ASSOCIATION BETWEEN RURALITY AND SUBCLINICAL MYOCARDIAL INJURY

Abstract

Therapeutic Area: ASCVD/CVD Risk Factors Background: Living in a rural setting has been linked to cardiovascular disease (CVD) morbidity and mortality. However, the association between rurality and subclinical myocardial injury (SC-MI) has not previously been studied. Methods: This cross-sectional analysis was restricted to adult participants without baseline CVD (myocardial infarction, heart failure, or stroke), who underwent 12-lead electrocardiogram (ECG) recording in the Third National Health and Nutritional Examination Survey (NHANES III), 1988 to 1994. Rurality classification was based on the U.S Department of Agriculture (USDA) rural-urban continuum codes. SC-MI was defined as a cardiac infarction/injury score ≥10 on ECG. Using multivariate logistic regression, we examined the association between rurality and SC-MI. Results: This analysis included 6,805 (age 59.1±13.4 years, 52.3% female, 49.8% White) participants, of whom 3,666 (53.9%) lived in rural areas. Compared to participants living in urban areas, those living in rural areas had a higher prevalence of SC-MI (28.6% vs. 23.4%; p-value <0.0001). In the multivariable logistic regression model, rural residence, relative to urban residency, was associated with 21% (p<0.001) higher odds of SC-MI (Table). These associations were consistent in subgroups stratified by demographics and CVD risk factors. Conclusions: Those living in rural areas had a higher likelihood of subclinical myocardial injury suggesting that rurality is not only associated with clinical CVD, but also subclinical forms of the disease.