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. 2016 Oct 25;11(10):e0165111.
doi: 10.1371/journal.pone.0165111. eCollection 2016.

Prognostic Importance of Dyspnea for Cardiovascular Outcomes and Mortality in Persons without Prevalent Cardiopulmonary Disease: The Atherosclerosis Risk in Communities Study

Mario Santos  1   2 , Dalane W Kitzman  3 , Kunihiro Matsushita  4 , Laura Loehr  5 , Carla A Sueta  5 , Amil M Shah  1
Affiliations

Prognostic Importance of Dyspnea for Cardiovascular Outcomes and Mortality in Persons without Prevalent Cardiopulmonary Disease: The Atherosclerosis Risk in Communities Study

Mario Santos et al. PLoS One. .

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.

Methods and 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).

Conclusion: 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.

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Conflict of interest statement

Dr Shah reports receiving research support from Novartis, Actelion Pharmaceuticals Ltd, and Gilead. The other authors have no disclosures. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Dyspnea prevalence, by prevalence of cardiopulmonary disease, age, gender, race, and obesity.
Fig 2
Fig 2. Mortality according to dyspnea severity among patients with (A) prevalent heart failure (n = 575), (B) prevalent coronary heart disease (N = 721), and (C) prevalent chronic obstructive pulmonary disease (n = 630).
Fig 3
Fig 3. Survival curves of patients with no prevalent CV or pulmonary disease according to dyspnea status regarding death, incident HF and MI.
See this image and copyright information in PMC

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