Small and large vessel disease in persons with unrecognized compared to recognized myocardial infarction: The Tromsø Study 2007–2008

  • Andrea Milde Øhrn
    Correspondence
    Corresponding author at: Faculty of Health Sciences, University of Tromsø, N-9037 Tromsø, Norway.
    Affiliations
    Epidemiology of Chronic Diseases Research Group, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway

    Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Oslo, Norway
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  • Henrik Schirmer
    Affiliations
    Department of Cardiology, University Hospital of North Norway, Tromsø, Norway

    Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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  • Therese von Hanno
    Affiliations
    Brain and Circulation Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway

    Department of Ophthalmology, Nordland Hospital, Bodø, Norway
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  • Ellisiv B. Mathiesen
    Affiliations
    Brain and Circulation Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway

    Department of Neurology, University Hospital of North Norway, Tromsø, Norway
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  • Kjell Arne Arntzen
    Affiliations
    Department of Neurology, University Hospital of North Norway, Tromsø, Norway
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  • Geir Bertelsen
    Affiliations
    Epidemiology of Chronic Diseases Research Group, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway

    Department of Ophthalmology, University Hospital of North Norway, Tromsø, Norway
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  • Inger Njølstad
    Affiliations
    Epidemiology of Chronic Diseases Research Group, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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  • Maja-Lisa Løchen
    Affiliations
    Epidemiology of Chronic Diseases Research Group, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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  • Tom Wilsgaard
    Affiliations
    Epidemiology of Chronic Diseases Research Group, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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  • C. Noel Bairey Merz
    Affiliations
    NBM Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States
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  • Haakon Lindekleiv
    Affiliations
    Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
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      Abstract

      Background

      Unrecognized myocardial infarction (MI) is a frequent condition with unknown underlying reason. We hypothesized the lack of recognition of MI is related to pathophysiology, specifically differences in underlying small and large vessel disease.

      Methods

      6128 participants were examined with retinal photography, ultrasound of the carotid artery and a 12‑lead electrocardiography (ECG). Small vessel disease was defined as narrower retinal arterioles and/or wider retinal venules measured on retinal photographs. Large vessel disease was defined as carotid artery pathology. We defined unrecognized MI as ECG-evidence of MI without a clinically recognized event. We analyzed the cross-sectional relationship between MI recognition and markers of small and large vessel disease, adjusted for age and sex.

      Results

      Unrecognized MI was present in 502 (8.2%) and recognized MI in 326 (5.3%) of the 6128 participants. Compared to recognized MI, unrecognized MI was associated with small vessel disease indicated by narrower retinal arterioles (OR 1.66, 95% CI 1.05–2.62, highest vs. lowest quartile). Unrecognized MI was less associated with wider retinal venules (OR 0.55, 95% CI 0.35–0.87, lowest vs. highest quartile). Compared to recognized MI, unrecognized MI was less associated with large vessel disease indicated by presence of plaque in the carotid artery (OR for presence of carotid artery plaque in unrecognized MI 0.51, 95% CI 0.37–0.69). No significant sex interaction was present.

      Conclusions

      Unrecognized MI was more associated with small vessel disease and less associated with large vessel disease compared to recognized MI. These findings suggest that the pathophysiology behind unrecognized and recognized MI may differ.

      Keywords

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