Silent Myocardial Infarction and Long-Term Risk of Heart Failure: The ARIC Study

Public Deposited
Analytics

Downloadable Content

Download PDF
Request Version for Screen Reader
Creator
  • Qureshi, W.T
    • Other Affiliation: Department of Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston Salem, North Carolina, United States
  • Zhang, Z.-M
    • Other Affiliation: Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
  • Chang, P.P
    • School of Medicine, Division of Cardiology, Department of Medicine
  • Rosamond, W.D
    • Gillings School of Global Public Health, Department of Epidemiology
  • Kitzman, D.W
    • Other Affiliation: Department of Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston Salem, North Carolina, United States
  • Wagenknecht, L.E
    • Other Affiliation: Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
  • Soliman, E.Z
    • Other Affiliation: Department of Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston Salem, North Carolina, United States
Abstract
  • Background Although silent myocardial infarction (SMI) accounts for about one-half of the total number of myocardial infarctions (MIs), the risk of heart failure (HF) among patients with SMI is not well established. Objectives The purpose of this study was to examine the association of SMI and clinically manifested myocardial infarction (CMI) with HF, as compared with patients with no MI. Methods This analysis included 9,243 participants from the ARIC (Atherosclerosis Risk In Communities) study who were free of cardiovascular disease at baseline (ARIC visit 1: 1987 to 1989). SMI was defined as electrocardiographic evidence of MI without CMI after the baseline until ARIC visit 4 (1996 to 1998). HF events were ascertained starting from ARIC visit 4 until 2010 in individuals free of HF before that visit. Results Between ARIC visits 1 and 4, 305 SMIs and 331 CMIs occurred. After ARIC visit 4 and during a median follow-up of 13.0 years, 976 HF events occurred. The incidence rate of HF was higher in both CMI and SMI participants than in those without MI (incidence rates per 1,000 person-years were 30.4, 16.2, and 7.8, respectively; p < 0.001). In a model adjusted for demographics and HF risk factors, both SMI (hazard ratio [HR]: 1.35; 95% confidence interval [CI]: 1.02 to 1.78) and CMI (HR: 2.85; 95% CI: 2.31 to 3.51) were associated with increased risk of HF compared with no MI. These associations were consistent in subgroups of participants stratified by several HF risk predictors. However, the risk of HF associated with SMI was stronger in those younger than the median age (53 years) (HR: 1.66; 95% CI: 1.00 to 2.75 vs. HR: 1.19; 95% CI: 0.85 to 1.66, respectively; overall interaction p by MI type <0.001). Conclusions SMI is associated with an increased risk of HF. Future research is needed to examine the cost effectiveness of screening for SMI as part of HF risk assessment, and to identify preventive therapies to improve the risk of HF among patients with SMI.
Date of publication
Keyword
DOI
Identifier
Resource type
  • Article
Rights statement
  • In Copyright
Journal title
  • Journal of the American College of Cardiology
Journal volume
  • 71
Journal issue
  • 1
Page start
  • 1
Page end
  • 8
Language
  • English
Version
  • Postprint
Funder
  • National Heart, Lung, and Blood Institute, NHLBI: HHSN268201100011C
ISSN
  • 0735-1097
Publisher
  • Elsevier USA

Relations

Parents:

This work has no parents.

Items

Thumbnail Title Date Uploaded Visibility Actions
file details nihms917447.pdf 2024-04-17 Public Download