@article {596, title = {Association of aortic-valve sclerosis with cardiovascular mortality and morbidity in the elderly.}, journal = {N Engl J Med}, volume = {341}, year = {1999}, month = {1999 Jul 15}, pages = {142-7}, abstract = {

BACKGROUND: Although aortic-valve stenosis is clearly associated with adverse cardiovascular outcomes, it is unclear whether valve sclerosis increases the risk of cardiovascular events.

METHODS: We assessed echocardiograms obtained at base line from 5621 men and women 65 years of age or older who were enrolled in a population-based prospective study. On echocardiography, the aortic valve was normal in 70 percent (3919 subjects), sclerotic without outflow obstruction in 29 percent (1610), and stenotic in 2 percent (92). The subjects were followed for a mean of 5.0 years to assess the risk of death from any cause and of death from cardiovascular causes. Cardiovascular morbidity was defined as new episodes of myocardial infarction, angina pectoris, congestive heart failure, or stroke.

RESULTS: There was a stepwise increase in deaths from any cause (P for trend, <0.001) and deaths from cardiovascular causes (P for trend, <0.001) with increasing aortic-valve abnormality; the respective rates were 14.9 and 6.1 percent in the group with normal aortic valves, 21.9 and 10.1 percent in the group with aortic sclerosis, and 41.3 and 19.6 percent in the group with aortic stenosis. The relative risk of death from cardiovascular causes among subjects without coronary heart disease at base line was 1.66 (95 percent confidence interval, 1.23 to 2.23) for those with sclerotic valves as compared with those with normal valves, after adjustment for age and sex. The relative risk remained elevated after further adjustment for clinical factors associated with sclerosis (relative risk, 1.52; 95 percent confidence interval, 1.12 to 2.05). The relative risk of myocardial infarction was 1.40 (95 percent confidence interval, 1.07 to 1.83) among subjects with aortic sclerosis, as compared with those with normal aortic valves.

CONCLUSIONS: Aortic sclerosis is common in the elderly and is associated with an increase of approximately 50 percent in the risk of death from cardiovascular causes and the risk of myocardial infarction, even in the absence of hemodynamically significant obstruction of left ventricular outflow.

}, keywords = {Aged, Angina Pectoris, Aortic Valve, Calcinosis, Cardiovascular Diseases, Cerebrovascular Disorders, Female, Heart Failure, Heart Valve Diseases, Humans, Male, Mortality, Myocardial Infarction, Prospective Studies, Risk, Risk Factors, Ultrasonography, United States, Ventricular Outflow Obstruction}, issn = {0028-4793}, doi = {10.1056/NEJM199907153410302}, author = {Otto, C M and Lind, B K and Kitzman, D W and Gersh, B J and Siscovick, D S} } @article {607, title = {Prevalence, predisposing factors, and prognosis of clinically unrecognized myocardial infarction in the elderly.}, journal = {J Am Coll Cardiol}, volume = {35}, year = {2000}, month = {2000 Jan}, pages = {119-26}, abstract = {

OBJECTIVES: This study was designed to determine the prevalence of unrecognized myocardial infarction (UMI), as well as risk factors, and to compare prognosis after detection of previously UMI to that after recognized myocardial infarction (RMI).

BACKGROUND: Past studies revealed that a significant proportion of MIs escape recognition, and that prognosis after such events is poor, but the epidemiology of UMI has not been reassessed in the contemporary era.

METHODS: The Cardiovascular Health Study (CHS) database, composed of individuals > or =65, was queried for participants who, at entry, demonstrated electrocardiographic evidence of a prior Q-wave MI, but who lacked a history of this diagnosis. The features and outcomes of this group were compared to those of individuals with prevalent RMI.

RESULTS: Of 5,888 participants, 901 evidenced a past MI, and 201 (22.3\%) were previously unrecognized. The independent predictors of UMI were the absence of angina and the absence of congestive heart failure (CHF). Six-year mortality did not significantly differ between the two groups.

CONCLUSIONS: 1) In the elderly, UMI continues to represent a significant proportion of all MIs; 2) associations with angina and CHF may reflect complex neurological issues, but they also may represent diagnosis bias; 3) these individuals can otherwise not be distinguished from those with recognized infarctions; and 4) mortality rates after UMI and RMI are similar. Future studies should address screening for UMI, risk stratification after detection of previously UMI, and the role of standard post-MI therapies.

}, keywords = {Aged, Cause of Death, Coronary Disease, Cross-Sectional Studies, Databases, Factual, Electrocardiography, Female, Follow-Up Studies, Humans, Male, Myocardial Infarction, Prognosis, Risk Factors, Stroke, Survival Rate}, issn = {0735-1097}, doi = {10.1016/s0735-1097(99)00524-0}, author = {Sheifer, S E and Gersh, B J and Yanez, N D and Ades, P A and Burke, G L and Manolio, T A} }