Chest pain and shortness of breath might offer warnings not only of immediate problems but also of future heart problems over 30 years, according to a new study.
Little research has looked at what chest pain might bode for future health even though it accounts for more than 6.5 million visits a year to U.S. hospital emergency departments, according to Dr. Kentaro Ejiri, a postdoctoral fellow with the Johns Hopkins Bloomberg School of Public Health in Baltimore.
Similarly, few studies have examined long-term implications of shortness of breath, known formally as dyspnea, according to Ejiri, the lead researcher for a new study that looked at both issues over the long run.
Using three decades of data, Ejiri and his colleagues examined chest pain and shortness of breath and found that both were signs of a greater future risk of heart attack, the potentially deadly type of irregular heartbeat known as atrial fibrillation and heart failure.
Chest pain was most strongly associated with a later heart attack. Dyspnea was most closely associated with future heart attack and heart failure.
Having both symptoms appeared to increase the risks even more.
The findings suggest the need to view chest pain and dyspnea as warning signs of not just an immediate crisis but also of possible long-term problems, said Dr. Kunihiro Matsushita, the study’s senior author and a professor at the Johns Hopkins Bloomberg School.
Even mild chest symptoms were linked to a long-term risk of heart problems though less so than with moderate to severe symptoms.
The study results — which are considered preliminary until full results are published in a peer-reviewed journal — were presented at the American Heart Association’s Scientific Sessions conference in Chicago at McCormick Place.
The study involved more than 13,000 people with no previous cardiovascular disease who were taking part in the Atherosclerosis Risk in Communities, or ARIC, study. Their average age was 54; 56% were female, and 25% were Black.
After evaluating their medical records and using standard grading scales for chest pain and shortness of breath, the researchers assessed risks of heart attack, heart failure, atrial fibrillation and stroke over the coming decades. The researchers adjusted for factors such as age, gender, race, medications and smoking history.
Someone who experienced the lowest severity of chest pain had a 21% greater chance of having a heart attack over the next 30 years compared with someone reporting no chest pain. Those with the highest level of chest pain had an 83% higher heart-attack risk versus those without chest pain.
People who reported the lowest level of shortness of breath had a 30% higher chance of having a heart attack in the next 30 years compared with someone who reported no breathing problems. Those with the highest level of shortness of breath were more than twice as likely to have a heart attack.
Those with the highest levels of both chest pain and shortness of breath were more than 21⁄2 times as likely to have a heart attack than someone with no issues. They also were more than twice as likely to have atrial fibrillation or heart failure and 85% more likely to have a stroke.
Quin Denfeld, a nurse scientist with Oregon Health & Science University in Portland, said most people tend to think of symptoms like chest pain as something that happens right before a serious health event, such as a heart attack. But Denfeld, who helped write a recent AHA scientific statement on cardiovascular disease symptoms, said the new study highlights how symptoms aren’t always so clear-cut: “They’re nuanced, and they’re complex.”
Denfeld said the new research, which she wasn’t involved with, stood out for taking a long-term look at symptoms and how they overlapped.
The findings suggest health care workers should be diligent about tracking even mild symptoms, Denfeld said.
“Prognosticating over 30 years is extremely hard to do,” she said. “But just recognizing and documenting symptoms and telling patients ‘this is something to pay attention to’ seems like an appropriate move.”
Both chest pain and shortness of breath can signal a heart attack, and the AHA says people shouldn’t hesitate to call 911 if they have those symptoms.
But even seemingly minor problems, such as being out of breath walking up a hill, warrant attention, Denfeld said: “It’s your body’s way of telling you, ‘There’s something going on.’ ”
It doesn’t mean that something bad is inevitable, she said. But it might be a sign it’s time for a lifestyle change, like exercising more.
