title: Prognostic Importance of Dyspnea for Cardiovascular Outcomes and Mortality in Persons without Prevalent Cardiopulmonary Disease: The Atherosclerosis Risk in Communities Study.
abstract: BACKGROUND
  The relationship between dyspnea and incident heart failure (HF) and myocardial infarction (MI) among patients without previously diagnosed cardiopulmonary disease is unclear. We studied the prognostic relevance of self-reported dyspnea for cardiovascular outcomes and all-cause mortality in persons without previously diagnosed cardiopulmonary disease.
  
  
  RESULTS
  We studied 10 881 community-dwelling participants (mean age 57±6, 56% women, 25% black) who were free of prevalent cardiopulmonary disease from Atherosclerosis Risk in Communities Study. Dyspnea status at study entry using the modified Medical Research Council (mMRC) scale. The primary outcomes were time to HF, MI or all-cause death. Dyspnea prevalence was 22%, and was mild (mMRC grade 1 or 2) in 21% and moderate-to-severe (mMRC 3 or 4) in 1%. The main correlates of dyspnea were older age, female sex, higher BMI and active smoking. Over a follow-up of 19±5 years, greater self-reported dyspnea severity was associated with worse prognosis. Mild dyspnea was associated with significantly heightened risk of HF (adjusted Hazard Ratio, HR,1.30; 95% CI: 1.16-1.46), MI (adjusted HR 1.34; 95%CI: 1.20-1.50), and death (adjusted HR 1.16; 95%CI: 1.06-1.26), with moderate/severe dyspnea associated with an even greater risk (adjusted HR 2.14, 95%CI: 1.59-2.89; 1.93, 95%CI: 1.41-2.56; 1.96, 95%CI: 1.55-2.48, respectively).
  
  
  CONCLUSIONS
  In community-dwelling persons free of previously diagnosed cardiopulmonary disease, self-reported dyspnea is common and, even when of mild intensity, it is independently associated with a greater risk of incident HF, MI, and death. Our data emphasize the prognostic importance of even mild self-reported dyspnea for cardiovascular outcomes.
authors: Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, United States of America.|Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Porto, Portugal.
authors: Mario
authors: M
authors: Santos
authors: Wake Forest Baptist Medical Center, Winston Salem, NC, United States of America.
authors: Dalane W
authors: DW
authors: Kitzman
authors: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
authors: Kunihiro
authors: K
authors: Matsushita
authors: University of North Carolina, Chapel Hill, NC, United States of America.
authors: Laura
authors: L
authors: Loehr
authors: University of North Carolina, Chapel Hill, NC, United States of America.
authors: Carla A
authors: CA
authors: Sueta
authors: Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, United States of America.
authors: Amil M
authors: AM
authors: Shah
mesh_terms: D004417:Dyspnea / Q000453:epidemiology*; D005260:Female; D006333:Heart Failure / Q000401:mortality*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality*; D011379:Prognosis; D011660:Pulmonary Heart Disease / Q000453:epidemiology