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Elsayed Z Soliman - One of the best experts on this subject based on the ideXlab platform.
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Silent Myocardial Infarction and subsequent ischemic stroke in the cardiovascular health study
Neurology, 2021Co-Authors: Alexander E Merkler, Traci M Bartz, Hooman Kamel, Elsayed Z Soliman, Virginia J Howard, Bruce M Psaty, Peter M Okin, M M Safford, Mitchell S V Elkind, W T LongstrethAbstract:Objective To test the hypothesis that Silent Myocardial Infarction (MI) is a risk factor for ischemic stroke, we evaluated the association between Silent MI and subsequent ischemic stroke in the Cardiovascular Health Study. Methods The Cardiovascular Health Study prospectively enrolled community-dwelling individuals ≥65 years of age. We included participants without prevalent stroke or baseline evidence of MI. Our exposures were Silent and clinically apparent, overt MI. Silent MI was defined as new evidence of Q-wave MI, without clinical symptoms of MI, on ECGs performed during annual study visits from 1989 to 1999. The primary outcome was incident ischemic stroke. Secondary outcomes were ischemic stroke subtypes: nonlacunar, lacunar, and other/unknown. Cox proportional hazards analysis was used to model the association between time-varying MI status (Silent, overt, or no MI) and stroke after adjustment for baseline demographics and vascular risk factors. Results Among 4,224 participants, 362 (8.6%) had an incident Silent MI, 421 (10.0%) an incident overt MI, and 377 (8.9%) an incident ischemic stroke during a median follow-up of 9.8 years. After adjustment for demographics and comorbidities, Silent MI was independently associated with subsequent ischemic stroke (hazard ratio [HR], 1.51; 95% confidence interval [CI], 1.03–2.21). Overt MI was associated with ischemic stroke both in the short term (HR, 80; 95% CI, 53–119) and long term (HR, 1.60; 95% CI, 1.04–2.44). In secondary analyses, the association between Silent MI and stroke was limited to nonlacunar ischemic stroke (HR, 2.40; 95% CI, 1.36–4.22). Conclusion In a community-based sample, we found an association between Silent MI and ischemic stroke.
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abstract 58 Silent Myocardial Infarction and subsequent ischemic stroke in the cardiovascular health study
Stroke, 2021Co-Authors: Alexander E Merkler, Traci M Bartz, Hooman Kamel, Elsayed Z Soliman, Virginia J Howard, Bruce M Psaty, Peter M Okin, M M Safford, Mitchell S V Elkind, W T LongstrethAbstract:Background: Whether Silent Myocardial Infarction (MI) is a risk factor for ischemic stroke remains uncertain. Hypothesis: Silent MI is associated with incident ischemic stroke. Methods: The Cardiov...
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the utility of Silent Myocardial Infarction on electrocardiogram as an ascvd risk enhancer for primary prevention the multi ethnic study of atherosclerosis
Journal of Electrocardiology, 2021Co-Authors: Matthew J Singleton, Elsayed Z Soliman, Charles A German, Gregory L Burke, Joseph YeboahAbstract:Abstract Background The 2018 AHA/ACC cholesterol guidelines introduced a new list of markers called “risk enhancers” that, if present, confer an increased risk of atherosclerotic cardiovascular disease (ASCVD). Silent Myocardial Infarction (SMI) on electrocardiogram (ECG) is notably absent, even though it associated with future ASCVD. Methods We assessed the utility of SMI on ECG as a risk-enhancer in intermediate-risk participants in MESA (Multi-Ethnic Study of Atherosclerosis) – those with 10-year ASCVD risk of 5–20% by the pooled cohort equation (PCE). SMI was defined as major Q-wave abnormality or minor Q/QS waves in the setting of major ST-T abnormalities without prevalent clinical cardiovascular disease. Results Among 2946 participants (mean age 63.1 ± 7.6, 53.9% women, 36% white, 11% Chinese-American, 33% African-American, 19% Hispanic), 66 (2.2%) had SMI at baseline. After a median 15.8 years of follow-up, incident ASCVD events occurred in 431/2876 (15.0%) of those without SMI and 16/66 (24.2%) of those with SMI. In a multivariable-adjusted Cox proportional hazards model, baseline SMI was associated with an increased risk of incident ASCVD events (HR 1.68, 95% CI 1.02–2.77, p = 0.04). However, adding SMI to the PCE did not improve discrimination and reclassification was modest—net reclassification improvement was 0.0161 (95% CI 0.002–0.034, p = 0.08). Conclusion Our findings suggest that the prevalence of SMI is 2.2% among those without known clinical cardiovascular disease considered intermediate-risk by the PCE. In our analysis, SMI only modestly improved classification of risk, suggesting that it may not be very useful as an ASCVD risk enhancer.
