Elpidoforos S. Soteriades, M.D., Jane C. Evans, D.Sc., Martin G. Larson, Sc.D., Ming Hui Chen, M.D., Leway Chen, M.D., Emelia J. Benjamin, M.D., and Daniel Levy, M.D.
Background Little is known about the epidemiology and prognosisof syncope in the general population.
Methods We evaluated the incidence, specific causes, and prognosisof syncope among women and men participating in the FraminghamHeart Study from 1971 to 1998.
Results Of 7814 study participants followed for an average of17 years, 822 reported syncope. The incidence of a first reportof syncope was 6.2 per 1000 person-years. The most frequentlyidentified causes were vasovagal (21.2 percent), cardiac (9.5percent), and orthostatic (9.4 percent); for 36.6 percent thecause was unknown. The multivariable-adjusted hazard ratiosamong participants with syncope from any cause, as comparedwith those who did not have syncope, were 1.31 (95 percent confidenceinterval, 1.14 to 1.51) for death from any cause, 1.27 (95 percentconfidence interval, 0.99 to 1.64) for myocardial infarctionor death from coronary heart disease, and 1.06 (95 percent confidenceinterval, 0.77 to 1.45) for fatal or nonfatal stroke. The correspondinghazard ratios among participants with cardiac syncope were 2.01(95 percent confidence interval, 1.48 to 2.73), 2.66 (95 percentconfidence interval, 1.69 to 4.19), and 2.01 (95 percent confidenceinterval, 1.06 to 3.80). Participants with syncope of unknowncause and those with neurologic syncope had increased risksof death from any cause, with multivariable-adjusted hazardratios of 1.32 (95 percent confidence interval, 1.09 to 1.60)and 1.54 (95 percent confidence interval, 1.12 to 2.12), respectively.There was no increased risk of cardiovascular morbidity or mortalityassociated with vasovagal (including orthostatic and medication-related)syncope.
Conclusions Persons with cardiac syncope are at increased riskfor death from any cause and cardiovascular events, and personswith syncope of unknown cause are at increased risk for deathfrom any cause. Vasovagal syncope appears to have a benign prognosis.
Source Information
From the National Heart, Lung, and Blood Institute Framingham Heart Study, Framingham, Mass. (E.S.S., J.C.E., M.G.L., M.H.C., L.C., E.J.B., D.L.); the Departments of Cardiology and Preventive Medicine, Boston Medical Center, Boston (E.J.B.); the National Heart, Lung, and Blood Institute, Bethesda, Md. (D.L.); and the Division of Cardiology, Beth Israel Deaconess Medical Center, Boston (D.L.).
Address reprint requests to Dr. Levy at the Framingham Heart Study, 73 Mt. Wayte Ave., Suite 2, Framingham, MA 01702-5827.
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