Occurrence and Prognosis of Ventricular Arrhythmia in Men With and Without Asymptomatic Leg Artery Disease: Results from a Prospective Population Study “Men Born in 1914,” Malmö, Sweden

Abstract

Background:The occurrence of frequent or complex ventricular arrhythmia in apparently healthy men during ambulatory ECG recording has been shown to be associated with an increased incidence and mortality in ischemic heart disease. Similar risk has been documented for individuals with asymptomatic leg artery disease. The objective of this follow‐up of 450 men from the prospective cohort study “Men born in 1914” in Malmö, Sweden has been to assess whether there is any relationship between the occurrence of ventricular arrhythmia and asymptomatic leg artery disease and whether the prognosis with regard to survival and incidence of myocardial infarction is different in men with and without asymptomatic leg artery disease. Methods:The ECG was recorded during 24 hours. Mortality and incidence of cardiac events (i.e., acute myocardial infarction and death in chronic ischaemic heart disease) during the 10 years following the baseline examination 1982–1983 has been related to occurrence of frequent or complex ventricular arrhythmia (i.e., Lown class 2–5) and prevalence of asymptomatic leg artery disease (i.e., ankle‐arm blood pressure index, ABPI < 0.9 at rest). Results:There was no association between the prevalence (14% vs 13%) or severity of leg artery disease and the occurrence of ventricular arrhythmia. History of cardiovascular disease was related to both conditions. In men without leg artery disease, occurrence of arrhythmia was associated with an increased mortality rate, from 29.1 to 41.5 per 1000 person‐years (P = 0.046) and cardiac event rate, from 15.6 to 27.1 per 1000 person‐years (P = 0.023). The increased incidence of cardiac events and death associated with arrhythmia was modified by the presence of leg artery disease. There was a low ABPI in the group with arrhythmia associated with an increase in mortality rate from 41.5 to 95.8 per 1000 person‐years and an increase of the cardiac event rate from 27.1 to 76.1 per 1000 person‐years. These associations remained statistically significant after adjustment in the analysis with regard to history of cardiovascular disease and other potential confounders. Conclusions:Occurrence of ventricular arrhythmia is a common condition in apparently healthy elderly men. Although it seems to be equally common in men with and without asymptomatic leg artery disease, with regard to the incidence of cardiac events and death it is associated with a more serious prognosis in men with leg artery disease. A.N.E. 1999;4(3):309–315