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Impact of minor electrocardiographic ST-segment and/or T-wave abnormalities on cardiovascular mortality during long-term follow-up

  • Philip Greenland
    Correspondence
    Address for reprints: Philip Greenland, MD, 680 North Lake Shore Drive, Suite 1102, Chicago, Illinois 60611, USA.
    Affiliations
    Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA

    Department ofPreventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;, USA
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  • Xiaoyuan Xie
    Affiliations
    Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA

    Department ofPreventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;, USA
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  • Kiang Liu
    Affiliations
    Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA

    Department ofPreventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;, USA
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  • Laura Colangelo
    Affiliations
    Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA

    Department ofPreventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;, USA
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  • Youlian Liao
    Affiliations
    Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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  • Martha L Daviglus
    Affiliations
    Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA

    Department ofPreventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;, USA
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  • Abby N Agulnek
    Affiliations
    Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA

    Department ofPreventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;, USA
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  • Jeremiah Stamler
    Affiliations
    Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA

    Department ofPreventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;, USA
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      Abstract

      Minor ST-T abnormalities are common on the resting electrocardiogram of otherwise healthy persons, but the long-term importance of these findings has not been extensively evaluated, especially in women. In a prospective study, 7,985 women and 9,630 men (aged 40 to 64 years at baseline) without other electrocardiographic abnormalities and free of previous coronary heart disease (CHD) were studied using Cox regression for 22-years of follow-up. Primary outcomes were death from CHD and total cardiovascular disease (CVD); total mortality was a secondary outcome. Minnesota Code was employed to assess the presence or absence of electrocardiographic abnormalities. Analyses compared persons with minor Minnesota Code ST-segment (codes 4–3 or 4–4) or T-wave findings (codes 5–3 or 5–4) to those with normal electrocardiographic findings. In combined analyses of men and women adjusted for age, isolated minor T-wave abnormality, minor ST-segment depression, or a combination of minor ST-segment and T-wave abnormalities were each associated with increased mortality risks. For CHD mortality, hazard ratios (HRs) ranged from 1.60 to 2.10; for CVD mortality, HRs ranged from 1.50 to 1.95; and for total mortality, HRs ranged from 1.31 to 1.50 (p <0.05 for all HRs). In separate analyses by gender adjusted for age, increased risks were observed for combined ST-T-wave abnormalities in both genders for CHD and CVD mortality (HR 1.72 to 1.75 for men, p <0.05; HR 2.07 to 2.51 for women, p <0.001). These data indicate that nonspecific (minor) ST-segment depression and/or T-wave abnormalities have a long-term prognostic impact for CHD and CVD death in middle-aged women and men and can be considered markers of heightened CHD and CVD risk.
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      References

