Author + information
- Received September 30, 2017
- Revision received October 18, 2017
- Accepted October 19, 2017
- Published online January 1, 2018.
- Waqas T. Qureshi, MDa,
- Zhu-Ming Zhang, MD, MPHb,
- Patricia P. Chang, MD, MHSc,
- Wayne D. Rosamond, PhDd,
- Dalane W. Kitzman, MDa,
- Lynne E. Wagenknecht, DrPHe and
- Elsayed Z. Soliman, MD, MSc, MSa,b,∗ ()
- aDepartment of Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston Salem, North Carolina
- bEpidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
- cDivision of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- dDepartment of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- eDivision of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
- ↵∗Address for correspondence:
Dr. Elsayed Z. Soliman, Epidemiological Cardiology Research Center (EPICARE), Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, North Carolina 27157.
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.
The ARIC study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute contracts (HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201100012C). Dr. Qureshi has served as a consultant for Medicure; and has traded Medtronic stock shares in the past 12 months (currently does not own any shares). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 30, 2017.
- Revision received October 18, 2017.
- Accepted October 19, 2017.
- 2018 American College of Cardiology Foundation
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