Routine electrocardiogram screening may help find patients at high CVD risk
A study of more than 3.5 million working-age adults in Japan found that minor abnormalities on a baseline electrocardiogram were associated with the risk of cardiovascular disease (CVD) events during a median follow-up of 5.5 years.
Routine electrocardiogram (EKG) screening may help identify individuals at high risk for cardiovascular events, a Japanese study found.
To investigate the association between EKG abnormalities and outcomes, researchers looked at individuals ages 35 to 65 years from the Japan Health Insurance Association database, which covers approximately 40% (30 million) of the working-age population in Japan. The study recorded baseline EKG status (categorized as normal, one minor abnormality, two or more minor abnormalities, or major abnormality) and used data from April 2015 to March 2022. The primary outcome was a composite of death and cardiovascular disease (CVD) hospital admission due to myocardial infarction, stroke, or heart failure; the secondary outcome was a new major EKG abnormality. Results were published July 1 by JAMA Internal Medicine.
Of 3,698,429 individuals enrolled in the nationwide annual health check program, 16.8% had one minor abnormality, 3.9% had two or more minor abnormalities, and 1.5% had a major abnormality. During a median follow-up of 5.5 years, having a baseline abnormality was independently associated with incidence of the composite endpoint (incidence rates per 10,000 person-years, 92.7 [95% CI, 92.2 to 93.2] for normal vs. 128.5 [95% CI, 127.2 to 129.9] for one minor abnormality, 159.7 [95% CI, 156.6 to 162.9] for two or more minor abnormalities, and 266.3 [95% CI, 259.9 to 272.3] for a major abnormality). Adjusted hazard ratios, compared to a normal reading, were 1.19 (95% CI, 1.18 to 1.20) for one minor, 1.37 (95% CI, 1.34 to 1.39) for two or more minor, and 1.96 (95% CI, 1.92 to 2.02) for a major EKG abnormality.
The presence and number of minor abnormalities were associated with incidence of developing new major EKG abnormalities (incidence rates per 10,000 person-years, 85.1 [95% CI, 84.5 to 85.5] for a normal EKG, 217.2 [95% CI, 215.5 to 219.0] for one minor abnormality, and 306.4 [95% CI, 302.1 to 310.7] for two or more minor EKG abnormalities). Adjusted hazard ratios were 2.52 (95% CI, 2.49 to 2.55) for one minor abnormality and 3.61 (95% CI, 3.55 to 3.67) for two or more minor abnormalities.
The study authors wrote that routine EKG screening might have a role in early prevention of CVD events.
An invited commentary noted that the U.S. Preventive Services Task Force and the European Society of Cardiology both currently recommend against screening EKGs in people at average risk, with the Task Force finding insufficient evidence to recommend for or against screening for patients at intermediate or high risk of CVD. They also cautioned about the potential harms of screening.
"The findings from this study are unlikely to change these recommendations," the commentary stated. "For clinicians and patients, merely knowing that someone is at risk for an adverse event is not helpful without knowing what should be done to reduce that risk." The strategies for reducing CVD risk, including statins, hypertension treatment, and healthier lifestyles, should be offered to appropriate patients irrespective of their EKG, the editorial continued.