        • Greenland P.
        • Abrams J.
        • Aurigemma G.P.
        • Bond M.G.
        • Clark L.T.
        • Criqui III, M.H., Crouse J.R.
        • Friedman L.
        • Fuster V.
        • Herrington D.M.
        • et al.
        Prevention Conference V. Beyond secondary prevention.
        Circulation. 2000; 101: 111-116
        • Smith Jr, S.C.
        • Blair S.N.
        • Bonow R.O.
        • Brass L.M.
        • Cerqueira M.D.
        • Dracup K.
        • Fuster V.
        • Gotto A.
        • Grundy S.M.
        • Miller N.H.
        • et al.
        AHA/ACC Scientific Statement. AHA/ACC guidelines for preventing heart attack and death in patients with atherosclerotic cardiovascular disease.
        Circulation. 2001; 104: 1577-1579
        • Heart Protection Study Collaborative Group
        MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals.
        Lancet. 2002; 360: 7-22
        • 27th Bethesda Conference
        Matching the intensity of risk factor management with the hazard for coronary disease events.
        J Am Coll Cardiol. 1996; 27: 957-1047
        • Ashley E.A.
        • Raxwal V.K.
        • Froelicher V.F.
        The prevalence and prognostic significance of electrocardiographic abnormalities.
        Curr Probl Cardiol. 2000; 25: 1-72
        • Liao Y.
        • Liu K.
        • Dyer A.
        • Schoenberger J.A.
        • Shekelle R.B.
        • Collette P.
        • Stamler J.
        Sex differential in the relationship of electrocardiographic ST-T abnormalities to risk of coronary death.
        Circulation. 1987; 75: 347-352
        • Kannel W.B.
        • Anderson K.
        • McGee D.L.
        • Degatano L.S.
        • Stampfer M.J.
        Nonspecific electrocardiographic abnormality as a predictor of coronary heart disease.
        Am Heart J. 1987; 113: 370-376
        • De Bacquer D.
        • Pereira M.
        • De Backer G.
        • Henauw D.
        • Kornitzer M.
        The predictive value of electrocardiographic abnormalities for total and cardiovascular disease mortality in men and women.
        Eur Heart J. 1994; 15: 1604-1610
        • Atterhog J.H.
        A 5-year follow-up of young men with primary T-wave aberrations in their electrocardiograms.
        Acta Med Scand. 1981; 209: 75-82
        • Sigurdsson E.
        • Sigfusson N.
        • Sigvaldason H.
        • Thorgeirsson G.
        Silent ST-T changes in an epidemiologic cohort study—a marker of hypertension or coronary heart disease, or both.
        J Am Coll Cardiol. 1996; 27: 1140-1147
        • Burch G.E.
        Significance of certain early changes in the T-wave in coronary disease.
        JAMA. 1957; 165: 1781-1784
        • Rose G.
        • Baxter P.J.
        • Reid D.D.
        • McCartney P.
        Prevalence and prognosis of electrocardiographic findings in middle-aged men.
        Br Heart J. 1978; 40: 636-643
        • Cullen K.
        • Stenhouse N.S.
        • Wearne K.L.
        • Cumpston G.N.
        Electrocardiograms and 13 year cardiovascular mortality in Busselton Study.
        Br Heart J. 1982; 47: 209-221
        • Bartel A.
        • Heyden S.
        • Tyroler H.A.
        • Tabseh E.
        • Cassel J.C.
        • Hames C.G.
        Electrocardiographic predictors of coronary heart disease.
        Arch Intern Med. 1971; 128: 929-937
        • Knutsen R.
        • Knutsen S.F.
        • Curb J.D.
        • Reed D.M.
        • Kautz J.A.
        • Yano K.
        The predictive value of resting electrocardiograms for 12-year incidence of coronary heart disease in the Honolulu Heart Program.
        J Clin Epidemiol. 1988; 41: 293-302
        • Stamler J.
        • Rhomberg P.
        • Schoenberger J.A.
        • Shekelle R.B.
        • Dyer A.
        • Shekelle S.
        • Stamler R.
        • Wannamaker J.
        Multivariate analysis of the relationship of seven variables to blood pressure.
        J Chronic Dis. 1975; 28: 527-548
        • De Bacquer D.
        • De Backer G.
        • Kornitzer M.
        • Myny K.
        • Doyen Z.
        • Blackburn H.
        Prognostic value of ischemic electrocardiographic findings for cardiovascular mortality in men and women.
        J Am Coll Cardiol. 1998; 32: 680-685
        • De Bacquer D.
        • De Backer G.
        • Kornitzer M.
        • Blackburn H.
        Prognostic value of ECG findings for total, cardiovascular disease, and coronary heart disease death in men and women.
        Heart. 1998; 80: 570-577
        • Ostrander Jr, L.D.
        The relation of “silent” T-wave inversion to cardiovascular disease in an epidemiologic study.
        Am J Cardiol. 1970; 25: 325-328
        • The Pooling Project Research Group
        Relationship of blood pressure, serum cholesterol, smoking habit, relative weight and ECG abnormalities to incidence of major coronary events.
        J Chron Dis. 1978; 31: 201-306
        • Berkson D.M.
        • Stamler J.
        • Stevens E.
        • Soyugenc R.
        • Smoot E.
        The electrocardioanalyzer.
        Israeli J Med Sci. 1969; 5: 687-690
        • Prineas R.J.
        • Crow R.S.
        • Blackburn H.
        The Minnesota Code Manual of Electrocardiographic Findings. John Wright-PSG Inc, Littleton, MA1982
        • Macfarlane P.W.
        Minnesota coding and the prevalence of ECG abnormalities.
        Heart. 2000; 84: 582-584
        • Stamler R.
        • Stamler J.
        • Schoenberger J.A.
        • Shekelle R.B.
        • Collette P.
        • Shekelle S.
        • Dyer A.
        • Garside D.
        • Wannamaker J.
        Relationship of glucose tolerance to prevalence of ECG abnormalities and to 5-year mortality from cardiovascular disease. Findings of the Chicago Heart Association Detection Project in Industry.
        J Chronic Dis. 1979; 32: 817-828
      1. International Classification of Diseases, 8th revision. Adapted for use in the United States (ICDA). Vol. I (PHS) 1693. Washington, DC: National Center for Health Statistics, 1967:49

        • Therneau T.M.
        • Grambsch P.M.
        Modeling Survival Data. Extending The Cox Model. Springer, New York2000: 130-139
        • Daviglus M.L.
        • Liao Y.
        • Greenland P.
        • Greenland P.
        • Dyer A.R.
        • Liu K.
        • Xie X.
        • Huang C.F.
        • Prineas R.J.
        • Stamler J.
        Association of nonspecific minor ST-T abnormalities with cardiovascular mortality. The Chicago Western Electric Study.
        JAMA. 1999; 281: 530-536
        • Davis C.E.
        • Rifkind B.M.
        • Brenner H.
        • Gordon D.J.
        A single cholesterol measurement underestimates the risk of coronary heart disease.
        JAMA. 1990; 264: 3044-3046
        • Sekikawa A.
        • Kuller L.H.
        Striking variation in coronary heart disease mortality in the United States among African-American and white women aged 45–54 by state.
        J Women’s Health Gender Based Med. 2000; 9: 545-558
        • Lloyd-Jones D.M.
        • Martin D.O.
        • Larsen M.G.
        • Levy D.
        Accuracy of death certificates for coding coronary heart disease as the cause of death.
        Ann Intern Med. 1998; 129: 1020-1026