Association of cardiac ausculatory findings with coronary heart disease mortality

BACKGROUND: Relationships between cardiac murmurs detected during physical examination and coronary heart disease mortality among the general population are not well described. AIMS: To assess the relationship between cardiac murmurs detected during physical examination and coronary heart disease mortality. METHODS AND RESULTS: This relationship was examined with Cox regression analyses of data from 7990 adults, aged 30–75 years, from the Second National Health and Nutrition Examination Survey Mortality Study (1976–1992). Covariates included age, race, sex, history of CVD, diabetes, probable left ventricular hypertrophy, serum cholesterol, body mass index, blood pressure, and smoking status. During 16.8 follow-up years , there were 457 deaths from coronary heart disease (CHD) (ICD-9 410–414) and 661 deaths from diseases of the heart (ICD-9 390–398, 402, 404, 410–414, 415–417, 420–429). A systolic murmur was present in 420 persons and a diastolic murmur was present in 56 persons at baseline. Persons with a heart murmur were at increased risk of death from CHD (relative risk=1.7, 95% confidence interval=1.2, 2.5) and from diseases of the heart (RR=2.2, 95% CI=1.6, 2.9) after multivariate adjustment for cardiovascular disease risk factors. Similar results were observed when murmur intensity (i.e., murmur grade) was accounted for. CONCLUSIONS: These results suggest that the presence of a heart murmur may be associated with an increased risk for mortality from both CHD and diseases of the heart.