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Newly developed ST-T abnormalities on the electrocardiogram and chronologic changes in cardiovascular risk factors
T Kawamura1, R Yamamoto, K WaKai
1Department of Preventive Medicine, Nagoya University School of Medicine, Japan.
Insights
ST-T abnormalities on electrocardiograms (ECGs) predict cardiovascular disease. This study found that gradually increasing blood pressure and decreasing uric acid levels over 10 years preceded ST-T abnormalities in men.
Area of Science:
- Cardiology
- Preventive Medicine
- Clinical Research
Background:
- ST-T abnormalities on electrocardiograms (ECGs) are established predictors of cardiovascular morbidity and mortality.
- The chronological development of ST-T abnormalities in relation to cardiovascular risk factors requires further investigation.
Purpose of the Study:
- To investigate the longitudinal changes in cardiovascular risk factors preceding the development of ST-T abnormalities in apparently healthy men.
Main Methods:
- A longitudinal study identified 68 men with initially normal ECGs who later developed ST-T abnormalities (ST-T subjects) and compared them with 68 age-matched controls with consistently normal ECGs.
- Cardiovascular risk factors, including blood pressure, serum cholesterol, glucose, and uric acid, were reviewed retrospectively over 10 years prior to the onset of ST-T abnormality.
- Echocardiography was performed on a subset of ST-T subjects to assess for left ventricular hypertrophy.
Main Results:
- ST-T subjects exhibited a gradual increase in systolic and diastolic blood pressure over the 10-year period, unlike controls.
- Serum uric acid levels significantly decreased over 10 years exclusively in ST-T subjects.
- Multivariate analysis indicated that the chronological changes in blood pressure and uric acid were independent of other risk factors.
Conclusions:
- The temporal progression of cardiovascular risk factors, particularly blood pressure and uric acid, plays a significant role in the development of ST-T abnormalities.
- These findings highlight the importance of monitoring longitudinal trends in risk factors for early detection and prevention of cardiovascular events.
Abstract:
An ST-T abnormality on an electrocardiogram (ECG) is known to independently predict subsequent morbidity and mortality from cardiovascular diseases. But how ST-T abnormality develops in relation to chronologic changes in cardiovascular risk factors has not been fully discussed. Sixty-eight men whose ECG had been initially normal but who exhibited ST-T abnormality later (ST-T subjects) were identified among 21,579 apparently healthy adults who had undergone comprehensive health examinations for > 10 years. Echocardiography proved that 26 of 29 examinees among ST-T subjects had left ventricular hypertrophy. Antihypertensive drugs were given to 26 of the ST-T subjects. Their cardiovascular risk factors were chronologically reviewed from 10 years before the onset of definite ST-T abnormality, and were compared with those of 68 men whose ECG had remained consistently normal for 10 years (controls). Mean values of systolic and diastolic blood pressure gradually increased over 10 years (from 127/78 to 144/84 mm Hg) among ST-T subjects, but showed little change (from 122/76 to 124/77 mm Hg) during the same period in controls. The time course of blood pressure over 10 years was similar in ST-T subjects, irrespective of final blood pressure level. Mean serum cholesterol and glucose increased over 10 years in both ST-T and control subjects. Uric acid decreased over 10 years (from 6.1 to 5.6 mg/dl) only in ST-T subjects. Multivariate analysis revealed that blood pressure and uric acid before onset of ST-T abnormality were chronologically changed independent of other risk factors. The time course of risk factors may be of great importance in the development of cardiovascular disorders.