Background: Increased detection of heart disease in women has been advocated nationally in recent years. The atherosclerotic cardiovascular disease (ASCVD) risk score was validated as determinant of the 10-year risk for first occurrence of nonfatal myocardial infarction, coronary heart disease death, or fatal or nonfatal stroke in 2013. While measurement of blood pressure, glucose, and lipid levels are common in screening, the utility of non-traditional methods such as electrocardiogram (ECG) and transthoracic echocardiography (TTE) remains unknown. We examined the association of ECG and TTE abnormalities with ASCVD risk score among asymptomatic women from a community-based event.
Methods: Data were gathered from 355 women (mean age 53±13 years, 24.2% African American, 59.7% Caucasian, 6.2% Hispanic, 9.9% Others) from a voluntary cardiovascular community screening event sponsored by the 2BigHearts Foundation and Rush University Medical Center in February 2007 and May 2008. Demographics, lipid panel, blood pressure, self- reported medication lists, co-morbidities, screening TTE, and ECG were obtained. The 10-year ASCVD risk score was ascertained for the cohort (283 persons, 79.7%). Chi-square testing was used to determine association of ECG and/or TTE abnormalities with ASCVD risk score.
Results: The average ASCVD risk score for the entire cohort was 5.49%, with a range from 0.1-49.2. The mean ASCVD risk score was elevated in patients with either ECG or TTE abnormalities compared to those with normal findings (ECG: 7.59±9.46 vs. 4.62±5.39, p<0.0014; TTE: 8.19±10.12 vs. 4.81±5.73, p<0.037). The presence of both ECG and TTE abnormalities was associated with a higher mean ASCVD risk score compared to having either ECG or TTE abnormalities alone (ECG+TTE: 13.07±14.32 vs. ECG: 5.7±6.19 vs. TTE: 5.27±4.65, p<0.006).
Conclusion: Detection of ECG and/or TTE abnormalities are associated with elevated ASCVD risk scores in this cohort of asymptomatic women and could potentially identify patients at higher risk for cardiovascular events, and facilitate aggressive risk factor modification. Further studies are needed to confirm ECG and TTE as viable additional screening tools to traditional risk screening.