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Abstract
Background
Silent myocardial infarction (SMI) accounts for more than half of all MIs, and common risk factors and pathophysiological pathways coexist between SMI and frailty. The risk of frailty among patients with SMI is not well established. This study aimed to examine the association between SMI and frailty.
Methods and Results
This analysis included data from the Atherosclerosis Risk in Communities study. Patients without MI at baseline were eligible for inclusion. SMI was defined as electrocardiographic evidence of MI without clinical MI (CMI) after the baseline and until the fourth visit. Frailty was assessed during the fifth visit. A total of 4953 participants were included with an average age of 52.2±5.1 years. Among these participants, 2.7% (n=135) developed SMI, and 2.9% (n=146) developed CMI. After a median follow-up time of 14.7 (14.0–15.3) years, 6.7% (n=336) of the participants developed frailty. Patients with SMI and CMI were significantly more likely to become frail than those without MI (15.6% vs 6.2%, P<0.001 and 16.4% vs 6.2%, P<0.001, respectively). After adjusting for confounders, SMI and CMI were found to be independent predictors of frailty (odds ratio [OR]=2.243, 95% confidence interval [CI]=1.307–3.850, P=0.003 and OR=2.164, 95% CI=1.259–3.721, P=0.005, respectively). The association was consistent among the subgroups of age, sex, race, diabetes, and hypertension.
Conclusion
In conclusion, both SMI and CMI were found to be associated with a higher risk of frailty. Future studies are needed to confirm the beneficial effects of screening for SMI as well as to implement standardized preventive treatment to reduce the risk of frailty.
Clinical Trial Registration
URL: https://www.clinicaltrials.gov; Unique identifier: NCT0005131.
Acknowledgments
The authors thank the staff and participants of the ARIC study, and BioLINCC for their important contributions.
Abbreviations
ARIC, Atherosclerosis Risk in Communities; BMI, body mass index; CAD, coronary artery disease; CHD, coronary heart disease; CI, confidence interval; CMI, clinical myocardial infarction; COPD, chronic obstructive pulmonary disease; CVD, cardiovascular disease; DBP, diastolic blood pressure; ECG, electrocardiogram; HF, heart failure; HDL, high density lipoprotein; LDL, Low density lipoprotein; LVEF, left ventricular ejection fraction; MI, myocardial infarction; OR, odds ratio; SMI, Silent myocardial infarction; SCD, sudden cardiac death; SBP, systolic blood pressure.
Ethics Approval and Informed Consent
The study was conducted in agreement with the Declaration of Helsinki and was approved by the Institutional Review Committee.
Author Contributions
All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.
Disclosure
The authors declare that there is no conflict of interest.