Incidental abnormal ECG findings and long-term cardiovascular morbidity and all-cause mortality: A population based prospective study
Section snippets
Background
Cardiovascular disease (CVD) is the leading cause of death globally, accounting for 23.4% of all deaths in the US in 2015 [1]. In Europe, it is the leading cause of death among older adults [2]. Annual costs of CVD in the US and the European-Union were estimated at $316.6 and $210 billion, respectively, which is more than every other group of diseases [3].
The Framingham study (1998) introduced the primary coronary heart disease risk calculator in the US, based on CVD risk factors: age, gender,
Study design and population
A subsample of 2769 men and women (Supplementary Fig. 1– study flowchart) from the Israel Study of Glucose Intolerance, Obesity and Hypertension (GOH) were included in the current follow-up study. The subsample was representative of the original cohort, which was randomly selected during 1967 from the Israel population registry, stratified according to sex, birth decade and ethnic origin (Supplementary 1- study methods) [14]. During 1976–1982 (“Phase-2”), participants underwent medical
Baseline characteristics
The mean baseline age was 54.5 ± 8.0 years, 52% were women, and 1199 (46.1%) were found to have incidental abnormal ECG findings ([15], Table 3). Sex and ethnic origin distributions, smoking habits, diabetes frequencies, and serum creatinine mean values were similar between individuals with incidental abnormal ECG findings and those with completely normal ECG results (Table 1). Mean age, blood pressure, total cholesterol and BMI were significantly lower in individuals with normal ECG results.
All-cause mortality
Discussion
Our results demonstrate that incidental abnormal ECG findings, in adults randomly selected from a population without known preexisting CVD, are associated with an increased risk of CVD, during a median follow-up of 23-years, and overall mortality during a median of 31-years. Moreover, incidental abnormal ECG findings conferred increased risk of CVD and all-cause mortality beyond any other CVD risk factor. We found ECG incidental abnormal findings at baseline to be associated with an 18%
Conclusion
Our findings demonstrate that incidental ECG abnormal findings in asymptomatic adults significantly increase the long-term risk of CVD and all-cause mortality. NST changes and left-axis deviation were the changes found to have the most significant association with the outcomes of interest. ECG abnormalities are linked to various pathological processes and may be the first sign of an underlying cardiac morbidity. Therefore, resting ECG screening tests can contribute to the identification of
Acknowledgement
\This study is part of the Master's thesis of Mr. Adam Goldman in fulfillment of his M.D. M.P.H. studies at the School of Public Health at the Sackler School for Medicine, the Tel Aviv University, Israel.
Declaration of competing interest
None to declare.
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This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.