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.