Association of electrocardiogram screening criteria in a national health checkup program with future cardiovascular disease risk: NIPPON DATA90

Abstract Background/Introduction In the Specific Health Checkup program by Japanese government, the criteria for electrocardiogram (ECG) test is applied only to individuals with hypertension or those with symptom of arrhythmia. ECG test is useful for the early detection and prevention of cardiovascular diseases (CVD). However, individuals who do not meet the current criteria have no opportunity to undergo ECG test. Purpose This study aimed to evaluate the association of the criteria for ECG test in Japan and ECG abnormality with future CVD mortality risk. Additionally, the population attributable fraction (PAF) was estimated to determine whether the current ECG screening criteria can predict future CVD deaths in Japanese. Methods The NIPPON DATA90 is a cohort study that followed 8,383 general residents who participated in the 1990 National Cardiovascular Survey in Japan for 25 years. After excluding individuals younger than 40 or older than 75 years and those with missing ECG or related data, 5,641 participants (2,399 men and 3,242 women) were included in the analysis. ECG screening eligibility was defined as having systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, taking antihypertensive medication, or self-reported symptom of arrhythmia. Participants were categorized into two groups based on ECG screening eligibility. ECG findings were classified into three categories following the 2003 guidelines of the Japanese Circulatory Management Research Council: normal, borderline requiring follow-up, and abnormal requiring medical attention. A total of six subgroups were created based on ECG screening eligibility and ECG findings. Cox proportional hazards models were used to assess the association of these categories with future CVD mortality risk, stratified by sex, and PAF was also estimated. Results During the 25-year follow-up, 254 men and 274 women died from CVD. In men, the hazard ratios (HRs) for CVD mortality were 1.99 0.59–6.72 in the ineligible abnormal ECG group, 2.09 1.23–3.54 in the eligible normal ECG group, 1.99 1.22–3.24 in the eligible borderline ECG group, and 4.30 2.35–7.86 in the eligible abnormal ECG group. In women, HRs were 5.20 2.05–13.2 in the ineligible abnormal ECG group, 1.58 0.91–2.76 in the eligible normal ECG group, 1.93 1.15–3.22 in the eligible borderline ECG group, and 4.35 2.39–7.92 in the eligible abnormal ECG group. The PAF in men was 0.8% in the ineligible group and 42.8% in the eligible group, while in women, it was 2.1% in the ineligible group and 26.9% in the eligible group. Conclusion(s) In this cohort study of representative Japanese population, the current ECG screening criteria appear to be appropriate. The findings suggest that the criteria effectively identify high-risk individuals who attribute to the excess CVD deaths. However, further research is needed to determine whether additional risk factors should be considered for refining ECG screening criteria.