Health News for Senior Citizens

Health News for Seniors

Silent heart attacks have hit about 8 percent of seniors suggests new study

Men more likely than women to have myocardial scars: 80% missed in evaluations

doctors explaining discovery to male patientNov. 8, 2015 - A study of boomers and seniors with an average age of 68 found eight percent had suffered a heart attack without knowing it and that 80 percent of myocardial scars from these attacks were not recognized in electrocardiography or clinical evaluation.

They study group was multiethnic and about 52 percent males according to the report in the November 10 issue of JAMA. This issue, a cardiovascular disease theme issue, coincides with the American Heart Association’s Scientific Sessions 2015.

Ischemic heart disease is an important public health concern, but the evidence shows a considerable proportion of myocardial infarctions (heart attacks) are clinically unrecognized.


Given the aging of the U.S. population, it is important to understand the prevalence, risk factors, and prognosis of unrecognized MI, according to the researchers.

In patients who survive a heart attack, normal contractile (having the property of contracting) tissue is replaced by noncontractile fibrosis (formation of excess fibrous connective tissue in a reparative process – or scar tissue). Myocardial scarring leads to abnormal heart function and poor prognosis.

The prevalence of and factors associated with unrecognized MI and scar have not been previously defined using contemporary methods in a multiethnic U.S. population, according to the article.

David A. Bluemke, M.D., Ph.D., of the National Institute of Biomedical Imaging and Bioengineering, Bethesda, Md., and colleagues examined the prevalence of myocardial scar using cardiac magnetic resonance (CMR), which is considered a standard of reference for defining the presence of myocardial scar.

Participants were 45 through 84 years of age and free of clinical cardiovascular disease (CVD) at study entry in 2000-2002.

In the 10th year examination (2010-2012), 1,840 participants (average age, 68 years; 52 percent men) underwent CMR imaging with gadolinium to detect myocardial scar. Cardiovascular disease risk factors and coronary artery calcium (CAC) scores were measured at study entry and year 10.

The overall prevalence of myocardial scar found by CMR was 7.9 percent (146 of 1,840). The prevalence of previously unrecognized myocardial scar was 6.2 percent, whereas 1.7 percent had clinically recognized MI. Thus, 78 percent (114 of 146) of myocardial scars were unrecognized by clinical or electrocardiography (ECG) evaluation.

Men had a higher prevalence of myocardial scar than women (12.9 percent vs 2.5 percent).

Of individual risk factors, age, male sex, CAC score, body mass index, current smoking, and use of antihypertensive medications at study entry were associated with higher odds of myocardial scar.

“The clinical significance of unrecognized myocardial scar remains to be defined, although prior myocardial scar has been noted pathologically in more than 70 percent of patients with sudden cardiac death but without prior known coronary artery disease,” the authors write.

“Further studies are needed to understand the clinical consequences of these undetected scars.”

>> Abstract on “Prevalence and Correlates of Myocardial Scar in a US Cohort

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