Electrocardiogram Risk Score and Prevalence of Subclinical Atherosclerosis: A Cross-Sectional Study

Integrated abnormal electrocardiogram (ECG) parameters predict the risk of cardiovascular disease (CVD); however, its relationship with subclinical CVD is unknown. We aimed to evaluate the association between the integrated ECG risk score and the prevalence of coronary artery calcium (CAC). A cross-sectional study comprised 134,802 participants with no known CVD who underwent ECG and CAC computed tomography. The ECG risk score was the sum of five ECG abnormalities: heart rate of >80 beats, QRS of >110 ms, left ventricular hypertrophy, T-wave inversion, and prolonged QTc. A multinomial regression model was used to estimate the prevalence ratios (PRs) and their 95% confidence intervals (CIs) for prevalent CAC. The prevalence of CAC progressively increased as the ECG risk score increased. After adjustment for conventional CVD risk factors and other confounders, the multivariable-adjusted PRs (95% CI) for a CAC of 1-100 in the 1, 2, and >= 3 ECG risk score groups were 1.06 (1.02-1.10), 1.12 (1.03-1.22), and 1.19 (1.00-1.42), respectively, while the corresponding PRs for a CAC of >100 were 1.03 (0.95-1.12), 1.44 (1.25-1.66), and 1.75 (1.33-2.29), respectively. Integrative ECG scoring may help identify individuals requiring lipid-lowering medications, even in young and asymptomatic populations.

Automated summary

The integrated abnormal electrocardiogram (ECG) risk score is associated with the prevalence of coronary artery calcium (CAC), indicating its potential as an early predictor of subclinical cardiovascular disease (CVD). This finding suggests that the integrated ECG scoring can be used to identify individuals requiring lipid-lowering medications, even in young and asymptomatic populations.