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abstract 13196 the utility of Silent Myocardial Infarction on electrocardiogram as an ascvd risk enhancer for primary prevention the multi ethnic study of atherosclerosis
Circulation, 2020Co-Authors: Matthew J Singleton, Elsayed Z Soliman, Charles A German, Gregory L Burke, Joseph YeboahAbstract:Introduction: The 2018 AHA/ACC cholesterol guidelines introduced a new list of markers called “risk enhancers” that, if present, confer an increased risk of atherosclerotic cardiovascular disease (...
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interrelations of cumulative social risk Silent Myocardial Infarction and mortality in the general population
American Journal of Cardiology, 2020Co-Authors: Nikhil Patel, Muhammad Imtiaz Ahmad, Wei Zhang, Elsayed Z SolimanAbstract:Cumulative social risk (CSR), defined as experiencing more than one social risk factor, is associated with a significant increase in cardiovascular mortality. However, it is unclear whether CSR is associated with prevalent Silent Myocardial Infarction (SMI), and whether their joint presence is predictive of mortality more than the presence of CSR in isolation. This analysis included 6,708 participants from the third National Health and Nutrition Examination Survey who were free of clinical cardiovascular disease at the time of enrollment. Baseline social risk factors (poverty-income ratio
Muhammad Imtiaz Ahmad - One of the best experts on this subject based on the ideXlab platform.
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interrelations of cumulative social risk Silent Myocardial Infarction and mortality in the general population
American Journal of Cardiology, 2020Co-Authors: Nikhil Patel, Muhammad Imtiaz Ahmad, Wei Zhang, Elsayed Z SolimanAbstract:Cumulative social risk (CSR), defined as experiencing more than one social risk factor, is associated with a significant increase in cardiovascular mortality. However, it is unclear whether CSR is associated with prevalent Silent Myocardial Infarction (SMI), and whether their joint presence is predictive of mortality more than the presence of CSR in isolation. This analysis included 6,708 participants from the third National Health and Nutrition Examination Survey who were free of clinical cardiovascular disease at the time of enrollment. Baseline social risk factors (poverty-income ratio
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serum cotinine and Silent Myocardial Infarction in individuals free from cardiovascular disease
American Journal of Cardiology, 2019Co-Authors: Ryan Brunetti, Muhammad Imtiaz Ahmad, Harry Hicklin, Justin Rackley, Elsayed Z SolimanAbstract:Serum cotinine is a sensitive and specific marker of tobacco exposure, including second-hand smoke exposure. We sought to explore the association of tobacco exposure determined by serum cotinine with electrocardiographic Silent Myocardial Infarction (SMI). A total of 7,006 participants (59.0 ± 13.3 years; 52.6% women, 49.7% non-Hispanic whites) without cardiovascular disease from the Third National Health and Nutrition Examination Survey (NHANES III) were included in this analysis. SMI was defined as electrocardiographic evidence of MI in the absence of a history of MI. Multivariable logistic regression analysis was used to examine the association between SMI and serum cotinine tertiles. SMI was detected in 114 (1.63%) of the participants. The prevalence of SMI was higher among those with higher levels of serum cotinine (SMI prevalence was 1.25%, 1.49%, and 2.14% across serum cotinine lower [0.03 to 0.12 ng/ml], middle [0.12 to 1.39 ng/ml], and higher [1.40 to 1890 ng/ml] tertiles, respectively). In a model adjusted for potential confounders, participants within the highest serum cotinine tertile had significantly greater odds of SMI (odds ratio [95% confidence interval]: 2.51 [1.55 to 4.08]) compared with those with serum cotinine levels in the first tertile. Each 10 ng/ml increase in serum cotinine levels was associated with a 2% (p
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interrelationships between american heart association s life s simple 7 ecg Silent Myocardial Infarction and cardiovascular mortality
Journal of the American Heart Association, 2019Co-Authors: Muhammad Imtiaz Ahmad, Parag A Chevli, Harsh Barot, Elsayed Z SolimanAbstract:Background We examined the interrelationships among cardiovascular health (CVH), assessed by the American Heart Association's Life's Simple 7 (LS7) health metrics, Silent Myocardial Infarction (SMI...
