Electrocardiographic abnormalities among Mexican Americans: Correlations with diabetes, obesity, and the metabolic syndrome
Author(s)
Saulette R. Queen,
Beverly Smulevitz,
Anne R. Rentfro,
Kristina P. Vatcheva,
David D. McPherson,
Susan P. Fisher-Hoch,
Joseph B. McCormick,
Susan T. Laing*
Affiliation(s)
Division of Cardiology, Department of Internal Medicine, University of Texas Health Science Center-Houston, Houston, USA. College of Nursing, University of Texas at Brownsville, Brownsville, USA. Division of Epidemiology, Human Genetics and Environmental Health, University of Texas School of Public Health, Brownsville Campus, Brownsville, USA.
Division of Cardiology, Department of Internal Medicine, University of Texas Health Science Center-Houston, Houston, USA. College of Nursing, University of Texas at Brownsville, Brownsville, USA. Division of Epidemiology, Human Genetics and Environmental Health, University of Texas School of Public Health, Brownsville Campus, Brownsville, USA.
ABSTRACT
INTRODUCTION: Resting ischemic electrocardiographic abnormalities have been associated with cardio-vascular mortality. Simple markers of abnormal autonomic tone have also been associated with diabetes, obesity, and the metabolic syndrome in some populations. Data on these electrocardiographic abnormalities and correlations with coronary risk factors are lacking among Mexican Americans wherein these conditions are prevalent. This study aimed to evaluate the prevalent resting electrocardiographic abnormalities among community-dwelling Mexican Americans, and to correlate these findings with coronary risk factors, particularly diabetes, obesity, and the metabolic syndrome. METHODS: Study subjects (n = 1280) were drawn from the Cameron County Hispanic Cohort comprised of community-dwelling Mexican Americans living in Brownsville, Texas at the United States-Mexico border. Ischemic electro-cardiographic abnormalities were defined as presence of ST/T wave abnormalities suggestive of ischemia, abnormal Q waves, and left bundle branch block. Parameters that reflect autonomic tone, such as heart rate-corrected QT interval and resting heart rate, were also measured. RESULTS: Ischemic electrocar-diographic abnormalities were more prevalent among older persons and those with hypertension, diabetes, obesity, and the metabolic syndrome. Subjects in the highest quartiles of QTc interval and resting heart rate were also more likely to have diabetes, hypertension, obesity, or the metabolic syndrome. CONCLU- SIONS: Among Mexican Americans, persons with diabetes, obesity, and the metabolic syndrome were more likely to have ischemic electrocardiographic abnormalities, longer QTc intervals, and higher resting heart rates. A resting electrocardiogram can play a complementary role in the comprehensive evaluation of cardiovascular risk in this minority population.
INTRODUCTION: Resting ischemic electrocardiographic abnormalities have been associated with cardio-vascular mortality. Simple markers of abnormal autonomic tone have also been associated with diabetes, obesity, and the metabolic syndrome in some populations. Data on these electrocardiographic abnormalities and correlations with coronary risk factors are lacking among Mexican Americans wherein these conditions are prevalent. This study aimed to evaluate the prevalent resting electrocardiographic abnormalities among community-dwelling Mexican Americans, and to correlate these findings with coronary risk factors, particularly diabetes, obesity, and the metabolic syndrome. METHODS: Study subjects (n = 1280) were drawn from the Cameron County Hispanic Cohort comprised of community-dwelling Mexican Americans living in Brownsville, Texas at the United States-Mexico border. Ischemic electro-cardiographic abnormalities were defined as presence of ST/T wave abnormalities suggestive of ischemia, abnormal Q waves, and left bundle branch block. Parameters that reflect autonomic tone, such as heart rate-corrected QT interval and resting heart rate, were also measured. RESULTS: Ischemic electrocar-diographic abnormalities were more prevalent among older persons and those with hypertension, diabetes, obesity, and the metabolic syndrome. Subjects in the highest quartiles of QTc interval and resting heart rate were also more likely to have diabetes, hypertension, obesity, or the metabolic syndrome. CONCLU- SIONS: Among Mexican Americans, persons with diabetes, obesity, and the metabolic syndrome were more likely to have ischemic electrocardiographic abnormalities, longer QTc intervals, and higher resting heart rates. A resting electrocardiogram can play a complementary role in the comprehensive evaluation of cardiovascular risk in this minority population.
