title: Midlife Cardiovascular Risk Factors and Late-Life Unrecognized and Recognized Myocardial Infarction Detect by Cardiac Magnetic Resonance: ICELAND-MI, the AGES-Reykjavik Study.
abstract: BACKGROUND
  Associations of atherosclerosis risk factors with unrecognized myocardial infarction (UMI) are unclear. We investigated associations of midlife risk factors with UMI and recognized MI (RMI) detected 31 years later by cardiac magnetic resonance.
  
  
  RESULTS
  The Reykjavik Study (1967-1991) collected serial risk factors in subjects, mean (SD) age 48 (7) years. In ICELAND-MI (2004-2007), 936 survivors (76 (5) years) were evaluated by cardiac magnetic resonance. Analysis included logistic regression and random effects modeling. Comparisons are relative to subjects without MI. At baseline midlife evaluation, a modified Framingham risk score was significantly higher in RMI and in UMI versus no MI (7.4 (6.3)%; 7.1 (6.2)% versus 5.4 (5.8)%, P<0.001). RMI and UMI were more frequent in men (65%, 64% versus 43%; P<0.0001). Baseline systolic and diastolic blood pressure were significantly higher in UMI (138 (17) mm Hg versus 133 (17) mm Hg; P<0.006; 87 (10) mm Hg versus 84 (10) mm Hg; P<0.02). Diastolic BP was significantly higher in RMI (88 (10) mm Hg versus 84 (10) mm Hg; P<0.02). Cholesterol and triglycerides were significantly higher in RMI (6.7 (1.1) mmol/L versus 6.2 (1.1) mmol/L; P=0.0005; and 1.4 (0.7) mmol/L versus 1.1 (0.7) mmol/L; P<0.003). Cholesterol trended higher in UMI (P=0.08). Serial midlife systolic BP was significantly higher in UMI versus no MI (β [SE] = 2.69 [1.28] mm Hg, P=0.04). Serial systolic and diastolic BP were significantly higher in RMI versus no MI (4.12 [1.60] mm Hg, P=0.01 and 2.05 [0.91] mm Hg, P=0.03) as were cholesterol (0.43 [0.11] mmol/L, P=0.0001) and triglycerides (0.3 [0.06] mmol/L, P<0.0001).
  
  
  CONCLUSIONS
  Midlife vascular risk factors are associated with UMI and RMI detected by cardiac magnetic resonance 31 years later. Systolic blood pressure was the most significant modifiable risk factor associated with later UMI.
authors.affiliation: National Institutes of Health (NIH) Clinical Center, Bethesda, MD dmcareavey@cc.nih.gov.
authors.forename: Dorothea
authors.initials: D
authors.lastname: McAreavey
authors.affiliation: AP-HP, Hôpital Broca, Service de Gérontologie I, and Université Paris Descartes, Sorbonne Paris cité, Paris, France.
authors.forename: Jean-Sébastien
authors.initials: JS
authors.lastname: Vidal
authors.affiliation: The Icelandic Heart Association, Kopavogur, Iceland University of Iceland, Reykjavik, Iceland.
authors.forename: Thor
authors.initials: T
authors.lastname: Aspelund
authors.affiliation: The Icelandic Heart Association, Kopavogur, Iceland.
authors.forename: Gudny
authors.initials: G
authors.lastname: Eiriksdottir
authors.affiliation: National Heart Lung and Blood Institute, NIH, Bethesda, MD.
authors.forename: Erik B
authors.initials: EB
authors.lastname: Schelbert
authors.affiliation: The Icelandic Heart Association, Kopavogur, Iceland.
authors.forename: Olafur
authors.initials: O
authors.lastname: Kjartansson
authors.affiliation: National Heart Lung and Blood Institute, NIH, Bethesda, MD.
authors.forename: Jie J
authors.initials: JJ
authors.lastname: Cao
authors.affiliation: The Icelandic Heart Association, Kopavogur, Iceland University of Iceland, Reykjavik, Iceland.
authors.forename: Gudmundur
authors.initials: G
authors.lastname: Thorgeirsson
authors.affiliation: The Icelandic Heart Association, Kopavogur, Iceland.
authors.forename: Sigurdur
authors.initials: S
authors.lastname: Sigurdsson
authors.affiliation: Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Aging, NIH, Bethesda, MD.
authors.forename: Melissa
authors.initials: M
authors.lastname: Garcia
authors.affiliation: Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Aging, NIH, Bethesda, MD.
authors.forename: Tamara B
authors.initials: TB
authors.lastname: Harris
authors.affiliation: Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Aging, NIH, Bethesda, MD.
authors.forename: Lenore J
authors.initials: LJ
authors.lastname: Launer
authors.affiliation: The Icelandic Heart Association, Kopavogur, Iceland University of Iceland, Reykjavik, Iceland.
authors.forename: Vilmundur
authors.initials: V
authors.lastname: Gudnason
authors.affiliation: National Heart Lung and Blood Institute, NIH, Bethesda, MD.
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Arai
mesh_terms: D000328:Adult; D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D002784:Cholesterol / Q000097:blood; D005260:Female; D006801:Humans; D007055:Iceland / Q000453:epidemiology; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014280:Triglycerides / Q000097:blood
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D014280:Triglycerides; D002784:Cholesterol
keywords: epidemiology; hypertension; magnetic resonance imaging; myocardial infarction; risk factors