{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T23:17:36Z","timestamp":1781133456271,"version":"3.54.1"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2023,1,10]],"date-time":"2023-01-10T00:00:00Z","timestamp":1673308800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002996","name":"Dutch Heart Foundation","doi-asserted-by":"publisher","award":["CVON2017-15 RESCUED"],"award-info":[{"award-number":["CVON2017-15 RESCUED"]}],"id":[{"id":"10.13039\/501100002996","id-type":"DOI","asserted-by":"publisher"}]},{"name":"EFSD\u2019s European Pilot Research"},{"name":"Innovative Measurement of Diabetes Outcomes"},{"DOI":"10.13039\/501100007601","name":"European Union's Horizon 2020 research and innovation programme","doi-asserted-by":"publisher","award":["733381"],"award-info":[{"award-number":["733381"]}],"id":[{"id":"10.13039\/501100007601","id-type":"DOI","asserted-by":"publisher"}]},{"name":"ZonMw-vidi","award":["91718304"],"award-info":[{"award-number":["91718304"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>To investigate the association of (changes in) electrocardiogram (ECG) abnormalities with incident major adverse cardiac events (MACE) in people with Type 2 diabetes (T2D) without pre-existing cardiovascular disease (CVD).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>A prospective longitudinal study of 11 993 people with T2D without known CVD from the Hoorn Diabetes Care System cohort. Annually repeated measurements (1998\u20132018), included cardiovascular risk factors, over 70 000 ECG, and self-reported cardiovascular events. ECG abnormalities were classified according to the Minnesota Classification as prolonged PR duration, prolonged QRS duration, left QRS-axis, QS pattern, ST-segment\/T-wave abnormalities, or tall R-wave. The association of ECG abnormalities with MACEs was assessed using time-dependent Cox-regression models, adjusted for time-varying cardiovascular risk factors, and medication use [hazard ratios (HRs) with 95% confidence intervals (CIs)]. During a median follow-up of 6.6 (IQR, 3.1\u201310.7) years, 5445 (45.4%) of the participants had an ECG abnormality (prevalent or incident) at any of the median 6 (IQR, 3\u201310) annual ECG recordings, and 905 people (7.5%) had a MACE (529 coronary heart disease (CHD), 250 heart failure (HF), and 126 sudden cardiac arrest (SCA)). After adjustment, most ECG abnormalities were associated with HF: prolonged QRS duration [HR, 4.01 (95% CI, 2.67\u20136.03)], QS pattern [2.68 (0.85\u20138.49)], ST-segment\/T-wave abnormalities [4.26 (2.67\u20136.80)], and tall R-wave [2.23 (1.33\u20133.76)]. Only QS pattern [2.69 (1.20\u20136.03)] and ST-segment\/T-wave abnormalities [2.11 (1.48\u20133.02)] were associated with CHD. These associations were robust across age, sex, hypertension, or estimated CVD risk subgroups.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>In people with T2D without pre-existing CVD, ECG abnormalities related to decelerated conduction, ischaemia, and hypertrophy are predominantly early signs of emerging HF, while only abnormalities related to ischaemic disorders are signs of CHD.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/eurjpc\/zwac314","type":"journal-article","created":{"date-parts":[[2023,1,9]],"date-time":"2023-01-09T20:14:43Z","timestamp":1673295283000},"page":"624-633","source":"Crossref","is-referenced-by-count":16,"title":["Longitudinal association of electrocardiogram abnormalities with major adverse cardiac events in people with Type 2 diabetes: the Hoorn Diabetes Care System cohort"],"prefix":"10.1093","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7721-6198","authenticated-orcid":false,"given":"Peter P","family":"Harms","sequence":"first","affiliation":[{"name":"General Practice Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam , Boelelaan 1117, 1081 HV, Amsterdam , The Netherlands"},{"name":"Health Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute , Amsterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petra P J M","family":"Elders","sequence":"additional","affiliation":[{"name":"General Practice Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam , Boelelaan 1117, 1081 HV, Amsterdam , The Netherlands"},{"name":"Health Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute , Amsterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Femke","family":"Rutters","sequence":"additional","affiliation":[{"name":"Epidemiology and Data Science, Amsterdam UMC location Vrije Universiteit Amsterdam , Boelelaan 1117, 1081 HV, Amsterdam , The Netherlands"},{"name":"Health Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute , Amsterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Birgit I","family":"Lissenberg-Witte","sequence":"additional","affiliation":[{"name":"Epidemiology and Data Science, Amsterdam UMC location Vrije Universiteit Amsterdam , Boelelaan 1117, 1081 HV, Amsterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanno L","family":"Tan","sequence":"additional","affiliation":[{"name":"Clinical and Experimental Cardiology, Amsterdam UMC location University of Amsterdam , Meibergdreef 9, 1105 AZ, Amsterdam , The Netherlands"},{"name":"Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias Research Institute , Amsterdam , The Netherlands"},{"name":"Netherlands Heart Institute , Moreelsepark 1, 3511 EP, Utrecht , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joline W J","family":"Beulens","sequence":"additional","affiliation":[{"name":"Epidemiology and Data Science, Amsterdam UMC location Vrije Universiteit Amsterdam , Boelelaan 1117, 1081 HV, Amsterdam , The Netherlands"},{"name":"Health Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute , Amsterdam , The Netherlands"},{"name":"Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht , P.O. 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