Chest pain and dyspnea warning signs of future heart attacks and heart failure
USA: A recent study in the Circulation has pointed out that shortness of breath (dyspnea) and chest pain in patients without prior cardiovascular disease (CVD) indicate future heart problems over 30 years.
The findings, also presented at the American Heart Association's Scientific Sessions conference in Chicago and virtually, showed that dyspnea and chest pain were linked mainly to future atrial fibrillation, heart attack, and heart failure. Stroke was the least linked with chest symptoms.
Dyspnea was most strongly associated with future heart failure and heart attack; chest pain was most closely associated with a later heart attack. The presence of both symptoms further increased the risk.
The 2021 Chest Pain Guideline by AHA/ACC has classified the likelihood of ischemia as per chest symptom characteristics. However, there has been no investigation on the associations of several chest symptoms with the long-term risk of different cardiovascular diseases. Kentaro Ejiri, EPIDEMIOLOGY, Johns Hopkins Sch of Public Health, Baltimore, MD, and colleagues sought to quantify the associations of chest pain and dyspnea with incident significant CVD.
The study involved 13,200 participants of the ARIC study who did not have prior CVD at visit 1 (1987-89). Chest pain in these patients was categorized into possible angina, definite angina, no chest pain, and non-anginal chest pain based on the WHO Rose questionnaire; dyspnea was classified into grades 0, 1, 2, and 3-4 based on a scale by the Medical Research Council.
CVD outcomes included heart failure (HF), ischemic stroke, atrial fibrillation (AF), and myocardial infarction (MI), with a follow-up of 26-28 years. The authors estimated a 30-year cumulative incidence accounting for competing death risks.
The study led to the following findings:
- Definite angina and possible angina were robustly associated with incident MI, with adjusted HR 1.83 and 1.64, respectively.
- These two chest pain types were also related to HF, AF, and ischemic stroke, although possible angina did not reach statistical significance for stroke. Even non-anginal chest pain was associated with MI, HF, and AF.
- Dyspnea showed a graded association with all CVD outcomes, particularly with MI and HF. For example, grades 3-4 and 2 showed HR of 2.13 and 1.41 for MI.
- When chest pain and dyspnea were modelled simultaneously, their associations were independent.
"In people not having prior cardiovascular disease, dyspnea and chest pain is independently associated with different CVD events over 30 years," the authors wrote. "The results indicate prognostic implications of chest pain other than coronary disease and stress the importance of dyspnea recognition for CVD risk management."
Reference:
Abstract 11021: Chest Symptoms and Subsequent Risk of Incident Cardiovascular Disease: The Atherosclerosis Risk in Communities (ARIC) Study.
