European Heart Journal Advance Access originally published online on March 17, 2005
European Heart Journal 2005 26(14):1402-1409; doi:10.1093/eurheartj/ehi169
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Prevalence and prognostic significance of daily-life silent myocardial ischaemia in middle-aged and elderly subjects with no apparent heart disease
1Department of Cardiology, Copenhagen University Hospital of Bispebjerg, Bispebjerg Bakke 23, DK-2400 Copenhagen NV, Denmark
2Department of Cardiology, Copenhagen University Hospital of Hvidovre, Hvidovre, Denmark
3Epidemiological Research Center, Copenhagen University Hospital of Bispebjerg, Bispebjerg Bakke 23, DK-2400 Copenhagen NV, Denmark
Received 9 May 2004; revised 6 January 2005; accepted 13 January 2005; online publish-ahead-of-print 17 March 2005.
* Corresponding author. Tel: +45 35 31 33 33; fax: +45 35 31 32 26. E-mail address: ahs{at}dadlnet.dk
Aims We aimed to determine the prevalence and prognostic significance of daily-life silent myocardial ischaemia (SMI) in healthy middle-aged and elderly subjects with no previous heart disease.
Methods and results Six hundred and seventy-eight healthy men and women between 55 and 75 years of age and with no history of cardiovascular disease or stroke were included. Baseline examinations included physical examination, fasting laboratory testing, and 48 h ambulatory electrocardiogram monitoring. An episode of ischaemia was defined by a down-sloped or horizontal ST depression of at least 1 mm at a duration of at least 1 min. Seventy-seven subjects (11.4%) had SMI. All participants were followed for up to 5 years. In 77 subjects with SMI, 16 (20.7%) had an event (death or myocardial infarction). In 601 subjects without SMI, 50 (8.3%) had an event. The hazard ratios for SMI in relation to cardiac and combined events after correction for conventional risk factors were 3.1 [(1.24–7.97), P=0.016] and 1.97 [(1.06–3.69), P=0.033], respectively.
Conclusion SMI as detected by Holter monitoring was detected in 11.4% of these subjects and was associated with more than three-fold increase in the cardiac event rate after correction for risk factors, implying that this test could be used to identify high-risk individuals among these subjects.
Key Words: Silent myocardial ischaemia • Holter recording • Coronary heart disease • Risk factors
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