Cite this paper
Queen, S. , Smulevitz, B. , Rentfro, A. , Vatcheva, K. , McPherson, D. , Fisher-Hoch, S. , McCormick, J. and Laing, S. (2012) Electrocardiographic abnormalities among Mexican Americans: Correlations with diabetes, obesity, and the metabolic syndrome. World Journal of Cardiovascular Diseases, 2, 50-56. doi: 10.4236/wjcd.2012.22009.
Queen, S. , Smulevitz, B. , Rentfro, A. , Vatcheva, K. , McPherson, D. , Fisher-Hoch, S. , McCormick, J. and Laing, S. (2012) Electrocardiographic abnormalities among Mexican Americans: Correlations with diabetes, obesity, and the metabolic syndrome. World Journal of Cardiovascular Diseases, 2, 50-56. doi: 10.4236/wjcd.2012.22009.
References
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[9] Pearson, T.A., Mensah, G.A., Alexander, W., Anderson, J.L., Cannon, R.O., Criqui, M., et al. (2003) Markers of inflammation and cardiovascular disease: Application to clinical and public health practice: A statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation, 107, 499-511. doi:10.1161/01.CIR.0000052939.59093.45 [10] Executive Summary (2010) Standards of medical care in diabetes—2010. Diabetes Care, 33, S4-S10. doi:10.2337/dc10-S004 [11] Prineas, R., Crow, R. and Black-burn, H. (1982) The Min-nesota code manual of electrocardio-graphic findings. John Wright-PSG Inc., Little-ton. [12] Sokolow, M. and Lyon, T.O. (1949) The ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial and link leads. American Heart Journal, 37, 161-186. doi:10.1016/0002-8703(49)90562-1 [13] Casale, P.N., Devereux, R.B., Alonso, D.R., Campo, E. and Kligfield, P. (1987) Improved sex-specific criteria of left ventricular hypertrophy for clinical and computer interpretation of elec-trocardiograms: Validation with au- topsy findings. Circulation, 75, 565-572. doi:10.1161/01.CIR.75.3.565 [14] Mitchell, B.D., Hazuda, H.P., Haffner, S.M., Patterson, J.K. and Stern, M.P. (1991) Myocardial infarction in Mexican-Americans and non-hispanic whites: The San Antonio heart study. Circulation, 83, 45-51. [15] Perez, M.V., Yaw, T.S., Myers, J. and Froelicher, V.F. (2007) Prognostic value of the computerized ECG in His-panics. Clinical Cardiology, 30, 189-194. doi:10.1002/clc.20053 [16] Nabipour, I., Amiri, M., Imami, S.R., Jahfari, S.M., Shafeiae, E., Nosrati, A., et al. (2007) The metabolic syn- drome and nonfatal ischemic heart disease: A population based study. International Journal of Cardiology, 118, 48-53. doi:10.1016/j.ijcard.2006.06.017 [17] De Bacquer, D., De Backer, G. and Kornitzer, M. (2000) Prevalences of ECG findings in large population based samples of men and women. Heart, 84, 625-633. doi:10.1136/heart.84.6.625 [18] Kim, H.K., Kim, C.H., Ko, K.H., Park, S.W., Park, J.Y. and Lee, K.U. (2010) Variable association between components of the metabolic syndrome and electrocardiographic abnormalities in Korean adults. Korean Journal of Internal Medicine, 25, 174-180. doi:10.3904/kjim.2010.25.2.174 [19] Peng, S., Yu, Y., Hao, K., Xing, H., Li, D., Chen, C., et al. (2006) Heart rate-corrected QT interval duration is significantly associated with blood pressure in Chinese hy- pertensives. Journal of Electrocardiology, 39, 206-210. doi:10.1016/j.jelectrocard.2005.08.007 [20] Fraley, M.A., Birchem, J.A., Senkottaiyan, N. and Alpert, M.A. (2005) Obesity and the electrocardiogram. Obesity Reviews, 6, 275-281. doi:10.1111/j.1467-789X.2005.00199.x [21] Grassi, G., Are-nare, F., Quarti-Trevano, F., Seravalle, G. and Mancia, G. (2009) Heart