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Abnormal ECGs Predict CVD in Asymptomatic, Postmenopausal Women

Electrocardiographic abnormalities, whether minor or major, enhanced the predictive value of traditional risk assessment.

Men who present with electrocardiographic abnormalities are at increased risk for incident coronary heart disease (CHD) and cardiovascular disease (CVD) events. To find out whether this association applies to women, researchers analyzed data from 14,749 asymptomatic, postmenopausal Women’s Health Initiative (WHI) participants (age 50–79): 66% had normal baseline ECGs, 28% had minor ECG abnormalities (e.g., nonspecific ST-segment changes), and 6% had major ECG abnormalities (e.g., atrial fibrillation, bundle-branch block).

During a mean follow-up of 5.6 years, annual CHD event rates per 10,000 women were 21 among those with normal baseline ECGs, 40 among those with minor ECG abnormalities, and 75 among those with major ECG abnormalities. Corresponding figures for incident CVD events were 55, 91, and 168, respectively.

In analyses adjusted for traditional risk factors in which women with normal baseline ECGs were the reference group, women with minor ECG abnormalities had significantly increased risks for CHD events (hazard ratio, 1.55) and CVD events (HR, 1.39), as did women with major ECG abnormalities (HRs, 3.01 and 2.34, respectively). Hormone therapy assignment (for the WHI study) did not affect the findings. Adding baseline ECG abnormality status to traditional risk-prediction models significantly improved their predictive value.

Comment: Independent of traditional risk factors, baseline ECG abnormalities (both minor and major) predicted incident CHD and CVD events in asymptomatic, postmenopausal participants in the WHI primary-prevention trial of hormone therapy. The data do not clarify whether ECG abnormalities reflected subclinical disease or were associated with traditional risk markers such as high cholesterol and hypertension.

— Mark S. Link, MD

Published in Journal Watch Cardiology March 6, 2007

Citation(s):

Denes P et al. Major and minor ECG abnormalities in asymptomatic women and risk of cardiovascular events and mortality. JAMA 2007 Mar 7; 297:978-85.

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