Elsevier

The American Journal of Cardiology

Volume 97, Issue 8, 15 April 2006, Pages 1176-1181.e3
The American Journal of Cardiology

Coronary artery disease
Electrocardiographic Findings and Incident Coronary Heart Disease Among Participants in the Atherosclerosis Risk in Communities (ARIC) Study

https://doi.org/10.1016/j.amjcard.2005.11.036Get rights and content

The associations of many electrocardiographic (ECG) abnormalities at rest with incident coronary heart disease (CHD) are not completely established, and whether individual ECG abnormalities convey similar risk across gender and race is uncertain. We studied the independent association of several ECG findings with incident CHD, testing for effect modification by gender and race, in a large, population-based, prospective cohort study. Findings from the baseline 12-lead electrocardiograms in 1987 to 1989 were classified according to the Minnesota Code in 12,987 black and white men and women, aged 45 to 64 years, who were initially free of CHD and the use of specific cardiac medications. The incidence of CHD was ascertained through 2000. After adjustment for multiple cardiovascular risk factors, the ECG findings that had the highest hazard rate ratios (HRRs) for incident CHD, when considered singly, were left ventricular hypertrophy with ST-T strain pattern in white men (HRR 6.50) and in black women (HRR 2.31) and, in the whole cohort, major (HRR 2.27) and minor (HRR 2.47) ST depression and major T-wave abnormalities (HRR 2.12). Statistically significant associations were also found in the whole cohort for minor Q waves and left ventricular hypertrophy by the Cornell definition, but not for a prolonged QTc interval, major ventricular conduction defects, or ST elevation. In conclusion, several 12-lead ECG findings were independently associated with incident CHD in middle-aged adults. With only a few exceptions, the associations were similar for blacks and whites.

Section snippets

Study population

From 1987 to 1989, the Atherosclerosis Risk in Communities (ARIC) study8 recruited 15,792 men and women aged 45 to 64 years by probability sampling in 4 communities: Forsyth County, North Carolina, Jackson, Mississippi, the northwestern suburbs of Minneapolis, Minnesota, and Washington County, Maryland. In Jackson, a representative sample of only black persons was selected. Communities in Maryland and Minnesota had <1% of blacks, and in North Carolina, the cohort comprised 12% blacks.

Baseline measurements

Results

The sample free of CHD and not taking specific cardiac medications at baseline comprised 2,190 black women, 5,177 white women, 1,358 black men, and 4,262 white men. Black and white men and women differed in baseline risk characteristics in the expected fashion (Web Table 1; see the Journal web site [www.AJConline.org]) and as previously reported in other ARIC publications.17

Age-adjusted, race- and gender-specific baseline prevalences of ECG variables are reported in Table 1. The most prevalent

Discussion

In the middle-age population-based ARIC study, among those free of CHD and not using specific cardiac medications, the prevalence of individual ECG abnormalities was low and comparable to the findings in other populations.2 The gender differences in the prevalence of some ECG findings in ARIC are similar to those reported by others.2

Few population-based studies have examined ECG findings in blacks. In the Evans County Study,3 high-amplitude R-wave and major T-wave abnormalities were more common

Acknowledgment

We thank the ARIC study participants and staff; and Joanlise Marco de Leon, MS, MPH, for technical assistance.

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    The ARIC Study was a collaborative study supported by Grants N01-HC-55015, N01-HC-55016, N01-HC-55018, N01-HC-55019, N01-HC-55020, N01-HC-55021, and N01-HC-55022 from the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.

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