title: Low-grade systolic murmurs in healthy middle-aged individuals: innocent or clinically significant? A 35-year follow-up study of 2014 Norwegian men.
abstract: OBJECTIVE
  To determine whether a low-grade systolic murmur, found at heart auscultation, in middle-aged healthy men influences the long-term risk of aortic valve replacement (AVR) and death from cardiovascular disease (CVD). Setting and subjects.  During 1972-1975, 2014 apparently healthy men aged 40-59 years underwent an examination programme including case history, clinical examination, blood tests and a symptom-limited exercise ECG test. Heart auscultation was performed under standardized conditions, and murmurs were graded on a scale from I to VI. No men were found to have grade V/VI murmurs. Participants were followed for up to 35 years.
  
  
  RESULTS
  A total of 1541 men had no systolic murmur; 441 had low-grade murmurs (grade I/II) and 32 had moderate-grade murmurs (grade III/IV). Men with low-grade murmurs had a 4.7-fold [95% confidence interval (CI) 2.1-11.1] increased age-adjusted risk of AVR, but no increase in risk of CVD death. Men with moderate-grade murmurs had an 89.3-fold (95% CI 39.2-211.2) age-adjusted risk of AVR and a 1.5-fold (95% CI 0.8-2.5) age-adjusted increased risk of CVD death.
  
  
  CONCLUSIONS
  Low-grade systolic murmur was detected at heart auscultation in 21.9% of apparently healthy middle-aged men. Men with low-grade murmur had an increased risk of AVR, but no increase in risk of CVD death. Only 1.6% of men had moderate-grade murmur; these men had a very high risk of AVR and a 1.5-fold albeit non-significant increase in risk of CVD death.
authors: Department of Cardiology, Oslo University Hospital, Ullevaal Faculty of Medicine, University of Oslo, Oslo, Norway. johan.bodegard@gmail.com
authors: J
authors: J
authors: Bodegard
authors: P T
authors: PT
authors: Skretteberg
authors: K
authors: K
authors: Gjesdal
authors: K
authors: K
authors: Pyörälä
authors: S E
authors: SE
authors: Kjeldsen
authors: K
authors: K
authors: Liestøl
authors: G
authors: G
authors: Erikssen
authors: J
authors: J
authors: Erikssen
mesh_terms: D000328:Adult; D001024:Aortic Valve Stenosis / Q000175:diagnosis; D015331:Cohort Studies; D005500:Follow-Up Studies; D006326:Heart Auscultation / Q000379:methods; D006331:Heart Diseases / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D006337:Heart Murmurs / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D019918:Heart Valve Prosthesis Implantation / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D016017:Odds Ratio; D010808:Physical Examination; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors