartan Intervention for Endpoint reduction in Hypertension (LIFE) Study Circulation 108 684–690 Occurrence Handle1:CAS:528:DC%2BD3sXmtVWitrw%3D Occurrence Handle12885747
S MacMahon G Collins P Rautaharju et al. (1989) ArticleTitleElectrocardiographic left ventricular hypertrophy and effects of antihypertensive drug therapy in hypertensive participants in the Multiple Risk Factor Intervention Trial Am J Cardiol 63 202–210 Occurrence Handle1:STN:280:BiaD1cnivVM%3D Occurrence Handle2521269
J Mathew P Sleight E Lonn et al. (2001) ArticleTitleReduction of cardiovascular risk by regression of electrocardiographic markers of left ventricular hypertrophy by the angiotensin-converting enzyme inhibitor ramipril Circulation 104 1615–1621 Occurrence Handle1:CAS:528:DC%2BD3MXotVeht7w%3D Occurrence Handle11581138
P Verdecchia F Angeli G Reboldi et al. (2003) ArticleTitleImproved cardiovascular risk stratification by a simple ECG index in hypertension Am J Hypertens 16 646–652 Occurrence Handle12878370
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Larsen, C.T., Blackburn, H., Bruun, N.E. et al. The ischemic electrocardiogram: A harbinger for ischemic heart disease independent of the blood pressure level. The Copenhagen City Heart Study. Eur J Epidemiol 20, 301–309 (2005). https://doi.org/10.1007/s10654-004-7535-y
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DOI: https://doi.org/10.1007/s10654-004-7535-y