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interrelations between serum uric acid Silent Myocardial Infarction and mortality in the general population
American Journal of Cardiology, 2019Co-Authors: Muhammad Imtiaz Ahmad, Abhishek Dutta, Muhammad Ali Anees, Elsayed Z SolimanAbstract:Whether elevated uric acid (UA) is associated with Silent Myocardial Infarction (SMI) or whether their joint association predicts an increased risk of mortality has not been explored. This analysis included 6,323 participants (58.4 ± 13.1 years, 53.9% women, and 49.7% Non-Hispanic whites) without clinical cardiovascular disease (CVD) from third National Health and Nutrition Examination Survey. SMI was defined as electrocardiographic evidence of Myocardial Infarction (MI) without a history of MI. Multivariable logistic regression model was used to examine the cross-sectional association between baseline UA and SMI. Cox-proportional hazard analysis was used to calculate hazard ratio (HR) with 95% confidence interval (CI) for the risk of all-cause and CVD mortality with UA in the absence and presence of SMI. The higher baseline level of UA was associated with higher odds of baseline SMI. The prevalence of SMI was 0.79%, 1.18%, 1.59%, and 2.27% across the UA quartiles respectively; multivariable-adjusted odds ratio (95% CI): 2.37 (1.11 to 5.08) comparing the upper with lower quartile. During a median follow up of 14 years, there were 1916 all-cause death of whom 774 were CVD deaths. Compared with participants with the lowest UA quartile values and without SMI, those with highest UA had a 29% increased the risk of all-cause mortality (multivariable-adjusted HR: [95% CI]: 1.29 [1.10 to 1.51]). This risk increased by 107% in the presence of SMI (multivariable-adjusted HR (95% CI): 2.07 (1.38 to 3.10)). Similar results were observed for CVD mortality. SMI carried an increased risk of all-cause and CVD mortality only in higher quartiles of UA. In conclusion, the strong association of UA with SMI and the additive effect of UA and SMI on mortality further support the potential role of UA as a marker of poor outcomes.
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abstract p414 the interrelations between serum uric acid Silent Myocardial Infarction and mortality in the general population
Circulation, 2019Co-Authors: Muhammad Imtiaz Ahmad, Abhishek Dutta, Muhammad Ali Anees, Elsayed Z SolimanAbstract:Background: Whether elevated uric acid (UA) is associated with Silent Myocardial Infarction (SMI) or whether their joint association predicts an increased risk of mortality has not been explored. M...
Venu Menon - One of the best experts on this subject based on the ideXlab platform.
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abstract 15752 incidence of Silent Myocardial Infarction in a major cardiovascular clinical trial insights from the precision trial
Circulation, 2017Co-Authors: Nyal Borges, A Lincoff, Steven E Nissen, Katherine E Wolski, Lisa Wisniewski, Kimberly Brown, Venu MenonAbstract:Introduction: Although clinically meaningful, adjudication of Silent MI in the setting of a cardiovascular (CV) outcome trial is logistically challenging and expensive. The PRECISION trial evaluate...
Romulo E Colindres - One of the best experts on this subject based on the ideXlab platform.
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blood pressure usually considered normal is associated with an elevated risk of cardiovascular disease
The American Journal of Medicine, 2006Co-Authors: Abhijit V Kshirsagar, Myra A Carpenter, Heejung Bang, Sharon B Wyatt, Romulo E ColindresAbstract:Abstract Purpose Research on the risk of cardiovascular disease among individuals with prehypertension (blood pressure 120/80 to 139/89 mm Hg) is incomplete. Additional information among individuals with a high risk of cardiovascular disease complications may help to focus current and future efforts. Subjects and methods We performed a prospective cohort analysis among 8960 middle-aged adults in the Atherosclerosis Risk in Communities (ARIC) study. The exposure variables were blood pressure levels: high normal blood pressure, systolic blood pressure 130-139 mm Hg or diastolic blood pressure 85-89 mm Hg; and normal blood pressure, systolic blood pressure 120-129 mm Hg or diastolic blood pressure 80-84 mm Hg. The outcome was incident cardiovascular disease defined as fatal/nonfatal coronary heart disease, cardiac procedure, Silent Myocardial Infarction, or ischemic stroke. Subgroup analysis was performed among blacks, diabetics, individuals aged 55-64 years, individuals with renal insufficiency, and among individuals with varying levels of low-density lipoprotein (LDL) cholesterol and body mass index (BMI). Results Compared with optimal blood pressure (systolic blood pressure 30 kg/m 2 : RR for high normal blood pressure was 3.56 (95% CI, 1.99-6.35); and among individuals with LDL >160 mg/dL, RR for high normal blood pressure was 1.85 (95% CI, 1.26-2.72). Conclusions Individuals with prehypertensive levels of blood pressure have an increased risk of developing cardiovascular disease relative to those with optimal levels. The association is pronounced among blacks, among individuals with diabetes mellitus, and among those with high BMI.
