Association Between ECG Findings and Atherosclerotic Cardiovascular Disease (ASCVD) Risk Score: A Cross-Sectional Analysis of a Cohort Study

Abstract

Background and aims: Cardiovascular disease remains a leading cause of morbidity and mortality worldwide, making early detection and risk assessment critical. Various clinical tools, including the Atherosclerotic Cardiovascular Disease (ASCVD) risk score, have been developed to predict cardiovascular risk. This study aimed to evaluate the association of various Electrocardiogram (ECG) findings with 10-year ASCVD risk scores in asymptomatic individuals without prior cardiovascular events, using data from the Shiraz Heart Study (SHS).

Materials and methods: This cross-sectional study included participants aged 40-70 years from the Shiraz Heart Study (SHS). Inclusion criteria required complete ECG data and recorded ASCVD risk factors. ECG findings, encompassing both continuous and categorical variables, were reviewed by trained cardiologists. ASCVD risk scores were calculated using demographic and clinical variables. Statistical analyses, including multivariate regression, assessed associations between ECG parameters and 10-year ASCVD risk scores, adjusting for key confounders.

Result: A total of 1471 participants were included in the study, with 44.5% male (N = 654) and a mean age of 51.65 years (SD = 7.84). The mean ASCVD score was 5.49 (SD = 6.41). Significant associations were found between continuous ECG variables, such as P-wave duration, PR interval, QRS duration, and QRS axis, with ASCVD risk. Categorical ECG findings, including ST depression, ST elevation, left bundle branch block (LBBB), prolonged P-wave duration, and left atrial enlargement, were also significantly associated with ASCVD scores. Multivariate linear regression identified ST depression (B = 0.060, p < 0.001) and LBBB (B = 0.031, p = 0.039) as independent predictors of ASCVD risk, after adjusting for confounders such as age, gender, hypertension, diabetes, and cholesterol levels.

Conclusion: ST depression and LBBB show a modest association with cardiovascular risk stratification using the 10-year ASCVD risk score. Incorporating these ECG markers into clinical assessments may aid in identifying high-risk individuals, enabling more personalized interventions and refining cardiovascular risk prediction models.

Keywords: ST‐segment depression; aatherosclerotic cardiovascular disease; bundle‐branch block; cardiovascular risk prediction; electrocardiography.