Prognostic importance of dyspnea for cardiovascular outcomes and mortality in persons without prevalent cardiopulmonary disease: The atherosclerosis risk in communities study

Mario Santos, Dalane W. Kitzman, Kunihiro Matsushita, Laura Loehr, Carla A. Sueta, Amil M. Shah

Research output: Contribution to journalArticle

Abstract

Background The relationship between dyspnea and incident heart failure (HF) and myocardial infarction (MI) among patients without previously diagnosed cardiopulmonary disease is unclear. We studied the prognostic relevance of self-reported dyspnea for cardiovascular outcomes and all-cause mortality in persons without previously diagnosed cardiopulmonary disease. Methods and Results We studied 10 881 community-dwelling participants (mean age 57-6, 56% women, 25% black) who were free of prevalent cardiopulmonary disease from Atherosclerosis Risk in Communities Study. Dyspnea status at study entry using the modified Medical Research Council (mMRC) scale. The primary outcomes were time to HF, MI or all-cause death. Dyspnea prevalence was 22%, and was mild (mMRC grade 1 or 2) in 21% and moderate-tosevere (mMRC 3 or 4) in 1%. The main correlates of dyspnea were older age, female sex, higher BMI and active smoking. Over a follow-up of 19-5 years, greater self-reported dyspnea severity was associated with worse prognosis. Mild dyspnea was associated with significantly heightened risk of HF (adjusted Hazard Ratio, HR,1.30; 95% CI: 1.16-1.46), MI (adjusted HR 1.34; 95%CI: 1.20-1.50), and death (adjusted HR 1.16; 95%CI: 1.06-1.26), with moderate/severe dyspnea associated with an even greater risk (adjusted HR 2.14, 95%CI: 1.59-2.89; 1.93, 95%CI: 1.41-2.56; 1.96, 95%CI: 1.55-2.48, respectively). Conclusion In community-dwelling persons free of previously diagnosed cardiopulmonary disease, self-reported dyspnea is common and, even when of mild intensity, it is independently associated with a greater risk of incident HF, MI, and death. Our data emphasize the prognostic importance of even mild self-reported dyspnea for cardiovascular outcomes.

Original languageEnglish (US)
Article number0165111
JournalPLoS One
Volume11
Issue number10
DOIs
StatePublished - Oct 1 2016

Fingerprint

dyspnea
atherosclerosis
Dyspnea
Atherosclerosis
Mortality
myocardial infarction
heart failure
biomedical research
Heart Failure
Myocardial Infarction
Independent Living
Biomedical Research
Hazards
death
prognosis
Cause of Death
Smoking
gender

ASJC Scopus subject areas

  • Medicine(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Prognostic importance of dyspnea for cardiovascular outcomes and mortality in persons without prevalent cardiopulmonary disease : The atherosclerosis risk in communities study. / Santos, Mario; Kitzman, Dalane W.; Matsushita, Kunihiro; Loehr, Laura; Sueta, Carla A.; Shah, Amil M.

In: PLoS One, Vol. 11, No. 10, 0165111, 01.10.2016.

Research output: Contribution to journalArticle

@article{8e5b829f10bf4fba847e229a60fe8fff,
title = "Prognostic importance of dyspnea for cardiovascular outcomes and mortality in persons without prevalent cardiopulmonary disease: The atherosclerosis risk in communities study",
abstract = "Background The relationship between dyspnea and incident heart failure (HF) and myocardial infarction (MI) among patients without previously diagnosed cardiopulmonary disease is unclear. We studied the prognostic relevance of self-reported dyspnea for cardiovascular outcomes and all-cause mortality in persons without previously diagnosed cardiopulmonary disease. Methods and Results We studied 10 881 community-dwelling participants (mean age 57-6, 56{\%} women, 25{\%} black) who were free of prevalent cardiopulmonary disease from Atherosclerosis Risk in Communities Study. Dyspnea status at study entry using the modified Medical Research Council (mMRC) scale. The primary outcomes were time to HF, MI or all-cause death. Dyspnea prevalence was 22{\%}, and was mild (mMRC grade 1 or 2) in 21{\%} and moderate-tosevere (mMRC 3 or 4) in 1{\%}. The main correlates of dyspnea were older age, female sex, higher BMI and active smoking. Over a follow-up of 19-5 years, greater self-reported dyspnea severity was associated with worse prognosis. Mild dyspnea was associated with significantly heightened risk of HF (adjusted Hazard Ratio, HR,1.30; 95{\%} CI: 1.16-1.46), MI (adjusted HR 1.34; 95{\%}CI: 1.20-1.50), and death (adjusted HR 1.16; 95{\%}CI: 1.06-1.26), with moderate/severe dyspnea associated with an even greater risk (adjusted HR 2.14, 95{\%}CI: 1.59-2.89; 1.93, 95{\%}CI: 1.41-2.56; 1.96, 95{\%}CI: 1.55-2.48, respectively). Conclusion In community-dwelling persons free of previously diagnosed cardiopulmonary disease, self-reported dyspnea is common and, even when of mild intensity, it is independently associated with a greater risk of incident HF, MI, and death. Our data emphasize the prognostic importance of even mild self-reported dyspnea for cardiovascular outcomes.",
author = "Mario Santos and Kitzman, {Dalane W.} and Kunihiro Matsushita and Laura Loehr and Sueta, {Carla A.} and Shah, {Amil M.}",
year = "2016",
month = "10",
day = "1",
doi = "10.1371/journal.pone.0165111",
language = "English (US)",
volume = "11",
journal = "PLoS One",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "10",

