Chest Symptoms and Long-Term Risk of Incident Cardiovascular Disease.

Autor:	Ejiri K; Johns Hopkins Bloomberg School of Public Health, Baltimore, Md., Mok Y; Johns Hopkins Bloomberg School of Public Health, Baltimore, Md., Ding N; Yale New Haven Health Bridgeport Hospital, Bridgeport, Conn., Chang PP; University of North Carolina, Chapel Hill., Rosamond WD; University of North Carolina, Chapel Hill., Shah AM; University of Texas Southwestern Medical Center, Dallas, TX., Lutsey PL; University of Minnesota, Minneapolis., Chen LY; University of Minnesota, Minneapolis., Blaha MJ; Johns Hopkins School of Medicine, Baltimore, Md., Mathews L; Johns Hopkins School of Medicine, Baltimore, Md., Matsushita K; Johns Hopkins Bloomberg School of Public Health, Baltimore, Md; Johns Hopkins School of Medicine, Baltimore, Md. Electronic address: kuni.matsushita@jhu.edu.
Jazyk:	angličtina
Zdroj:	The American journal of medicine [Am J Med] 2024 Dec; Vol. 137 (12), pp. 1255-1263.e16. Date of Electronic Publication: 2024 Jul 30.
DOI:	10.1016/j.amjmed.2024.07.009
Abstrakt:	Background: We sought to evaluate the associations of chest pain and dyspnea with the long-term risk of cardiovascular disease including coronary disease, heart failure, atrial fibrillation, and stroke. Methods: In 13,200 participants without cardiovascular disease in the Atherosclerosis Risk in Communities study (1987-1989), chest pain was categorized into definite angina, possible angina, non-anginal chest pain, and no chest pain using the Rose questionnaire. Dyspnea was categorized into grades 3-4, 2, 1, and 0 by the modified Medical Research Council scale. The associations of chest pain and dyspnea with incident myocardial infarction, heart failure, atrial fibrillation, and stroke over a median follow-up of ∼27 years were quantified with multivariable Cox models. Results: Definite angina and possible angina were associated with myocardial infarction (adjusted hazard ratios [HR] 1.80 [95%CI 1.45-2.13] and 1.65 [1.27-2.15]). Although lesser magnitude than myocardial infarction, both definite and possible angina were associated with heart failure. For atrial fibrillation, possible angina showed higher HR than definite angina. Dyspnea showed similar HRs for myocardial infarction and heart failure in grades 3-4 (2.00 [1.61-2.49] and 1.94 [1.62-2.32]). Stroke was least associated with chest symptoms. Chest pain and dyspnea significantly improved the discrimination of cardiovascular disease except stroke, beyond traditional risk factors. Conclusions: In individuals without cardiovascular disease, chest pain and dyspnea were independently associated with incident cardiovascular disease for about 3 decades, suggesting the need for evaluating chest pain from a broader perspective of cardiovascular disease beyond coronary disease and the importance of dyspnea for cardiovascular risk assessment including myocardial infarction. (Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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