Prognostic value of ECG findings for total, cardiovascular disease, and coronary heart disease death in men and women

Abstract

Objective-To study abnormalities in the resting ECG as independent predictors for all cause, cardiovascular disease (CVD), and coronary heart disease (CHD) mortality in a population based random sample of men and women, and to explore whether their prognostic value is diVerent between sexes. Design and subjects-An age and sex stratified random sample was selected from the total Belgian population aged 25 to 74 years. Baseline data were gathered and resting ECGs were classified according to Minnesota code criteria. The sample was then followed for at least 10 years with respect to cause specific death. Results are based on observations from 5208 men and 4746 women free from prevalent CHD at the start of the follow up period. Results-Although the prevalence of major abnormalities in general was comparable between sexes, women had more ischaemic findings, ST segment changes, and abnormal T waves on their baseline ECG, while men showed more arrhythmias, bundle branch blocks, and left ventricular hypertrophy. Fitting the multiplicative eVect on subsequent mortality between all ECG classifications under study and sex indicated that the prognostic value of ECG changes was equal in women and men. Independently of other risk factors and other major ECG changes, almost all ECG classifications were significantly related to all cause, CVD, and CHD mortality. The most predictive ECG findings for CVD death were ST segment depression (risk ratio (RR) 4.71), major ECG findings (RR 3.26), left ventricular hypertrophy (RR 2.79), bundle branch blocks (RR 2.58), T wave flattening (RR 2.47), ischaemic ECG findings (RR 2.35), and arrhythmias (RR 2.15). The prognostic value of major ECG findings for CVD and CHD death was more powerful than well established cardiovascular risk factors. Conclusions-Abnormalities in the baseline ECG are strongly associated with subsequent all cause, CVD, and CHD mortality. Their predictive value was similar for men and women. (Heart 1998;80:570-577) Keywords: ECG; mortality; Minnesota code; risk factors As part of the standard routine examination procedure in cardiac medicine, the resting ECG has proved its value as a diagnostic tool for detecting heart disease. Apart from their use in the clinical context, ECGs from apparently healthy subjects have been used to study the prevalence, correlates, and the predictive value of asymptomatic heart diseases in the general population.1 Since the introduction of the Minnesota codes 2 several epidemiological studies have concentrated on the association between initial ECG abnormalities and subsequent fatal and non-fatal cardiovascular disease (CVD) in a standardised way. However, most of these studies were based on population samples of men; only a few reports were dealing with the prognostic role of ECGs in women.This study investigates the independent prognostic value of initial ECG changes for mortality from all causes, CVD, and coronary heart disease (CHD) in a random sample of men and women free from symptomatic CHD at baseline, focusing in partic...

Left ventricular hypertrophy determined by Sokolow–Lyon criteria: a different predictor in women than in men?

“…28 The Framingham study found higher risk estimates for CHD, stroke and any CVD morbidity for women versus men with ECG LVH, 2 whereas in a Belgian study the risk of CVD mortality was statistically significant among men only. 5 In the Glasgow Blood Pressure Clinic, ECG LVH among men was associated with a significant 2.7-, 1.8-and 1.6-fold risk of dying from ischaemic heart disease, stroke and all causes. The corresponding relative risks among women were 2.0, 4.0 and 2.4, respectively.…”

“…This concept is supported to a large extent by the three studies discussed above. 2,5,9 Non-insulin-dependent diabetes mellitus has been independently associated with an increase in left ventricular mass. 33,34 In our previous study among DHCCP patients, blood glucose concentration tended to be inversely related to the presence of ECG LVH by Sokolow-Lyon criterion.…”

“…3 Left ventricular hypertrophy has been shown to be associated with a significant increase in risk of cardiovascular mortality among the general population and hypertensive patients, independently of whether it is determined by electrocardiogram (ECG LVH), echocardiography (ECHO LVH) or radiology. 2,[4][5][6][7][8][9][10][11][12][13] Echocardiography is the gold standard for assessing anatomical LVH. 2,14 However, it is less readily available and sometimes difficult to perform in obese and elderly subjects.…”

A slight increase of fasting plasma glucose after 2 years was associated with electrocardiogram changes suggestive of coronary heart disease in normal subjects

“…However, abnormalities in the resting ECG have been shown to be strongly associated with subsequent CVD, CHD, and all other causes of mortality in a population based on random samples. 8 Moreover, persistent nonspecific minor ST-T abnormalities have been shown to be associated with increased long-term risks of mortality due to CVD and all other causes. 9 These previous studies emphasized and proved that minor ECG changes are related to the occurrence of CHD and poor prognosis.…”

Sex Differences in Biological Markers of Health in the Study of Stress, Aging and Health In russia

“…Many studies have demonstrated that left ventricular hypertrophy, atrial fibrillation and bundle branch blocks are more prevalent among men, and that ST-T abnormalities and ischemia-like ECG changes are more prevalent among women, whereas the prevalence of minor ECG changes are similar in both sexes [29][30][31][32].…”