Chest Symptoms and Long-Term Risk of Incident Cardiovascular Disease

Authors

Kentaro Ejiri, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.Follow
Yejin Mok, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Ning Ding, Yale New Haven Health Bridgeport Hospital, Bridgeport, CT.Follow
Patricia P. Chang, University of North Carolina, Chapel Hill.
Wayne D. Rosamond, University of North Carolina, Chapel Hill.
Amil M. Shah, University of Texas Southwestern Medical Center, Dallas, TX.
Pamela L. Lutsey, University of Minnesota, Minneapolis, MN.
Lin Yee Chen, University of Minnesota, Minneapolis, MN.
Michael J. Blaha, Johns Hopkins School of Medicine, Baltimore, MD.
Lena Mathews, Johns Hopkins School of Medicine, Baltimore, MD.
Kunihiro Matsushita, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Johns Hopkins School of Medicine, Baltimore, MD. Electronic address: kuni.matsushita@jhu.edu.

Document Type

Article

Publication Title

The American journal of medicine

Abstract

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.

DOI

10.1016/j.amjmed.2024.07.009

Publication Date

7-30-2024

Recommended Citation

Ejiri, Kentaro; Mok, Yejin; Ding, Ning; Chang, Patricia P.; Rosamond, Wayne D.; Shah, Amil M.; Lutsey, Pamela L.; Chen, Lin Yee; Blaha, Michael J.; Mathews, Lena; and Matsushita, Kunihiro, "Chest Symptoms and Long-Term Risk of Incident Cardiovascular Disease" (2024). Internal Medicine. 70.
https://scholar.bridgeporthospital.org/internal_medicine/70

Identifier

39084313 (pubmed); 10.1016/j.amjmed.2024.07.009 (doi); S0002-9343(24)00474-1 (pii)