rate, sympathetic cardiovas-cular influences, and the metabolic syndrome. Progress in Cardiovascular Diseases, 52, 31-37. doi:10.1016/j.pcad.2009.05.007 [22] Maser, R.E., Mitchell, B.D., Vink, A.I. and Freeman, R. (2003) The association between cardiovascular autonomic neuropathy and mortality in individuals with diabetes. Diabetes Care, 26, 1895-1901. doi:10.2337/diacare.26.6.1895 [23] Wei, M., Mitchell, B.D., Haffner, S.M. and Stern, M.P. (1996) Effects of cigarette smoking, diabetes, high cholesterol, and hypertension on all-cause mortality and cardiovascular disease mortality in Mexican Americans. American Journal of Epidemiology, 144, 1058-1065. [24] Ridker, P.M., Buring, J.E., Cook, N.R. and Rifai, N. (2003) C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events: An 8-year follow- up of 14,719 initially healthy American women. Circula- tion, 107, 391-397. doi:10.1161/01.CIR.0000055014.62083.05 [25] Flegal, K.M., Carroll, M.D., Ogden, C.L. and Curtin, L.R. (2010) Prevalence and trends in obesity among US adults, 1999-2008. Journal of the American Medical Association, 303, 235-241. doi:10.1001/jama.2009.2014
[1] De Bacquer, D., De Backer, G., Kornitzer, M. and Black-burn, H. (1998) Prognostic value of ECG findings for total, cardi-ovascular disease, and coronary heart disease death in men and women. Heart, 80, 570-577. [2] Schouten, E.G., Dekker, J.M., Meppelink, P., Kok, F.J., Vandenbroucke, J.P. and Pool, J. (1991) QT interval pro-longation predicts cardiovascular mortality in an apparently healthy population. Circulation, 84, 1516-1523. [3] Cooney, M.T., Vartiainen, E., Laakitainen, T., Juolevi, A., Dudina, A. and Graham, I.M. (2010) Elevated resting heart rate is an independent risk factor for cardiovascular disease in healthy men and women. American Heart Journal, 159, 612-619. doi:10.1016/j.ahj.2009.12.029 [4] Rana, J.S., Hardison, R.M., Pop-Busui, R., Brooks, M.M., Jones, T.L., Nesto, R.W., et al. (2010) Resting heart rate and metabolic syndrome in patients with diabetes and coronary artery disease in bypass angioplasty revascu- larization investigation 2 diabetes (BARI 2D) Trial. Preventive Cardiology, 13, 112-116. doi:10.1111/j.1751-7141.2010.00067.x [5] Faramawi, M.F., Wildman, R.P., Gustat, J., Rice, J. and Abdul Kareem M.Y. (2008) The association of the metabolic syndrome with QTc interval in NHANES III. European Journal of Epidemiology, 23, 459-465. doi:10.1007/s10654-008-9252-4 [6] Meigs, J.B., Wilson, P.W.F., Nathan, D.M., D’Agostino, R.B., Williams, K. and Haffner, S.M. (2003) Prevalence and characteristics of the metabolic syndrome in the San Antonio Heart and Framingham Offspring Studies. Diabetes, 52, 2160-2167. [7] Bernstein, R. (2008) US Hispanic population surpassed 45 million: Now 15 percent of total US. http://www.census.gov/newsroom/releases/archives/population/cb08-67.html [8] Fisher-Hoch, S.P., Rentfro, A.R., Salinas, J.J., Perez, A., Brown, H.S., Reininger, B.M., et al. (2010) Socioeco-nomic status and prevalence of obesity and diabetes in a Mexican American community, Cameron County, Texas, 2004-2007. Preventing Chronic Disease, 7, 1-10. [9] Pearson, T.A., Mensah, G.A., Alexander, W., Anderson, J.L., Cannon, R.O., Criqui, M., et al. (2003) Markers of inflammation and cardiovascular disease: Application to clinical and public health practice: A statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation, 107, 499-511. doi:10.1161/01.CIR.0000052939.59093.45 [10] Executive Summary (2010) Standards of medical care