Timothy M E Davis - One of the best experts on this subject based on the ideXlab platform.
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prognostic significance of Silent Myocardial Infarction in newly diagnosed type 2 diabetes mellitus united kingdom prospective diabetes study ukpds 79
Circulation, 2013Co-Authors: Timothy M E Davis, Ruth L Coleman, R R HolmanAbstract:Background—We aimed to determine the prevalence of Silent Myocardial Infarction (SMI) in people with newly diagnosed type 2 diabetes mellitus and its relationships to future Myocardial Infarction (MI) and all-cause mortality. Methods and Results—We examined data from the 5102 patients in the 30-year UK Prospective Diabetes Study (UKPDS) and used Cox proportional hazards regression to examine outcomes by SMI status. Of 1967 patients with complete baseline data, 326 (16.6%) had ECG evidence of SMI (Minnesota codes 1.1 or 1.2) at enrollment. Those with SMI were more likely to be older, female, sedentary, and nonsmokers compared with those without SMI. Their mean blood pressure was greater despite more intensive antihypertensive treatment; they were more likely to be taking aspirin and lipid-lowering therapy; and they had a greater prevalence of microangiopathy. Fully adjusted hazard ratios for those with versus those without SMI in multivariate models that included UKPDS Risk Engine variables were 1.58 (95% ...
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incidence and predictors of Silent Myocardial Infarction in type 2 diabetes and the effect of fenofibrate an analysis from the fenofibrate intervention and event lowering in diabetes field study
European Heart Journal, 2010Co-Authors: D Burgess, Timothy M E Davis, David M Hunt, Diana Zannino, Elizabeth A Williamson, Markku Laakso, Antero Y Kesaniemi, Jun Zhang, Seppo Lehto, Stewart MannAbstract:Aims To determine the incidence and predictors of, and effects of fenofibrate on Silent Myocardial Infarction (MI) in a large contemporary cohort of patients with type 2 diabetes in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study. Methods and results Routine electrocardiograms taken throughout the study were assessed by Minnesota-code criteria for the presence of new Q-waves without clinical presentation and analysed with blinding to treatment allocation and clinical outcome. Of all MIs, 36.8% were Silent. Being male, older age, longer diabetes duration, prior cardiovascular disease (CVD), neuropathy, higher HbA1c, albuminuria, high serum creatinine, and insulin use all significantly predicted risk of clinical or Silent MI. Fenofibrate reduced MI (clinical or Silent) by 19% [hazard ratio (HR) 0.81, 95% confidence interval (CI) 0.69–0.94; P = 0.006], non-fatal clinical MI by 24% ( P = 0.01), and Silent MI by 16% ( P = 0.16). Among those having Silent MI, fenofibrate reduced subsequent clinical CVD events by 78% (HR 0.22, 95% CI 0.08–0.65; P = 0.003). Conclusion Silent and clinical MI have similar risk factors and increase the risk of future CVD events. Fenofibrate reduces the risk of a first MI and substantially reduces the risk of further clinical CVD events after Silent MI, supporting its use in type 2 diabetes.
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Silent Myocardial Infarction and its prognosis in a community based cohort of type 2 diabetic patients the fremantle diabetes study
Diabetologia, 2004Co-Authors: Timothy M E Davis, P Fortun, J Mulder, Wendy A Davis, David G BruceAbstract:Our study investigated the prognosis of Type 2 diabetic patients with Silent Myocardial Infarction in a community-based cohort. We analysed data from 1269 patients with Type 2 diabetes mellitus from a community-based observational study of diabetes care, control and complications. Silent Myocardial Infarction was defined as Q waves (Minnesota codes 1.1, 1.2) on a baseline electrocardiogram in the absence of a history or symptoms of CHD. Silent Myocardial Infarction was present in 3.9% of patients, or 44% of all Q-wave Myocardial Infarctions. The patients were subdivided into those with (i) no clinical or Q-wave evidence of Myocardial Infarction (Group 1), (ii) Silent Myocardial Infarction (Group 2), (iii) self-reported CHD but no Q waves (Group 3), and (iv) self-reported CHD and Q waves (Group 4). Compared to Groups 3 and 4, Group 2 patients were more likely to be women, less likely to have smoked, and had higher serum HDL-cholesterol concentrations and higher blood pressure. Over an average of seven years, and after adjusting for other independent predictors of death, all-cause and CHD mortality were similar in Groups 1 and 2 and greater (twofold for all-cause and fourfold for CHD mortality) in Groups 3 and 4. Silent Myocardial Infarction is common in Type 2 diabetes and has a prognosis similar to that in patients without a history of CHD or Q waves.