Prevalence of and association between silent myocardial ischemia and new coronary events in older men and women with and without cardiovascular disease

OBJECTIVES: To investigate the prevalence of silent ischemia (SI) in older men and women detected by 24-hour ambulatory electrocardiograms (AECGs) and the association between SI and new coronary events. DESIGN: In a prospective study, the prevalence of SI detected by 24-hour AECGs and the incidence of new coronary events in 915 older men and 1,874 older women with coronary artery disease (CAD); with hypertension, valvular disease, or cardiomyopathy without CAD; and with no cardiovascular disease were investigated. SETTING: Large long-term healthcare facility. PARTICIPANTS: Nine hundred fifteen men, mean age 80, and 1,874 women, mean age 81. MEASUREMENTS: The prevalence of SI and the incidence of new coronary events in older men and women. RESULTS: SI was present in 34% of men and 33% of women with CAD; 15% of men and 14% of women with hypertension, valvular disease, or cardiomyopathy without CAD; and 6% of men and 5% of women with no cardiovascular disease. At 45-month follow-up in men and 47-month follow-up in women, SI significantly increased the incidence of new coronary events by 2.0 times in men and women with CAD (P < .001); by 1.8 times in men and 1.7 times in women with hypertension, valvular disease, or cardiomyopathy without CAD (P < .001); and by 6.3 times in men (P = .018) and 4.4 times in women (P = .008) with no cardiovascular disease. CONCLUSIONS: SI increases the incidence of new coronary events in older men and women with CAD, with hypertension, valvular disease, or cardiomyopathy without CAD, and with no cardiovascular disease.