21 Jun Nearly Half of All Heart Attacks are ‘Silent’ or Lack Classic Symptoms
MedicalResearch.com Interview with:
Dr. Zhu-Ming Zhang
Zhu-Ming Zhang, MD, MPH, FAHA
Associate Professor
Epidemiological Cardiology Research Center (EPICARE)
Wake Forest School of Medicine
Medical Center Blvd, Winston Salem, NC 27157
MedicalResearch.com: What is the background for this study?
Response: Heart disease still is the leading cause of death globally. About 635,000 new cases of coronary heart disease occur annually in the United States, with an additional 155,000 incidentally discovered asymptomatic silent myocardial infarctions (SMI). Silent myocardial infarctions, defined as the presence of pathological Q waves in the absence of a history of typical cardiac symptoms, is one of the important cardiac abnormalities, and given them medical attention could prevent subsequent adverse outcomes or even their lives.
MedicalResearch.com: What are the main findings?
Response:
There are three main findings for this study:
1) Silent myocardial infarction is common, represents over 45% of incident MIs;
2) SMI is associated with poor prognosis;
3) There are race and sex differences in the incidence and prognostic significance of silent myocardial infarctions.
MedicalResearch.com: What should readers take away from your report?
Response: A heart attack does not always have classic symptoms. Nearly half of all heart attacks may be silent and lack of chest pain or other warning signs. Our study highlights the importance of detection of silent myocardial infarctions, and the potential impact of such detection on personalized prevention of coronary heart disease that takes into account race and sex.
Silent myocardial infarctions can be detected through ECG screening. The 12-lead ECG is a key widely available, inexpensive diagnostic tool for acute, old and silent MI and myocardial ischemia, and also is used for stratifying for cardiovascular disease status for mortality risk assessment. Therefore, it may be helpful for the reasonably ECG screening after middle age, especially for those with cardiovascular disease family history.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: In our study, men had higher incident silent myocardial infarctions than women, but women had increased risk of mortality than men . And there is similar finding for MI with clinical manifestations. The study also show that blacks may has worse outcome than whites, but the sample number of blacks in the study may be too small to say with certainty. Sex and race difference should be further evaluated by their social and economic factors, and as well as their medical attention and enhanced medical care.
MedicalResearch.com: Is there anything else you would like to add?
Response: Silent myocardial infarctions can be detected through ECG screening. Therefore further looking for ECG predictors of SMI will help identify individuals at risk who may benefit from more frequent follow-up or more aggressive risk factor management.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Citation:
Race and Sex Differences in the Incidence and Prognostic Significance of Silent Myocardial Infarction in the Atherosclerosis Risk in Communities (ARIC) Study
Zhu-Ming Zhang, Pentti M. Rautaharju, Ronald J. Prineas, Carlos J. Rodriguez,Laura Loehr, Wayne D. Rosamond, Dalane Kitzman, David Couper, and Elsayed Z. Soliman
Circulation. 2016;CIRCULATIONAHA.115.021177published online before print May 16 2016, doi:10.1161/CIRCULATIONAHA.115.021177
Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.
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Last Updated on June 21, 2016 by Marie Benz MD FAAD