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Abstract

Aims

Various cohort studies have shown a close association between long-term cardiovascular disease (CVD) outcomes and individual electrocardiographic (ECG) abnormalities such as axial, structural, and repolarization changes. The combined effect of these ECG abnormalities, each assumed to be benign, has not been thoroughly investigated.

Methods and Results

Community-dwelling Japanese residents from the National Integrated Project for Perspective Observation of Non-Communicable Disease and its Trends in the Aged, 1980–2004 and 1990–2005 (NIPPON DATA80 and 90), were included in this study. Baseline ECG findings were classified using the Minnesota Code and categorized into axial (left axis deviation, clockwise rotation), structural (left ventricular hypertrophy, atrial enlargement), and repolarization (minor and major ST–T changes) abnormalities. The hazard ratios of the cumulative impacts of ECG findings on long-term CVD death were estimated by stratified Cox proportional hazard models, including adjustments for cohort strata. In all, 16,816 participants were evaluated. The average age was 51.2 ± 13.5 years; 42.7% participants were male. The duration of follow up was 300,924 person-years (mean 17.9 ± 5.8 years); there were 1218 CVD deaths during that time. Overall, 4203 participants (25.0%) had one or more categorical ECG abnormalities: 3648 (21.7%) had a single abnormality, and 555 (3.3%) had two or more. The risk of CVD mortality increased as the number of abnormalities accumulated (single abnormality HR 1.29, 95% CI 1.13–1.48; ≥2 abnormalities HR 2.10, 95% CI 1.73–2.53).

Conclusions

Individual ECG abnormalities had an additive effect in predicting CVD outcome risk in our large-scale cohort study.

Keywords

Cardiovascular outcomes cohort study electrocardiography NIPPON DATA80 NIPPON DATA90

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References

US Preventive Services Task Force. Screening for coronary heart disease: recommendation statement. Ann Int Med 2004; 140: 569–572.

Greenland

Alpert

Beller

. 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines. Circulation 2010; 122: e584–e636.

Ministry of Health, Labour and Welfare. The ordinance on industrial safety and health. 2007.

De Bacquer

De Backer

Kornitzer

. Prognostic value of ECG findings for total, cardiovascular disease, and coronary heart disease death in men and women. Heart 1998; 80: 570–577.

Daviglus

Liao

Greenland

. Association of nonspecific minor ST–T abnormalities with cardiovascular mortality: the Chicago Western Electric Study. JAMA 1999; 281: 530–536.

Greenland

Xie

Liu

. Impact of minor electrocardiographic st-segment and/or t-wave abnormalities on cardiovascular mortality during long-term follow-up. Am J Cardiol 2003; 91: 1068–1074.

Larsen

Dahlin

Blackburn

. Prevalence and prognosis of electrocardiographic left ventricular hypertrophy, ST segment depression and negative T-wave; the Copenhagen City Heart Study. Eur Heart J 2002; 23: 315–324.

Machado

Crow

Boland

. Electrocardiographic findings and incident coronary heart disease among participants in the atherosclerosis risk in communities (ARIC) study. Am J Cardiol 2006; 97: 1176–1181.

Prineas

Grandits

Rautaharju

. Long-term prognostic significance of isolated minor electrocardiographic T-wave abnormalities in middle-aged men free of clinical cardiovascular disease (the Multiple Risk Factor Intervention Trial [MRFIT]). Am J Cardiol 2002; 90: 1391–1395.

10.

Sigurdsson

Sigfusson

Sigvaldason

. Silent 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 1996; 27: 1140–1147.

11.

Sutherland

Gazes

Keil

. Electrocardiographic abnormalities and 30-year mortality among white and black men of the Charleston Heart Study. Circulation 1993; 88: 2685–2692.

12.

Brown

Giles

Croft

. Left ventricular hypertrophy as a predictor of coronary heart disease mortality and the effect of hypertension. Am Heart J 2000; 140: 848–856.

13.

Nakamura

Okamura

Higashiyama

. Prognostic values of clockwise and counterclockwise rotation for cardiovascular mortality in japanese subjects: a 24-year follow-up of the National Integrated Project for Prospective Observation of Noncommunicable Disease and its Trends in the Aged, 1980–2004 (NIPPON DATA80). Circulation 2012; 125: 1226–1233.

14.

Strogatz

Tyroler

Watkins

. Electrocardiographic abnormalities and mortality among middle-aged black men and white men of Evans County, Georgia. J Chronic Dis 1987; 40: 149–155.

15.

Bakhoya VN, Kurl S and Laukkanen JA. T-wave inversion on electrocardiogram is related to the risk of acute coronary syndrome in the general population. Eur J Prev Cardiol 2014; 21: 500–506.

16.

Rumana

Turin

Miura

. Prognostic value of ST–T abnormalities and left high R waves with cardiovascular mortality in Japanese (24-year follow-up of NIPPON DATA80). Am J Cardiol 2011; 107: 1718–1724.

