Electrocardiographic predictors of future coronary heart disease : a possible role of autonomic control

This thesis presents a number of studies on the predictive value of electrocardiographic manifestations of autonomic control of the heart and of ischemic heart disease for coronary heart disease morbidity and mortality in the general population. The electrocardiograms of the Zutphen Study, a prospective study on cardiovascular disease in the general population, were used for this purpose. Physical examinations (including electrocardiography) were repeatedly carried out from 1960 to 1985, among 878 men from Zutphen, born between 1900 and 1920. In 1985 additional recruitment in the same birth cohort in Zutphen was performed. A cohort of 939 men, then aged 65 to 84, participated. These cohorts have been followed with respect to morbidity, vital status, and causes of death.

The results of these studies provide evidence that electrocardiographic characteristics (the Cardiac Infarction Injury Score, QTc duration, ST-T-characteristics, and heart rate variability) do predict the occurrence of future heart disease. Furthermore, there were indications that besides autonomic cardiac control, other determinants, like glucose tolerance, may affect ventricular electrical stability as well. In future research, determinants like glucose tolerance, physical activity, certain nutritional factors, and smoking, warrant further attention. Especially, it should be evaluated whether improvements in the electrocardiogram caused by interventions in these determinants are associated with a better prognosis.