in diabetes—2010. Diabetes Care, 33, S4-S10. doi:10.2337/dc10-S004 [11] Prineas, R., Crow, R. and Black-burn, H. (1982) The Min-nesota code manual of electrocardio-graphic findings. John Wright-PSG Inc., Little-ton. [12] Sokolow, M. and Lyon, T.O. (1949) The ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial and link leads. American Heart Journal, 37, 161-186. doi:10.1016/0002-8703(49)90562-1 [13] Casale, P.N., Devereux, R.B., Alonso, D.R., Campo, E. and Kligfield, P. (1987) Improved sex-specific criteria of left ventricular hypertrophy for clinical and computer interpretation of elec-trocardiograms: Validation with au- topsy findings. Circulation, 75, 565-572. doi:10.1161/01.CIR.75.3.565 [14] Mitchell, B.D., Hazuda, H.P., Haffner, S.M., Patterson, J.K. and Stern, M.P. (1991) Myocardial infarction in Mexican-Americans and non-hispanic whites: The San Antonio heart study. Circulation, 83, 45-51. [15] Perez, M.V., Yaw, T.S., Myers, J. and Froelicher, V.F. (2007) Prognostic value of the computerized ECG in His-panics. Clinical Cardiology, 30, 189-194. doi:10.1002/clc.20053 [16] Nabipour, I., Amiri, M., Imami, S.R., Jahfari, S.M., Shafeiae, E., Nosrati, A., et al. (2007) The metabolic syn- drome and nonfatal ischemic heart disease: A population based study. International Journal of Cardiology, 118, 48-53. doi:10.1016/j.ijcard.2006.06.017 [17] De Bacquer, D., De Backer, G. and Kornitzer, M. (2000) Prevalences of ECG findings in large population based samples of men and women. Heart, 84, 625-633. doi:10.1136/heart.84.6.625 [18] Kim, H.K., Kim, C.H., Ko, K.H., Park, S.W., Park, J.Y. and Lee, K.U. (2010) Variable association between components of the metabolic syndrome and electrocardiographic abnormalities in Korean adults. Korean Journal of Internal Medicine, 25, 174-180. doi:10.3904/kjim.2010.25.2.174 [19] Peng, S., Yu, Y., Hao, K., Xing, H., Li, D., Chen, C., et al. (2006) Heart rate-corrected QT interval duration is significantly associated with blood pressure in Chinese hy- pertensives. Journal of Electrocardiology, 39, 206-210. doi:10.1016/j.jelectrocard.2005.08.007 [20] Fraley, M.A., Birchem, J.A., Senkottaiyan, N. and Alpert, M.A. (2005) Obesity and the electrocardiogram. Obesity Reviews, 6, 275-281. doi:10.1111/j.1467-789X.2005.00199.x [21] Grassi, G., Are-nare, F., Quarti-Trevano, F., Seravalle, G. and Mancia, G. (2009) Heart rate, sympathetic cardiovas-cular influences, and the metabolic syndrome. Progress in Cardiovascular Diseases, 52, 31-37. doi:10.1016/j.pcad.2009.05.007 [22] Maser, R.E., Mitchell, B.D., Vink, A.I. and Freeman, R. (2003) The association between cardiovascular autonomic neuropathy and mortality in individuals with diabetes. Diabetes Care, 26, 1895-1901. doi:10.2337/diacare.26.6.1895 [23] Wei, M., Mitchell, B.D., Haffner, S.M. and Stern, M.P. (1996) Effects of cigarette smoking, diabetes, high cholesterol, and hypertension on all-cause mortality and cardiovascular disease mortality in Mexican Americans. American Journal of Epidemiology, 144, 1058-1065. [24] Ridker, P.M., Buring, J.E., Cook, N.R. and Rifai, N. (2003) C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events: An 8-year follow- up of 14,719 initially healthy American women. Circula- tion, 107, 391-397. doi:10.1161/01.CIR.0000055014.62083.05 [25] Flegal, K.M., Carroll, M.D., Ogden, C.L. and Curtin, L.R. (2010) Prevalence and trends in obesity among US adults, 1999-2008. Journal of the American Medical Association, 303, 235-241. doi:10.1001/jama.2009.2014