}

TY - JOUR

T1 - Prognostic importance of dyspnea for cardiovascular outcomes and mortality in persons without prevalent cardiopulmonary disease

T2 - The atherosclerosis risk in communities study

AU - Santos, Mario

AU - Kitzman, Dalane W.

AU - Matsushita, Kunihiro

AU - Loehr, Laura

AU - Sueta, Carla A.

AU - Shah, Amil M.

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Background The relationship between dyspnea and incident heart failure (HF) and myocardial infarction (MI) among patients without previously diagnosed cardiopulmonary disease is unclear. We studied the prognostic relevance of self-reported dyspnea for cardiovascular outcomes and all-cause mortality in persons without previously diagnosed cardiopulmonary disease. Methods and Results We studied 10 881 community-dwelling participants (mean age 57-6, 56% women, 25% black) who were free of prevalent cardiopulmonary disease from Atherosclerosis Risk in Communities Study. Dyspnea status at study entry using the modified Medical Research Council (mMRC) scale. The primary outcomes were time to HF, MI or all-cause death. Dyspnea prevalence was 22%, and was mild (mMRC grade 1 or 2) in 21% and moderate-tosevere (mMRC 3 or 4) in 1%. The main correlates of dyspnea were older age, female sex, higher BMI and active smoking. Over a follow-up of 19-5 years, greater self-reported dyspnea severity was associated with worse prognosis. Mild dyspnea was associated with significantly heightened risk of HF (adjusted Hazard Ratio, HR,1.30; 95% CI: 1.16-1.46), MI (adjusted HR 1.34; 95%CI: 1.20-1.50), and death (adjusted HR 1.16; 95%CI: 1.06-1.26), with moderate/severe dyspnea associated with an even greater risk (adjusted HR 2.14, 95%CI: 1.59-2.89; 1.93, 95%CI: 1.41-2.56; 1.96, 95%CI: 1.55-2.48, respectively). Conclusion In community-dwelling persons free of previously diagnosed cardiopulmonary disease, self-reported dyspnea is common and, even when of mild intensity, it is independently associated with a greater risk of incident HF, MI, and death. Our data emphasize the prognostic importance of even mild self-reported dyspnea for cardiovascular outcomes.

AB - Background The relationship between dyspnea and incident heart failure (HF) and myocardial infarction (MI) among patients without previously diagnosed cardiopulmonary disease is unclear. We studied the prognostic relevance of self-reported dyspnea for cardiovascular outcomes and all-cause mortality in persons without previously diagnosed cardiopulmonary disease. Methods and Results We studied 10 881 community-dwelling participants (mean age 57-6, 56% women, 25% black) who were free of prevalent cardiopulmonary disease from Atherosclerosis Risk in Communities Study. Dyspnea status at study entry using the modified Medical Research Council (mMRC) scale. The primary outcomes were time to HF, MI or all-cause death. Dyspnea prevalence was 22%, and was mild (mMRC grade 1 or 2) in 21% and moderate-tosevere (mMRC 3 or 4) in 1%. The main correlates of dyspnea were older age, female sex, higher BMI and active smoking. Over a follow-up of 19-5 years, greater self-reported dyspnea severity was associated with worse prognosis. Mild dyspnea was associated with significantly heightened risk of HF (adjusted Hazard Ratio, HR,1.30; 95% CI: 1.16-1.46), MI (adjusted HR 1.34; 95%CI: 1.20-1.50), and death (adjusted HR 1.16; 95%CI: 1.06-1.26), with moderate/severe dyspnea associated with an even greater risk (adjusted HR 2.14, 95%CI: 1.59-2.89; 1.93, 95%CI: 1.41-2.56; 1.96, 95%CI: 1.55-2.48, respectively). Conclusion In community-dwelling persons free of previously diagnosed cardiopulmonary disease, self-reported dyspnea is common and, even when of mild intensity, it is independently associated with a greater risk of incident HF, MI, and death. Our data emphasize the prognostic importance of even mild self-reported dyspnea for cardiovascular outcomes.

UR - http://www.scopus.com/inward/record.url?scp=84992426995&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84992426995&partnerID=8YFLogxK

U2 - 10.1371/journal.pone.0165111

DO - 10.1371/journal.pone.0165111

M3 - Article

C2 - 27780208

AN - SCOPUS:84992426995

VL - 11

JO - PLoS One

JF - PLoS One

SN - 1932-6203

IS - 10

M1 - 0165111

ER -