Predicting Coronary Heart Disease Events in Women A Longitudinal Cohort Study

被引:32
作者
McSweeney, Jean [1 ]
Cleves, Mario A. [2 ]
Fischer, Ellen P. [3 ,4 ]
Moser, Debra K. [5 ]
Wei, Jeanne [2 ]
Pettey, Christina [1 ]
Rojo, Martha O. [1 ]
Armbya, Narain [2 ]
机构
[1] Univ Arkansas Med Sci, Coll Nursing, Little Rock, AR 72205 USA
[2] Univ Arkansas Med Sci, Coll Med, Little Rock, AR 72205 USA
[3] Cent Arkansas Vet Healthcare Syst, Ctr Mental Healthcare & Outcomes Res, Little Rock, AR USA
[4] Univ Arkansas Med Sci, Dept Psychiat & Behav Sci, Little Rock, AR 72205 USA
[5] Univ Kentucky, Coll Nursing, Lexington, KY 40506 USA
基金
美国国家卫生研究院;
关键词
cardiovascular disease; coronary disease; myocardial infarction; women; CARDIOVASCULAR RISK PROFILE; FRAMINGHAM; SYMPTOMS; VALIDATION; SEX;
D O I
10.1097/JCN.0b013e3182a409cc
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: More than 240 000 women in the United States die of coronary heart disease annually. Identifying women's symptoms that predict a coronary heart disease event such as myocardial infarction (MI) could decrease mortality. Objective: For this longitudinal observational study, we recruited 1097 women, who were either clinician referred or self-referred to a cardiologist and undergoing initial evaluation by a cardiologist, to assess the utility of the prodromal symptoms (PS) section of the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey (MAPMISS) in predicting the occurrence of cardiac events in women. Methods and Results: Seventy-seven women experienced events (angioplasty, stent placement, coronary artery bypass, MI, death) during the 2-year follow up. The most common events were stents alone (38.9%) or in combination with angioplasty (18.2%). Ten women had MIs; 4 experienced cardiac death. Cox proportional hazards was used to model time to event. The prodromal score was significantly associated with risk of an event (hazard ratio, 1.10; 95% confidence interval, 1.06-1.13), as was the number of PSs endorsed by each woman per visit. After covariate adjustment, 5 symptoms were significantly associated with increased risk: discomfort in jaws/teeth, unusual fatigue, arm discomfort, shortness of breath, and general chest discomfort (hazard ratio, 3.97; 95% confidence interval, 2.32-6.78). Women reporting 1 or more of these symptoms were 4 times as likely to experience a cardiac event as women with none. Conclusions: Both the MAPMISS PS scores and number of PS were significantly associated with cardiac events, independent of risk factors, suggesting that there are specific PSs that can be easily assessed using the MAPMISS. This instrument could be an important component of a predictive screen to assist clinicians in deciding the course of management for women.
引用
收藏
页码:482 / 492
页数:11
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