Electrocardiogram Risk Score and Prevalence of Subclinical Atherosclerosis: A Cross-Sectional Study
Minji Kang1, Yoosoo Chang1,2,3, Jeonggyu Kang1
1Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul 04514, Korea.
Insights
An integrated electrocardiogram (ECG) risk score effectively predicts subclinical cardiovascular disease (CVD) by identifying coronary artery calcium (CAC) prevalence. This scoring method aids in identifying individuals who may benefit from early interventions like lipid-lowering medications.
Area of Science:
- Cardiology
- Preventive Medicine
- Medical Diagnostics
Background:
- Integrated electrocardiogram (ECG) parameters are known predictors of cardiovascular disease (CVD) risk.
- The association between integrated ECG risk scores and subclinical CVD, specifically coronary artery calcium (CAC), remains underexplored.
Purpose of the Study:
- To evaluate the association between an integrated ECG risk score and the prevalence of subclinical coronary artery calcium (CAC).
- To determine if ECG parameters can identify individuals with subclinical CVD who may benefit from early intervention.
Main Methods:
- A cross-sectional study involving 134,802 participants without known CVD.
- ECG and CAC computed tomography were performed on all participants.
- An integrated ECG risk score was calculated based on five abnormalities: heart rate >80 bpm, QRS duration >110 ms, left ventricular hypertrophy, T-wave inversion, and prolonged QTc.
Main Results:
- The prevalence of CAC progressively increased with higher integrated ECG risk scores.
- Multivariable-adjusted analyses showed increased prevalence ratios for CAC (1-100 and >100) with increasing ECG risk score groups.
- Specifically, for CAC >100, PRs were 1.03, 1.44, and 1.75 for ECG risk score groups of 1, 2, and ≥3, respectively.
Conclusions:
- Integrated ECG scoring is associated with the prevalence of subclinical coronary artery calcium.
- This scoring system may help identify individuals, including young and asymptomatic ones, who require interventions such as lipid-lowering medications.
Abstract:
Integrated abnormal electrocardiogram (ECG) parameters predict the risk of cardiovascular disease (CVD); however, its relationship with subclinical CVD is unknown. We aimed to evaluate the association between the integrated ECG risk score and the prevalence of coronary artery calcium (CAC). A cross-sectional study comprised 134,802 participants with no known CVD who underwent ECG and CAC computed tomography. The ECG risk score was the sum of five ECG abnormalities: heart rate of >80 beats, QRS of >110 ms, left ventricular hypertrophy, T-wave inversion, and prolonged QTc. A multinomial regression model was used to estimate the prevalence ratios (PRs) and their 95% confidence intervals (CIs) for prevalent CAC. The prevalence of CAC progressively increased as the ECG risk score increased. After adjustment for conventional CVD risk factors and other confounders, the multivariable-adjusted PRs (95% CI) for a CAC of 1−100 in the 1, 2, and ≥3 ECG risk score groups were 1.06 (1.02−1.10), 1.12 (1.03−1.22), and 1.19 (1.00−1.42), respectively, while the corresponding PRs for a CAC of >100 were 1.03 (0.95−1.12), 1.44 (1.25−1.66), and 1.75 (1.33−2.29), respectively. Integrative ECG scoring may help identify individuals requiring lipid-lowering medications, even in young and asymptomatic populations.
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