Risk factors for syncope in a community-based sample (The Framingham Heart Study)

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Abstract

The epidemiology of syncope has not been well described. Prior studies have examined risk factors for syncope in hospital-based or other acute or long-term care settings. To determine risk factors for syncope in a community-based sample, we performed a nested case-control study. We examined reports of syncope in Framingham Heart Study participants who underwent routine clinic visits from 1971 to 1990. For each syncope case (n = 543) 2 controls were matched for age, sex, and examination period. Mean age of subjects was 67 years (range 25 to 95); 59% were women. History of stroke or transient ischemic attack, history of myocardial infarction, high blood pressure, use of antihypertensive medication, use of other cardiac medication, smoking, alcohol intake, body mass index, systolic blood pressure, diastolic blood pressure, heart rate, atrial fibrillation, PR interval prolongation, interventricular block, and diabetes or elevated glucose level were examined as potential predictors. Using conditional logistic regression analysis, the predictors of syncope included a history of stroke or transient ischemic attack (odds ratio [OR] 2.56, 95% confidence interval [CI] 1.62 to 4.04), use of cardiac medication (OR 1.67, 95% CI 1.21 to 2.30), and high blood pressure (OR 1.46, 95% CI 1.14 to 1.88). Lower body mass index was marginally associated with syncope (OR per 4 kg/m2 decrement 1.10, 95% CI 0.99 to 1.22), as were increased alcohol intake (OR per 5 oz/week 1.11, 95% CI 0.99 to 1.26), and diabetes or an elevated glucose level (OR 1.29, 95% CI 0.96 to 1.75). To our knowledge, this study represents the first community-based study of risk factors for syncope.

Section snippets

Subjects

The original participants in the Framingham Heart Study were enrolled in 1948. At study inception, the cohort contained 5,209 men and women aged 28 to 62 years from Framingham, Massachusetts. Since then, subjects have undergone biennial examinations to assess factors predisposing these subjects to cardiovascular disease. Details of study design and selection criteria are described elsewhere.18, 19

A second ongoing study, the Framingham Offspring Study, began in 1971, enrolling 5,124 offspring

Risk factors

Univariate analyses (Table II)identified 4 “highly significant” (i.e., p value <0.01) and 2 “nominally significant” (i.e., p value <0.05) risk factors for syncope, namely, history of stroke or transient ischemic attack, high blood pressure, cardiac medication use, and measured systolic blood pressure, as well as high blood pressure treatment and diabetes or elevated glucose level. Alcohol intake, history of myocardial infarction, and presence of PR interval prolongation were of marginal

Discussion

We recognize that syncope is a symptom attributable to different causes, and by itself is not a disease process. Although this study cannot definitely determine etiologies of syncope, several plausible risk factors did emerge from our analyses. Individuals with a history of stroke or transient ischemic attack were >2.5 times as likely to experience syncope. This may be due to recurrence of stroke or transient ischemic attack with loss of consciousness, neurologically mediated hypotension,

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