Comparison of QRS Duration and Associated Cardiovascular Events in American Indian Men Versus Women (The Strong Heart Study).

MedStar author(s):
Citation: American Journal of Cardiology. 119(11):1757-1762, 2017 Jun 01PMID: 28416200Institution: MedStar Health Research InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleYear: 2017Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006MH - AgedMH - *Coronary Disease/co [Complications]MH - Coronary Disease/eh [Ethnology]MH - Coronary Disease/pp [Physiopathology]MH - *Death, Sudden, Cardiac/eh [Ethnology]MH - Death, Sudden, Cardiac/et [Etiology]MH - *ElectrocardiographyMH - FemaleMH - Follow-Up StudiesMH - *ForecastingMH - HumansMH - IncidenceMH - *Indians, North AmericanMH - MaleMH - Middle AgedMH - Retrospective StudiesMH - *Risk Assessment/mt [Methods]MH - Risk FactorsMH - Survival Rate/td [Trends]MH - United States/ep [Epidemiology]AB - Electrocardiographic QRS duration at rest is associated with sudden cardiac death and death from coronary heart disease in the general population. However, its relation to cardiovascular events in American Indians, a population with persistently high cardiovascular disease mortality, is unknown. The relation of QRS duration to incident cardiovascular disease during 17.2 years of follow-up was assessed in 1,851 male and female Strong Heart Study participants aged 45 to 74 years without known cardiovascular disease at baseline. Cox regression with robust standard error estimates was used to determine the association between quintiles of QRS duration and incident cardiovascular disease in gender-stratified analyses, adjusted for age, systolic blood pressure, hypertension, antihypertensive medication use, body mass index, current smoking, diabetes, total cholesterol, high-density lipoprotein cholesterol, and albuminuria. In women only, QRS duration in the highest quintile (>=105 ms) conferred significantly higher risk of cardiovascular disease than QRS duration in the lowest quintile (64 to 84 ms) (hazard ratio 1.6, 95% CI 1.1 to 2.4) likely because of higher risks of coronary heart disease (hazard ratio 1.8, 95% CI 1.1 to 3.1) and myocardial infarction (hazard ratio 2.1, 95% CI 1.0 to 4.7). Furthermore, when added to the Strong Heart Study Coronary Heart Disease Risk Calculator, QRS duration significantly improved prediction of future coronary heart disease events in women (Net Reclassification Index 0.17, 95% CI 0.06 to 0.47). In conclusion, QRS duration is an independent predictor of cardiovascular disease in women in the Strong Heart Study cohort and may have value in estimating risk in populations with similar risk profiles and a high lifetime incidence of cardiovascular disease. Copyright (c)2017 Elsevier Inc. All rights reserved.ISSN:
  • 0002-9149
Name of journal: The American journal of cardiologyAll authors: Best LG, Deen JF, Devereux RB, Noonan C, Okin PM, Rhoades DA, Umans JGFiscal year: FY2017Digital Object Identifier: Date added to catalog: 2017-05-06
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 28416200 Available 28416200

Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006MH - AgedMH - *Coronary Disease/co [Complications]MH - Coronary Disease/eh [Ethnology]MH - Coronary Disease/pp [Physiopathology]MH - *Death, Sudden, Cardiac/eh [Ethnology]MH - Death, Sudden, Cardiac/et [Etiology]MH - *ElectrocardiographyMH - FemaleMH - Follow-Up StudiesMH - *ForecastingMH - HumansMH - IncidenceMH - *Indians, North AmericanMH - MaleMH - Middle AgedMH - Retrospective StudiesMH - *Risk Assessment/mt [Methods]MH - Risk FactorsMH - Survival Rate/td [Trends]MH - United States/ep [Epidemiology]AB - Electrocardiographic QRS duration at rest is associated with sudden cardiac death and death from coronary heart disease in the general population. However, its relation to cardiovascular events in American Indians, a population with persistently high cardiovascular disease mortality, is unknown. The relation of QRS duration to incident cardiovascular disease during 17.2 years of follow-up was assessed in 1,851 male and female Strong Heart Study participants aged 45 to 74 years without known cardiovascular disease at baseline. Cox regression with robust standard error estimates was used to determine the association between quintiles of QRS duration and incident cardiovascular disease in gender-stratified analyses, adjusted for age, systolic blood pressure, hypertension, antihypertensive medication use, body mass index, current smoking, diabetes, total cholesterol, high-density lipoprotein cholesterol, and albuminuria. In women only, QRS duration in the highest quintile (>=105 ms) conferred significantly higher risk of cardiovascular disease than QRS duration in the lowest quintile (64 to 84 ms) (hazard ratio 1.6, 95% CI 1.1 to 2.4) likely because of higher risks of coronary heart disease (hazard ratio 1.8, 95% CI 1.1 to 3.1) and myocardial infarction (hazard ratio 2.1, 95% CI 1.0 to 4.7). Furthermore, when added to the Strong Heart Study Coronary Heart Disease Risk Calculator, QRS duration significantly improved prediction of future coronary heart disease events in women (Net Reclassification Index 0.17, 95% CI 0.06 to 0.47). In conclusion, QRS duration is an independent predictor of cardiovascular disease in women in the Strong Heart Study cohort and may have value in estimating risk in populations with similar risk profiles and a high lifetime incidence of cardiovascular disease. Copyright (c)2017 Elsevier Inc. All rights reserved.

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