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Silent MI linked to increased HF risk
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Silent MI has been associated with an increased risk for HF, according to findings published in the Journal of the American College of Cardiology.
“Silent MI accounts for about one-half of the total number of MIs. Therefore, it is important to identify if there are adverse outcomes associated with its presence similar to clinical MI,” Elsayed Z. Soliman, MD, MSc, MS, FAHA, FACC, director of the Epidemiological Cardiology Research Center and professor of epidemiology and prevention at Wake Forest School of Medicine in Winston-Salem, North Carolina, told Cardiology Today. “HF is the final outcome of up to 15% of the patients who experience acute MI, and the risk of HF among patients with silent MI is not well established. That is why we sought to fill this gap in knowledge. This was the natural extension to our prior work in which we showed that silent MI is associated with increased risk of coronary heart disease and all-cause deaths.”
Soliman and colleagues conducted an analysis that included 9,243 participants from the ARIC study who were free of CVD at baseline.
The researchers defined silent MI as electrocardiographic evidence of MI with no clinically manifested MI after baseline until ARIC visit four, which took place from 1996 to 1998.
Soliman and colleagues identified HF events starting from ARIC visit four until 2010 in those free of HF before their visit.
According to Soliman, there are a few issues with mass screening that should be a focal point of future studies, such as cost-effectiveness and test accuracy. He said false-positive results could lead to unnecessary additional investigations and costs to the patients and society. As a result, the test results should not be read in the context of advocating for screening for silent MI without examining the cost-effectiveness of this approach.
According to the results of the study, researchers observed:
- 331 clinically manifested MI and 305 silent MI between ARIC visits one and four;
- 976 HF events after ARIC visit four and during a median follow-up of 13 years;
- a higher incidence rate of HF in participants with clinically manifested MI or silent MI participants than in those without MI (incidence rates per 1,000 person-years were 30.4, 16.2 and 7.8, respectively; P < .001);
- an increased risk for HF in silent MI (HR = 1.35; 95% CI, 1.02-1.78) compared with those with no prior MI; and
- an increased risk for HF in clinically manifested MI (HR = 2.85; 95% CI, 2.31-3.51) compared with those with no prior MI.
According to the researchers, these associations were consistent in subgroups of participants stratified by several HF risk predictors; however, HF risk associated with silent MI was stronger in those younger than the median age of 53 years (HR for age younger than 53 years = 1.66; 95% CI, 1-2.75; HR for age 53 years or older = 1.19; 95% CI, 0.85-1.66; P for interaction < .001).
According to Soliman, among those who would typically need an ECG, such as patients with CVD risk factors or symptoms suggestive of cardiac disease, the finding of silent MI should not be taken lightly.
“The management of silent MI should not be different from management of other types of MIs,” Soliman told Cardiology Today. “There are guidelines from scientific societies about how to manage MI and coronary heart disease, in general, and clinicians can follow. As for the patients, the same rules for prevention of cardiovascular disease apply, which is to quit smoking, reduce weight, control cholesterol and blood pressure, and get more exercise.”
In a related editorial, C. Michael Gibson, MD, from the division of cardiovascular medicine and department of medicine at Beth Israel Deaconess Medical Center at Harvard Medical School, and colleagues discussed the merits of the ARIC study, despite its limitations.
“In an era when complex microRNA samples and biomarkers are being developed to identify patients with an increased risk of HF, [the authors] remind us that sometimes preventive cardiology could be as simple as a Q-wave,” they wrote. – by Dave Quaile
Disclosures: Soliman reports no relevant financial disclosures. Gibson reports receiving consultant honoraria from Novo Nordisk. Please see the study and editorial for all other authors’ relevant financial disclosures.
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