17.

Nakamura

Okamura

Hayakawa

. Electrocardiogram screening for left high R-wave predicts cardiovascular death in a Japanese community-based population: NIPPON DATA90. Hypertens Res 2006; 29: 353–360.

18.

Kadota

Miura

Okamura

. Relationship of moderate metabolic risk factor clustering to cardiovascular disease mortality in non-lean Japanese: a 15-year follow-up of NIPPON DATA90. Atherosclerosis 2011; 215: 209–213.

19.

Higashiyama

Watanabe

Kokubo

. Relationships between protein intake and renal function in a Japanese general population: NIPPON DATA90. J Epidemiol 2010; 20(Suppl 3): S537–S543.

20.

Horibe

Kasagi

Kagaya

. A nineteen-year cohort study on the relationship of electrocardiographic findings to all cause mortality among subjects in the National Survey on Circulatory Disorders, NIPPON DATA80. J Epidemiol 2005; 15: 125–134.

21.

Ueshima

Choudhury

Okayama

. Cigarette smoking as a risk factor for stroke death in Japan: NIPPON DATA80. Stroke 2004; 35: 1836–1841.

22.

Okayama

Kadowaki

Okamura

. Age-specific effects of systolic and diastolic blood pressures on mortality due to cardiovascular diseases among Japanese men (NIPPON DATA80). J Hypertens 2006; 24: 459–462.

23.

Okamura

Tanaka

Miyamatsu

. The relationship between serum total cholesterol and all-cause or cause-specific mortality in a 17.3-year study of a Japanese cohort. Atherosclerosis 2007; 190: 216–223.

24.

Kadowaki

Okamura

Hozawa

. Relationship of elevated casual blood glucose level with coronary heart disease, cardiovascular disease and all-cause mortality in a representative sample of the Japanese population. NIPPON DATA80. Diabetologia 2008; 51: 575–582.

25.

Ohsawa

Okayama

Okamura

. Mortality risk attributable to atrial fibrillation in middle-aged and elderly people in the Japanese general population: nineteen-year follow-up in NIPPON DATA80. Circ J 2007; 71: 814–819.

26.

Okamura

Hayakawa

Kadowaki

. Resting heart rate and cause-specific death in a 16.5-year cohort study of the Japanese general population. Am Heart J 2004; 147: 1024–1032.

27.

Okamura

Hayakawa

Kadowaki

. The inverse relationship between serum high-density lipoprotein cholesterol level and all-cause mortality in a 9.6-year follow-up study in the Japanese general population. Atherosclerosis 2006; 184: 143–150.

28.

Woodward

. Epidemiology: study design and data analysis, 2nd ed. Boca Raton, FL: Chapman & Hall/CRC Press, 2005.

29.

World Health Organization. The global burden of disease: 2004 update. Geneva, World Health Organization, 2008.

30.

Christopher Jones

Pothier

Blackstone

. Prognostic importance of presenting symptoms in patients undergoing exercise testing for evaluation of known or suspected coronary disease. Am J Med 2004; 117: 380–389.

31.

Chou

Arora

Dana

. Screening asymptomatic adults with resting or exercise electrocardiography: a review of the evidence for the US Preventive Services Task Force. Ann Int Med 2011; 155: 375–385.

32.

Auer

Bauer

Marques-Vidal

. Association of major and minor ECG abnormalities with coronary heart disease events. JAMA 2012; 307: 1497–1505.

33.

Denes

Larson

Lloyd-Jones

. Major and minor ECG abnormalities in asymptomatic women and risk of cardiovascular events and mortality. JAMA 2007; 297: 978–985.

34.

Liao

Liu

Dyer

. Major and minor electrocardiographic abnormalities and risk of death from coronary heart disease, cardiovascular diseases and all causes in men and women. J Am Coll Cardiol 1988; 12: 1494–1500.

35.

Saito

Folsom

Aono

. Comparison of fatal coronary heart disease occurrence based on population surveys in Japan and the USA. Int J Epidemiol 2000; 29: 837–844.

36.

Ueshima

Sekikawa

Miura

. Cardiovascular disease and risk factors in Asia: a selected review. Circulation 2008; 118: 2702–2709.

37.

Teramoto

Sasaki

Ishibashi

. Executive summary of the Japan Atherosclerosis Society (JAS) guidelines for the diagnosis and prevention of atherosclerotic cardiovascular diseases in Japan -2012 version. J Atheroscl Thromb 2013; 20: 517–523.

38.

NIPPON DATA80 Research Group. Risk assessment chart for death from cardiovascular disease based on a 19-year follow-up study of a Japanese representative population. Circ J 2006; 70: 1249–1255.

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Cumulative impact of axial,structural,and repolarization ECG findings on long-term cardiovascular mortality among healthy individuals in Japan: National Integrated Project for Prospective Observation of Non-Communicable Disease and its Trends in the Aged,1980 and 1990

Abstract

Aims

Methods and Results

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Keywords

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