CLINICAL RESEARCH: RISK PREDICTORS AND CORONARY DISEASE
Heart rate-corrected QT interval prolongation predicts risk of coronary heart disease in black and white middle-aged men and women
The ARIC study
Jacqueline M. Dekker, PhD* ,*,
Richard S. Crow, MD ,
Peter J. Hannan, MStat,
Evert G. Schouten, MD, PhD* and
Aaron R. Folsom, MD, MPH
* Department of Epidemiology and Public Health, Wageningen University, Wageningen, The Netherlands
Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands
Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
Manuscript received December 13, 2002;
revised manuscript received August 15, 2003,
accepted September 17, 2003.
* Reprint requests and correspondence: Dr. Jacqueline M. Dekker, Institute for Research in Extramural Medicine, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
JM.Dekker{at}vumc.nl
OBJECTIVES: We aimed to study the predictive value of heart rate-corrected QT interval (QTc) for incident coronary heart disease (CHD) and cardiovascular disease (CVD) mortality in the black and white general population, and to validate various QT measurements.
BACKGROUND: QTc prolongation is associated with higher risk of mortality in cardiac patients and in the general population. Little is known about the association with incident CHD. No previous studies included black populations.
METHODS: We studied the predictive value of QTc prolongation in a prospective population study of 14,548 black and white men and women, age 45 to 64 year. QT was determined by the NOVACODE program in the digital electrocardiogram recorded at baseline.
RESULTS: In quintiles of QTc, cardiovascular risk profile deteriorated with longer QTc, and risk of CHD and CVD mortality increased. The high risk in the upper quintile was mostly explained by the 10% with the longest QTc. The age-, gender-, and race-adjusted hazard ratios for CVD mortality and CHD in subjects with the longest 10% relative to the other 90% of the gender-specific QTc distribution were 5.13 (95% confidence interval 3.80 to 6.94) and 2.14 (95% confidence interval 1.71 to 2.69), respectively. The increased risk was partly, but not completely, attributable to other risk factors or the presence of chronic disease. The association was stronger in black than in white subjects. Manual- and machine-coded QT intervals were highly correlated, and the method of rate correction did not affect the observed associations.
CONCLUSIONS: Long QTc is associated with increased risk of CHD and CVD mortality in black and white healthy men and women.
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Abbreviations and Acronyms
| | ARIC | = Atherosclerosis Risk In Communities study | | CHD | = coronary heart disease | | CVD | = cardiovascular disease | | ECG | = electrocardiogram | | QTc | = heart rate-corrected QT interval |
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