A systematic review 1 included 6 studies with a total of 2 197 involving ventricular arrhythmias, and 5 studies with 1 915 subjects involving silent ischaemia.
One study found approximately double the mortality in patients exhibiting ventricular premature beats: two other studies found no correlation. In 3 studies of complex ventricular arrhythmias, comparisons found at least 2 times more cardiac events in patients with heart disease exhibiting ventricular arrhythmias. No such correlation was observed in patients without heart disease.
One study found incidence of cardiac events 4 times higher after 120 months in patients with no heart disease but with silent myocardial ischaemia: another study found no such relationship after 26 months in healthy participants, but a greater than 2-fold incidence in patients with heart disease. Two studies found that in patients with coronary artery disease or systemic hypertension, those with silent ischaemia showed 2 times the incidence of cardiac events and in those with both silent ischaemia and ventricular arrhythmias the
Incidence was greater than 2.5 times higher than those without. One study compared patients with and without coronary artery disease: those without coronary artery disease with silent myocardial ischaemia had at least 4-fold greater risk of myocardial infarction: those with coronary artery disease and silent myocardial ischaemia had 16-fold increased risk.
Comment: The quality of evidence is upgraded by large magnitude of effect.
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